Summary
Multiple sclerosis is a chronic, often progressive disease of the central nervous system which can produce visual, sensory, motor, and genitourinary dysfunction. Although there is no cure, many disabling symptoms can be ameliorated. Baclofen is the treatment of choice for spasticity and is usually given in doses of 30 to 80 mg/day, although higher doses may be used.
Bladder symptoms in multiple sclerosis generally fall into the categories of failure to store, failure to empty, and mixed types. Most patients can be managed after obtaining a urine culture and sensitivity and post- voiding residual. A variety of anticholinergic agents plus intermittent self- catheterisation is usually the most effective treatment for bladder dysfunction. Prevention of infection is accomplished by urinary acidifiers or low- dose antibiotics.
There is no evidence that long term use of corticosteroids has a beneficial effect on the outcome of multiple sclerosis, although they appear to be useful in hastening the recovery time from an acute exacerbation. There are a number of experimental therapeutic agents which are used to modulate the immune response, which may prove to be of use in slowing or arresting the progression of multiple sclerosis.
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Aimard, G.; Confarreux, C; Trovillas, P. et al.: Our experience of azathioprine treatment in multiple sclerosis; in Delmotte et al. (Eds) Immunosuppressive Treatment in Multiple Sclerosis, pp.3–220 (European Press, Ghent 1979).
Blaivas, J.G.: Management of bladder dysfunction in multiple sclerosis. Neurology 30: 12–18 (1980).
Bolton, C.; Allsopp, G. and Curzner, M.L.: The effect of cyclosporin A on the adaptive transfer of EAE in the rat. Clinical and Experimental Immunology 47: 127–132 (1982).
Bornstein, M.B.; Miller, A.; Teitelbaum, D.; Arnon, R. and Sela, M.: Treatment of multiple sclerosis with a synthetic polypeptide. Preliminary results. Annals of Neurology 8: 117 (1980).
Bozek, C.B.; Kastrukoff, Z.F.; Wright, J.; Perry, T. and Paty, D.W.: A double-blind crossover trial of INH in the treatment of action tremor associated with multiple sclerosis. Neurology 34 (Suppl. 1): 128 (1984).
Dimitrijevic, M.R. and Sherwood, A.M.: Spasticity: Medical and surgical treatment. Neurology 30: 19–27 (1980).
Dowling, P.C.; Bosch, V.V. and Cook, S.D.: Possible beneficial effect of high-dose intravenous steroid therapy in acute demyelinating disease and transverse myelitis. Neurology 30: 33–36 (1980).
Ellison, G. and Myers, L.W.: Immunosuppressive drugs in multiple sclerosis. Neurology 30: 28–32 (1980).
Goldstein, N.P.; McGuckin, W.F.; McKenzie, B.F. and Mattoy, V.R.: Experimental intrathecal administration of methylpred-nisolone acetate in multiple sclerosis. Transactions of the American Neurological Association 95: 243–244 (1970).
Gonsette, R.E.; Delmotte, P. and Demonty, L.: Failure of basic protein therapy of multiple sclerosis. Journal of Neurology 216: 27–31 (1977a).
Gonsette, R.E.; Demonty, L. and Delmotte, P.: Intensive immunosuppression with cyclophosphamide in multiple sclerosis; in Delmotte et al. (Eds ) Immunosuppressive Treatment in Multiple Sclerosis, pp.116–131 (European Press, Ghent 1977b).
Hallett, M.; Lindsey, J.W.; Adelstein, B.D. and Riley, P.O.: Double-blind trial of Isoniazid for severe postural cerebellar tremor. Neurology 34 (Suppl. 1): 128 (1984).
Hauser, S.C.; Dawson, D.M.; Lehrich, J.R.; Beal, F.; Kevy, S.V.; Propper, R.D.; Mills, J.A. and Weiner, H.L.: Intensive immunosuppression in progressive multiple sclerosis. New England Journal of Medicine 308: 173–180 (1983).
Hommes, O.R. and Lamers, K.J.B.: Immunosuppressive treatment in chronic progressive multiple sclerosis; in Delmotte et al. (Eds) Immunosuppressive Treatment in Multiple Sclerosis, pp.48–64 (European Press, Ghent 1977).
Huddlestone, J. and Oldstone, M.B.A.: T suppressor lymphocytes fluctuate in parallel with changes in the clinical course of patients with multiple sclerosis. Journal of Immunology 123: 1615–1618 (1979).
