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The Expanded Disability Status Scale (EDSS) represents the most widely accepted measure of disease progression in multiple sclerosis (MS), and is used in many natural history studies. This chapter discusses natural history of relapsing onset MS, primary progressive MS, changes in natural history and impact on clinical trial design, traditional prognostic factors, and other factors which may influence prognosis such as race, comorbid diseases, and health behaviors. Pharmacoepidemiological studies using real world data derived from clinical practice represent a cost-effective means of evaluating the long-term effectiveness of immunomodulatory drug treatments for MS. Along with evidence from the basic sciences, epidemiological studies can provide insights into potentially novel treatments, as well as the rationale and hypotheses for testing these treatments in clinical trials. For example, vitamin D and estrogen are being evaluated in clinical trials based partly on epidemiological observations. Heterogeneity remains the hallmark of MS.
Treatment of multiple sclerosis (MS) with pulses of high dose methylprednisolone (HDMP) is currently the treatment of choice for MS relapses in many parts of the world. The use of corticosteroids as a treatment for MS was first reported in 1951. There is emerging evidence regarding the benefits of HDMP administered in pulses on the course of MS, either alone or in combination with other disease modifying therapy. HDMP was found to improve Expanded Disability Status Scale (EDSS) better than placebo, with improvements primarily in pyramidal, cerebellar, and sensory systems. In general, corticosteroid toxicity is reduced with short-term pulsed administration of HDMP. Altogether, numerous clinical and magnetic resonance imaging (MRI) studies suggest that HDMP not only has transient beneficial effects on clinical relapses and established areas of inflammation and demyelination, but may also have a prolonged, dose-dependent benefit involving early events in MS lesion formation, lesion propagation, and lesion recovery.
This chapter focuses on the influence of multiple sclerosis (MS) on school and psychosocial aspects of life in children and adolescents, offering practical information about how to address potential problems. The MS has substantial impacts on the lives of those diagnosed with the disorder. Both attacks and progressive symptoms associated with MS can contribute to the net burden of disease. The Expanded Disability Status Scale (EDSS) is a tool that provides a nonlinear score based predominantly on the neurologic examination to quantify this burden. MS can affect a child's cognitive functioning, including reasoning, processing, attention span, information processing and retrieval, and other thinking abilities. Cognitive dysfunction can, in turn, impact the learning and memory and, consequently, the academic performance of children with MS. Signs of psychosocial distress in children and teens include unexplained medical complaints, poor compliance with treatment plans, school refusal, and risk-taking behaviors.
This chapter articulates the clinical manifestations of multiple sclerosis (MS) in children. Defining the clinical features of MS in children is challenged by the variability of the available literature with respect to consistency in the definition of clinical features and diagnostic criteria for pediatric MS; age of inclusion; duration of clinical observation, a key issue in recognizing features that may not be present at onset or may change during the course of MS in children; and definition of disease onset. Impairment of executive functions, processing speed, working memory, and low functioning in activities related to school performances have been described in children with MS. Kurtzke's Functional System and Expanded Disability Status Scale (EDSS) is the most widely used scale to score neurological impairment in pediatric and adult MS patient. A key facet of care of children with MS involves the use of medications aimed at the reduction of relapse rate.
A large part of neurological disabilities of the young adult population of developed countries is due to multiple sclerosis (MS). This chapter focuses on the most prominent features of the etiology, natural history, and treatment of the disease. Hundreds of epidemiological studies on MS prevalence which have been conducted throughout the world provide evidence that the disease involves the interplay of genetic susceptibility factors and environmental exposures, possibly to infectious agents. The diagnosis for MS remains mainly based on clinical data. The expanded disability status scale (EDSS) was devised to evaluate neurological impairment in MS is widely used to describe disease progression in MS patients. Interventions in MS aim to reduce duration and severity of exacerbations, to alter the natural history of the disease, mainly by reducing the relapse rate, or to treat the consequences of neurological disorders including spasticity, chronic pain, or bowel and bladder dysfunction.
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