Types Of Multiple Sclerosis

Time heals all wounds except relapsing-remitting MS.

And primary-progressive MS.

And secondary-progressive MS.

And whole bunch of other age-related illnesses, like glaucoma, age-related macular degeneration and malignancy.

At least time is good for adhesive capsulitis, alternatively known as frozen shoulder!

Multiple sclerosis

MS is a chronic disease involving immune-mediated attacks on the central nervous system. Demyelination causes mayhem.

As a parallel, Guillan-Barre acutely affects the peripheral nervous system. When it’s chronic, it’s called chronic inflammatory demyelinating polymyopathy.

Symptoms

Neurological symptoms ensue after the disease has passed a threshold.

  • Optic neuritis, characterised by painful visual loss in an eye
  • Numbness, weakness
  • Ataxia, spasticity
  • Fatigue
  • Pain
  • Sexual and urinary dysfunction, such as detrusor overactivity causing urgency

Clinically isolated syndrome is a one-off presentation of demyelination that can progress to MS.

Investigations

MRI can show brain lesions.

CSF analysis can show inflammation.

Evoke potential measurement can show demyelination.

Treatment

Ongoing: immunotherapy agents.

Acute relapse: high-dose corticosteroids.

Spasticity: baclofen

Spasms: benzodiazepines

Mobility: fampridine

Paroxysmal symptoms: carbamazepine

Urinary symptoms: oxybutynin

Pregnancy

The risk of MS relapse is lower during pregnancy and higher in the first 3 months after giving birth.

Summary of major demyelinating illnesses

Central nervous system: clinically isolated syndrome (acute), MS (chronic)

Peripheral nervous system: Guillan-Barre (acute), CIDP (chronic)

References

  1. MS Australia. (2001). Types of MS | MS Australia. [online] Available at: https://www.msaustralia.org.au/about-ms/types-ms [Accessed 20 Jan. 2018].
  2. National Multiple Sclerosis Society. (n.d.). Definition of MS. [online] Available at: https://www.nationalmssociety.org/What-is-MS/Definition-of-MS [Accessed 20 Jan. 2018].
  3. Johns Hopkins Medicine. (n.d.). Guillain-Barre and CIDP. [online] Available at: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/conditions/guillain_barre_and_cidp.html [Accessed 20 Jan. 2018].
  4. Multiple sclerosis. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.
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Why Don’t NSAIDs Cause Malignancy?

Do topical NSAIDs increase the risk of skin cancer? After all, NSAIDs dampen inflammation and immune suppression is a factor that can promote malignancy. The answer is no!

For, on the contrary, research focuses more on the potential of using NSAIDs in the fight against cancer. How can this be?

Think of the mechanism of NSAIDs. They’re non-steroidal anti-inflammatory drugs, meaning they’re medications that reduce inflammation without being from the corticosteroid class.

NSAIDs indirectly inhibit prostaglandin synthesis by directly inhibiting COX enzymes. This provides anti-inflammatory effects and analgesia.

Prostaglandins play a starring role in situations such as fever.

In contrast, other things that are associated with increased malignancy risk have different ways of working.

For example, HIV impacts CD-4 T cells.

Meanwhile, chemotherapy agents have different mechanisms. For example, vincristine disruptively acts on microtubules.

Let’s not forget UV rays, which wreak havoc on the DNA process by inducing mutations.

These are just some of the villains of medicine. Thankfully, there are emerging medications that meet them in combat. But that’s a story for another day!

Hypersensitivity Reactions

Type I: Allergy and anaphylaxis

Type II: Cytotoxic and complement-mediated

Type III: Immune complex

Type IV: Delayed-type hypersensitivity

References

  1. McDaniel, B. (2014, November 24). Type 1, 2, 3 & 4 Hypersensitivity. Retrieved from Stomp on Step 1, http://www.stomponstep1.com/hypersensitivity-type-1-2-3-4-urticaria-anaphylaxis-immune-complexes-i-ii-iii-iv/.
  2. Ghaffar, A. Hypersensitivity reactions. Retrieved from Microbiology and Immunology On-line, http://www.microbiologybook.org/ghaffar/hyper00.htm.