Jacobs, L.; O’Malley, J.; Freeman, A. and Ekes, R.: Intrathecal interferon reduces exacerbations of multiple sclerosis. Science 214: 1026–1028 (1981).
Keys, T.F. and Edson, R.S.: Antimicrobial agents in urinary tract infections. Mayo Clinic Proceedings 58: 165–168 (1983).
Muller, R.: Studies on disseminated sclerosis with special reference to symptomatology, course and prognosis. Acta Medica Scandinavica 133 (Suppl. 222): 1–124 (1949).
Neighbour, A.P. and Bloom, B.R.: Absence of virus-induced lymphocyte suppression and interferon production in multiple sclerosis. Proceedings of the National Academy of Sciences of the USA 76: 476–480 (1979).
Parsons, C.L.: The bladder in multiple sclerosis; in Hallpike et al. (Eds). Multiple Sclerosis, pp.579–602 (Williams and Wilkins, Baltimore 1983).
Poser, S.: Diseases of the myelin sheath; in Baker and Bolon (Eds) Clinical Neurology, Vol. 2, pp.65–68 (C.V. Mosby, Illinois 1978).
Raine, C.S.; Traugott, U. and Stone, S.M.: Suppression of chronic allergic encephalomyelitis: Relevance to multiple sclerosis. Science 201: 445–448 (1978).
Reinherz, E.; Weiner, H.L.; Hauser, S.L.; Cohen, J.A.; Distasa, J.A. and Schlossman, S.F.: Loss of suppressor T cells in active multiple sclerosis: Analysis with monoclonal antibodies. New England Journal of Medicine 303: 125–129 (1980).
Romine, J.S. and Salk, J.: A study of MBP as a therapeutic probe in patients with multiple sclerosis; in Hallpike et al. (Eds) Multiple Sclerosis, pp.621–631 (Williams and Wilkins, Baltimore 1983).
Rose, A.S.; Kuzma, J.W.; Kurtzske, J. et al.: Cooperative study in the evaluation of therapy in MS: ACTH vs. placebo. Neurology 20: 1–59 (1970).
Rosen, J.A.: Prolonged azathioprine treatment of non-remitting multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry 42: 338–344 (1979).
Rosen, J.A.: Further experience with Azathioprine in multiple sclerosis. Proceedings of the Workshop on Immunosuppressive therapy in multiple sclerosis, Nymeegen, the Netherlands (1982).
Sabra, A.F.; Hallett, M.; Sudarsky, L. and Mullally, W.: Treatment of action tremor in multiple sclerosis with isoniazid. Neurology 32: 912–913 (1982).
Salonen, R.; Honen, J.; Reunanen, M.; Nikoskelainen, J. and Salmi, A.: PPD-, PWM-, and PHA-induced interferon in stable multiple sclerosis. Annals of Neurology 11: 279–284 (1982).
Scheinberg, L.C. and Giesser, B.: INH in multiple sclerosis. Neurology 34: 134 (1984).
Schumacher, G.; Beebe, G.; Kibler, R.F. et al.: Problems of experimental trials of therpay in multiple sclerosis. Annals of the New York Academy of Sciences 122: 552 (1965).
Tourtellotte, W.W. and Baumhefner, R.W.: Comprehensive management of multiple sclerosis; in Hallpike et al. (Eds) Multiple Sclerosis, pp.513–578 (Williams and Wilkins, Baltimore 1983).
Tourtellotte, W.W.; Baumhefner, R.; Potvin, A.; Ma, B.I.; Potvin, J.H.; Mendez, M. and Syndulko, K.: Multiple sclerosis de novo IgG synthesis: Effect of ACTH and corticosteroids. Neurology 30: 1155–1162 (1980).
Van Buren, C.T.; Kerman, R.; Agostino, G.; Payne, W.; Flechner, S. and Kahan, B.D.: The cellular target of cyclosporin A action in humans. Surgery 92: 167–174 (1982).
Wilkinson, S.P.; Portmann, B. and Williams, R.: Hepatitis from dantrolene sodium. Gut 20: 33–36 (1979).
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Giesser, B. Multiple Sclerosis. Drugs 29, 88–95 (1985). https://doi.org/10.2165/00003495-198529010-00004
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DOI: https://doi.org/10.2165/00003495-198529010-00004