Multiple sclerosis progressive-relapsing

The clinical course of multiple sclerosis has been described in four basic patterns relapsing remitting, secondary progressive, primary progressive, and progressive relapsing. 

May be useful for relapsing-remitting multiple sclerosis in patients who are not benefiting from, or are intolerant of, interferon p-1 aA> less effective in patients with advanced disease or chronic-progressive multiple sclerosis not a cure for multiple sclerosis and benefits achieved are relatively modest... 

Jacobs, L.D., D.L. Cookfair, R.A. Rndick, et al.. Intramuscular interferon beta-la for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol, 1996.39(3) 285-94. 

B. Indications and nse Avonex is indicated for the treatment of relapsing forms of multiple sclerosis to slow the accumulation of physical disability and decrease the frequency of clinical exacerbations. Safety and efficacy in patients with chronic progressive multiple sclerosis have not been evaluated. 

B. Indications and nse Betaseron is indicated for use in ambulatory patients with relapsing-remitting multiple sclerosis to reduce the frequency of chnical exacerbations. The safety and efficacy of Betaseron in chronic-progressive MS has not been fully evaluated. 

E Role in therapy Betaseron is useful for reducing symptomatic exacerbation in multiple sclerosis (MS) patients with relapsing-remitting disease. The drug should be considered in patients with ch-nically deflnite or laboratory-supported definite disease. It is not indicated in those patients with primary progressive MS. Interferon beta-la (Avonex) has also demonstrated activity in MS patients. 

Cytokines themselves may also be used for MS therapy. IFN-P has been in clinical nse as an immunomodulatory drug for the treatment of MS for more than 10 years. Administration of IFN-P decreases the relapse rates and new MRI lesions in patients with relapsing/remitting MS (The IFN-p Multiple Sclerosis Study Group, 1993) or delay disease progression in patients with secondary progressive MS (Jacobs et al., 1996 ... 

Interferon beta is used in the form of natural fibroblast or recombinant preparations (interferon beta-la and interferon beta-lb) and exerts antiviral and antiproliferative properties similar to those of interferon alfa. Although its efficacy has been debated (1), interferon beta has been approved for the treatment of relapsing-remitting multiple sclerosis, and more recently for secondary progressive multiple sclerosis. 

The effect of berbamine on experimental allergic encephalitis (EAG) was investigated in Lewis rats. Amelioration of the acute-phase of EAE was only minimal, but the incidence of relapsing EAE was reduced by 65% for berbamine at a non-toxic treatment dosage of 60 mg/kg via gavage on alternate days. These results suggest that berbamine, and perhaps other bisbenzylisoquinoline alkaloids, may have a potential role in the therapy of progressive multiple sclerosis [189]. 

NMR spectroscopy of CSF has been used in a number of studies of multiple sclerosis (MS). In one study a total of 19 patients with multiple sclerosis, 12 patients with degenerative dementia and 17 controls were examined. They showed increased lactate and fructose levels in multiple sclerosis patients but no correlations between NMR spectra and the differentiation of relapsing, remitting and primary, progressive multiple sclerosis. Another study examined 53 cases of multiple sclerosis plus others with a variety of neurological disorders and showed that the observed level of lactate correlated with the... 

FIGURE 53-2. Clinical course and treatment of multiple sclerosis. The horizontal axis represents time, and the vertical axis represents level of disability. The vertical dotted line represents the onset of the progressive disease phase. The progressive phase may evolve after a number of relapses or, in a subcategory of patients, may be the clinical course of the disease from the onset. (Reprinted with permission from Ann Neurol 1988 23 212.)... 

Cantorna, M.T., Hayes, C.E. and DeLuca, H.F. (1996) 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis. Proceedings of the National Academy of Sciences of the United States of America, 93, 7861-7864. 

The activity of C2GnTl is decreased in relapsing or progressing multiple sclerosis, and this may possibly be related to the autoimmune process and the influence of inflammatory cytokines that have the potential to regulate glycosylation. The activity normalized upon treatment with the anti-inflammatory... 

Gl. Galboiz, Y., Shapiro, S., Lahat, N., Rawashdeh, H., and Miller, A., Matrix metalloproteinases and their tissue inhibitors as markers of disease subtype and response to interferon-beta therapy in relapsing and secondary-progressive multiple sclerosis patients. Ann. Neurol. 50, 443-451 (2001). 

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