Multiple Sclerosis in Clinical Practice PDF
Preview Multiple Sclerosis in Clinical Practice
Karp front:Layout 1 7/31/08 2:59 PM Page ii Multiple Sclerosis in Clinical Practice Multiple Sclerosis in Clinical Practice Stanley van den Noort, MD, Professor Department of Neurology University of California, Irvine and Chief Medical Officer National Multiple Sclerosis Society and Nancy J. Holland, EdD Vice President, Clinical Programs Department National Multiple Sclerosis Society DemosMedicalPublishing,Inc.,386ParkAvenueSouth,NewYork,NewYork10016 © 1999 by Demos Medical Publishing, Inc. All rights reserved. This book is pro- tectedbycopyright.Nopartofitmaybereproduced,storedinaretrievalsystem, ortransmittedinanyformorbyanymeans,electronic,mechanical,photocopying, recording,orotherwise,withoutthepriorwrittenpermissionofthepublisher. LibraryofCongressCataloging-in-PublicationData Availablefromthepublisheruponrequest PrintedinCanada Preface Almost half a million people suffer from and are diagnosed with multiple sclerosis(MS)inNorthAmerica,andanunknownnumbersufferfromMS and are not yet diagnosed. With this prevalence, most primary care clini- cianswillhaveatleastoneortwopatientswithMSintheirpractice. Although glucocorticoids have long been the mainstay for the symp- tomatic treatment of acute episodes of MS, only since 1993 have effective treatments, such as beta interferon and glatiramer acetate, been available thatalterthecourseandprogressionofthedisease. Changes in our ability to diagnose and treat MS have created a para- dox, shared with other serious, complicated chronic diseases such as HIV/AIDS.Multiplesclerosishasbecomeatthesametimebothmoreofa primary care and subspecialty care disease. With more effective treatment options, the complexity of optimal management requires more and more subspecialtyexpertise,allthewhileheighteningtheimportanceofthepri- marycareclinician’sroleinearlydiagnosisandlong-termcomanagement. Thecollaborationofthepatient,primarycarephysician,MSspecialist,and other members of the health care team (i.e., nurses, physical and occupa- tionaltherapists,andothers)becomesevenmoreessentialforoptimalcare. As a family physician, I learned four important points from Multiple SclerosisinClinicalPractice: 1. Effective, disease-modifying treatments are now available, making earlydiagnosisandinitiationoftreatmentimperative. v vi PREFACE 2. New diagnostic tools, such as magnetic resonance imaging (MRI), mayplacetheastuteprimarycarephysicianintheroleofmakinga diagnosispreviouslymadebyneurologistswhospecializeinMS. 3. These more powerful diagnostic methods may shorten the limbo beforediagnosis(i.e.,“symptomsseparatedbyspaceandtime”)but place the acute grief reaction to the diagnosis of a chronic disease withanuncertainprognosisintheprimarycarephysician’soffice. 4. Patients with MS suffer, of course, from many other common con- ditions,includingpseudoexacerbations. The legacy of waiting and waiting—sometimes for years—for the dis- ease to manifest itself clearly enough for a definitive diagnosis is now his- torybutmeansnewresponsibilitiesfortheprimarycarephysician,bothin diagnosisandinlong-termcomanagementwithMSspecialists. My personal experience may not be typical but my professional expe- rience with MS probably is. I have one patient in my practice with MS whose many other problems, including cerebral blindness due to head traumafromdomesticviolence,dwarfherMSsymptoms. AnursepractitionercolleaguehasbeendiagnosedwithMSaftersep- arate episodes of optic neuritis but has had no furtherprogression. Why I am writing this Foreword comes from more personal experience. My best friend—Patricia Robertson Amusa-Shonubi—died in 1994 from what her neurologist,anMSspecialist,describedastheworstcaseofMShehadever seen.TreatmentcametoolateforPat,andherprimarycarewastragictoo, butwithwhatyouwillfindinthisbook,youwillbeabletoensurethatoth- erswillnothavetosufferherfate. A.H.Strelnick,M.D. Professor,FamilyMedicine MontefioreMedicalCenter AlbertEinsteinCollegeofMedicine Bronx,NewYork Foreword Those of us who work with people who have multiple sclerosis (MS) are acutelyawareoftheenormouslydifficultconsequencesofthisdisease,for boththeindividualswithMSandtheirlovedones.Weare,however,fortu- natetobelivinginatimemorepromisingthaneverbefore—treatmentsto alter the disease course and relieve many symptoms are now available. It remains for you, the physician, to bring these therapies to your patients withMS.Thisiscertainlyawonderfulopportunity,aswellasadifficultchal- lenge,giventhecomplexitiesandenigmaofthisdifficultdisease. AsyouprovidehealthcareforpeoplewithMS,theNationalMultiple SclerosisSocietyisyourpartner,providingprogramstosupportthosewith MS,theirfamilies,aswellasthephysiciansandalliedhealthprofessionals. We at the Society thank you for your dedication, knowledge, and skill in assisting people with MS. Together we will advance the mission of the NationalMultipleSclerosisSociety,“toendthedevastatingeffectsofMS.” Gen.MichaelJ.Dugan,USAF,Ret. President&CEO NationalMultipleSclerosisSociety vii
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