"Why are there no effective treatments for my condition? Why do researchers exclude patients with primary progressive multiple sclerosis from enrolling in clinical trials? Please let me know if you hear of studies that I might be allowed to enter or treatments that I could try for my condition. " Thus, in recent years, the sad lament of the patient with primary progressive MS (PPMS). This variant, often in the guise of a chronic progressive myelopathy or, less commonly, progressive cerebellar or bulbar dysfunction, usually responds poorly to corticosteroids and rarely seems to benefit to a significant degree from intensive immunosuppressive treatments. In recent years, most randomized clin ical trials have excluded PPMS patients on two counts. Clinical worsening devel ops slowly in PPMS and may not be recognized during the course of a 2-or 3-year trial even in untreated control patients. This factor alone adds to the potential for a type 2 error or, at the very least, inflates the sample size and duration of the trial. In addition, there is mounting evidence that progressive axonal degeneration and neuronal loss (rather than active, recurrent inflammation) may be important components of the pathology in this form of the disease. Although contemporary trials are evaluating whether PPMS patients may benefit from treatment with the ~-interferons and glatiramer acetate, preliminary, uncontrolled clinical experi ence suggests that the results may not be dramatic.

Primary progressive multiple sclerosis (PPMS) affects approximately 10% of the MS population, and is characterized by a steady decline in function, without relapses. This book is geared to the wide variety of physical and emotional issues of people with PPMS and their families. It explains the nature and characteristics of the disease, as well as comprehensive multidisciplinary management.

Written by world-renowned scientists, the volume provides a state-of-the-art on the most recent MRI techniques related to MS, and it is an indispensable tool for all those working in this field. The context in which this book exists is that there is an increasing perception that modern MR methodologies should be more extensively employed in clinical trials to derive innovative information.

Inflammation is a central mechanism in many neurological diseases, including stroke, multiple sclerosis, and brain trauma as well as meningitis and contributes to the generation of pain. We are now beginning to understand the impact of the immune system on different nervous system functions and diseases, ranging from damage through tolerance to modulation and repair.This book discusses some of the more common neuro-inflammatory diseases. Topics covered include multiple sclerosis, optic neuritis and Susac syndrome. - Comprehensive review of the latest developments in neuroinflammation - Includes contributions from leading authorities

Multiple sclerosis is a chronic and often disabling disease of the nervous system, affecting about 1 million people worldwide. Even though it has been known for over a hundred years, no cause or cure has yet been discovered-but now there is hope. New therapies have been shown to slow the disease progress in some patients, and the pace of discoveries about the cellular machinery of the brain and spinal cord has accelerated. This book presents a comprehensive overview of multiple sclerosis today, as researchers seek to understand its processes, develop therapies that will slow or halt the disease and perhaps repair damage, offer relief for specific symptoms, and improve the abilities of MS patients to function in their daily lives. The panel reviews existing knowledge and identifies key research questions, focusing on: Research strategies that have the greatest potential to understand the biological mechanisms of recovery and to translate findings into specific strategies for therapy. How people adapt to MS and the research needed to improve the lives of people with MS. Management of disease symptoms (cognitive impairment, depression, spasticity, vision problems, and others). The committee also discusses ways to build and financially support the MS research enterprise, including a look at challenges inherent in designing clinical trials. This book will be important to MS researchers, research funders, health care advocates for MS research and treatment, and interested patients and their families.

A translational overview of neuroimmune diseases for neuroscientists and clinicians that clarifies the pathological mechanisms underlying neuroimmune diseases and builds a comprehensive bridge between the latest research findings and their clinical implications in daily practice. The material is presented in two steps. The first section comprises a review of the pathogenic actions of immune cells in brain diseases. Here the authors discuss the mechanisms through which immune cells disrupt the functions of nerve cells. The second section explores the ways in which the brain becomes dysfunctional due to impaired nerve cell function. Based on pathogenesis, diagnostic and therapeutic strategies are discussed for each clinical category. The book will be invaluable for use in clinical practice of neuroimmune diseases

This is the latest edition of the classic book on the subject of multiple sclerosis. An international group of authors has been involved in updating this edition which features more information on imaging and investigations, and a new chapter on neurobiology and glial development.

This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)

Being diagnosed with multiple sclerosis (MS) doesn’t have to mean your life is over. Everyone’s MS is different and no one can predict exactly what yours will be like. The fact is, lots of people live their lives with MS without making a full-time job of it. MS for Dummies gives you easy to access, easy to understand information about what happens with MS—what kinds of symptoms it can cause, how it can affect your life at home and at work, what you can do to feel and function up to snuff, and how you can protect yourself and your family against the long-term unpredictability of the disease. You'll learn: Why some people get MS and others don’t How to make treatment and lifestyle choices that work for you What qualities to look for in a neurologist and in the rest of your healthcare team How to manage fatigue, walking problems, and visual changes Why the road to diagnosis can be full of twists and turns How to understand the pros and cons of alternative medicine Why and how to talk to your kids about MS How to find stress management strategies that work for you Your rights under the Americans with Disabilities Act Complete with listings of valuable resources such as other books, Web sites, and community agencies and organizations that you can tap for information or assistance, MS for Dummies will tell you everything you need to know in order to make educated choices and comfortable decisions about life with MS.

"MS is always in the back of your mind. If there is something you want to do, you always wonder if the MS will allow you do to it." —Darlene, living with MS for 22 years Living with multiple sclerosis (MS) is challenging and multidimensional. MS pervades all aspects of life: one’s body becomes unpredictable and unreliable, one’s identity and sense of self are tested, and relationships with others often change. MS symptoms emerge and remit; limitations evolve and progress. MS rehabilitation is an active, person-centered, and goal-oriented process embedded within a respectful and collaborative partnership between the person with MS and the members of his or her rehabilitation treatment team. Using the International Classification of Functioning, Disability and Health (ICF) as a guiding framework, Multiple Sclerosis Rehabilitation: From Impairment to Participation provides a comprehensive and evidence-based resource to inform and guide clinical reasoning and decision making during each phase of the MS rehabilitation process, from initial referral to post-discharge follow-up. With an emphasis on the application of evidence throughout the entire MS rehabilitation process, the specific objectives of the book are to increase the understanding of: The nature and impact of specific impairments, activity limitations, and participation restrictions experienced by people with MS How to select and use valid, reliable, and relevant assessment tools to inform the development of rehabilitation goals and intervention plans, and to evaluate outcomes This book provides information about the nature and impact of MS on the daily lives of people living with the disease, describes evidence-based assessment processes and instruments, and summarizes current knowledge that can inform goal setting and intervention planning. Thoughtful application of the knowledge contained in this book will inform and guide rehabilitation providers to work collaboratively with people with MS and enable them to achieve their goals for participation in everyday life.