Treatment of Acute Relapses in Multiple Sclerosis
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REVIEW
Treatment of Acute Relapses in Multiple Sclerosis Regina Berkovich
Published online: 11 December 2012 # The American Society for Experimental NeuroTherapeutics, Inc. 2012
Summary Multiple sclerosis (MS) is a chronic progressive inflammatory demyelinating disease affecting the central nervous system. The most common clinical type of MS tends to follow a relapsing course, affecting the vast majority of patients living with this disease. Relapses are a hallmark of MS, and are often associated with significant functional impairment and decreased quality of life. Although usually followed by a period of remission, residual symptoms after MS relapses may persist and lead to sustained disability. Adequate management of MS relapses is important, as it may help to shorten and lessen the disability associated with their course. Historically, treatment of MS relapse was the first approach (and for a period of time, the only approach) to MS treatment in general. Systemic corticosteroids and adrenocorticotropic hormone (ACTH) have broad regulatory approval and remain the most established and validated treatment options for MS relapse. Therapeutic mechanisms of ACTH were previously associated (perhaps mistakenly) with only corticotropic actions; however, recently the direct anti-inflammatory effects and immunomodulatory activity of ACTH gel acting through melanocortin pathways have been shown. Second-line treatments of steroid-unresponsive MS relapses and a possible algorithm for MS relapse management are also reviewed in this article. Keywords Relapse . ACTH . Corticosteroids . Plasmapheresis . Algorithm.
Electronic supplementary material The online version of this article (doi:10.1007/s13311-012-0160-7) contains supplementary material, which is available to authorized users. R. Berkovich (*) Multiple Sclerosis Center and Research Group, Keck School of Medicine, University of Southern California Neurology, University of Southern California, Los Angeles, CA 90033, USA e-mail: [email protected]
MS Relapse Definition and Diagnosis Multiple sclerosis (MS) is a chronic progressive inflammatory demyelinating disease; the relapsing-remitting MS course is the most common clinical type of MS affecting the vast majority of patients living with this disease. MS relapses are typically defined as a new or worsening neurological deficit lasting 24 h or more in the absence of fever or infection. Relapses are a hallmark of MS, and are often associated with significant functional impairment and decreased health-related quality of life [1]. For the vast majority of MS patients, relapses are the biggest concern associated with the disease and the unpredictability of MS exacerbations further compounds the potential impact on quality of life. MS relapses could represent formation of the new demyelinating activity or inflammation of any previously existing demyelinating lesion or lesions located in any segment of the central nervous system (CNS) [2, 3]. In general, the most commonly seen symptom complexes are related to new or worsening inf
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