Which is given to prevent relapse in multiple sclerosis?
Ans: a (IFN-beta) Ref: Harrison, 16th ed, p. 2467; Davidson, 20th ed, p. 1216Multiple sclerosis is characertised by a triad of inflammation, demylination and gliosis; the course can be relapsing - remitting or progressive.MS is twice more common in females. MS risk correlates with high socioeconomic status. High antibody titres against many viruses have been reported in serum and CSF of MS patients, including measles, herpes simplex, varicella, rubella, Epstein - Barr, and influenza C and some parainfluenza strains.Sensory loss is most common initial symptom followed by optic neuritis.MRI is the investigation of choice. Dawson's fingers corresponds to perivenous demylination seen in MRI in multiple sclerosisFour clinical types of MS are there.The relapsing /remitting type accounts for 85% of cases.DISEASE-MODIFYING TREATMENTS IN MSTreatmentMode of actionCommentInterferon betaImmune modulationIn widespread use for reducing relapse rateGlatiramer acetateImmune modulationSimilar efficacy to interferon betaAzathioprineImmune suppressionSimilar efficacy to interferon betaCyclophosphamideImmune suppression(cytotoxic)Occasionally used in aggressive disease.Not recommended for widespread use (no proven benefit in RCTs)MitoxantroneImmune suppression(cytotoxic)Early trials in aggressive disease (no proven benefit in RCTs)PlasmapheresisImmune modulationOccasionally used in aggressive disease (no proven efficacy in RCTs)Intravenous immunoglobulinImmune modulationOccasionally used in aggressive diseaseMonoclonal antibodies to beta-integrins(e.g. natalizumab)Immune modulation(lymphocyte entry into CNS)Encouraging experimental results (no proven efficacy in RCTs)Monoclonal antibodies to lymphocyte epitopes (e.g. campathl-H)Immune suppression(lymphocyte depletion)Encouraging experimental results (no proven efficacy in RCTs)
IFN-beta
Cyclosporine
Corticosteroids
I FIN-gamma
C.N.S.