Practical Neurology

Selected By
June Halper, MSN, APN-C, MSCN, FAAN

The newly published reference provides clearly written, clinical information in an outline format.  The text outlines the current MS subtype categories, most current disease-modifying therapies and emerging therapies.  This is the ideal resource if you are looking for a quick way to find updated information in one place.  

Here are some of the highlights of this chapter that you will want to read for yourself:

• Epidemiology
• Pathogenesis
• Clinical Features (which includes a section on classical presenting signs and symptoms and chronic symptoms)
• Diagnosis
• Defining the Course of Multiple Sclerosis
• Treatment of Acute Relapses
• Disease-Modifying Therapies
• Approved Therapies for Relapsing MS
• Multiple Sclerosis and Pregnancy

Key Points:

• MS is an inflammatory, demyelinating condition of the central nervous system
• The main characterization of MS is the occurrence of acute, focal neurologic symptoms with gradual, though sometimes incomplete, recovery
• In time, after repeated attacks, progressive neurologic symptoms may occur
• An arsenal of treatments to slow or halt the disease is ever-expanding

Epidemiology

Recent data call into question the accuracy of the theory that higher rates of MS occur in areas farther away from the equator (North America and Europe) and discusses the effects of Vitamin D and the role it plays in “one’s susceptibility to develop MS.”

Pathogenesis

At first glance, this section can be a bit overwhelming, but if you choose to dig through these four heavily clinical paragraphs you will find a wealth of information which provides insight for terms your health care provider has most likely referenced during your visits.  “Blood-brain barrier breakdown”, myelin, the contribution of B cells, plasma cells and antibodies, and the most recent advances in of T regulatory cells (T-REG cells) and dendritic cells (DC) and how the augmentation of T-REG cell function could potentially develop as integral part in therapeutic management of MS.

Clinical Features and Diagnosis Sections

Clinical Features simply defines the common and chronic symptoms of MS in an easy outline format with a quick reference table included. While the diagnostic section is intended for the neurology resident or practicing neurologists there are several superb MRI images demonstrating various lesions found in the brain and spinal cord, additionally, this section covers the diagnostic criteria used to diagnosis patients presenting with MS symptoms as well as key questions your health care provider should address with you.

Defining the Course of Multiple Sclerosis

Defining the Course of Multiple Sclerosis clearly outlines the various subtypes of MS as redefined by the United States National Multiple Sclerosis Society in 2013.  The newly defined subtypes which replace the four clinical courses that were originally defined in 1996 may or may not yet be used by your health care provider. By educating yourself on these new subtypes you can open up a health dialog with your provider which will help them answer a key point in the course of your treatment—“Am I at risk for future clinical or radiographic relapses?”, which is pivotal in determining the next steps in your treatment regimen.  The new subtypes also seem to be the first time annual imaging is recommended for patients with relapsing forms of MS.

Treatment of Acute Relapses, Disease-Modifying Therapies and Approved Therapies

The Treatment of Acute Relapses, Disease-Modifying Therapies and Approved Therapies for Relapsing MS content include the most up-to-date treatment information currently available.  It is important to remember that your health care provider is the best resource regarding your current course of treatment; however, the table found on page 571 provides proper dosage information, common side effects as well as any potential warnings for each currently approved drug therapy for relapsing MS and the last paragraph discusses emerging therapies which you may wish to discuss further with your health care provider.

Multiple Sclerosis and Pregnancy

Finally, the final section on pregnancy thoroughly discusses key concerns for women of child-bearing who wish to become pregnant. The author clearly states, “MS should have no impact on most obstetric decisions, including pain management.” 

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