Multipel sklerose: Forskelle mellem versioner
Content deleted Content added
PHE77 (diskussion | bidrag) retter fejl i cite-skabelon |
PHE77 (diskussion | bidrag) m retter cite-skabelon (fjerner parameteren "note") |
||
Linje 142:
Behandling af progressiv MS er mere vanskeligt end af relapserende-remitterende MS. Mitoxantron har vist positive resultater hos patienter med sekundær progressiv og progressiv-relapserende mønstre. Det er moderat effektivt til at reducere sygdommens progression og hyppigheden af tilbagefald hos patienterne i det korte løb.<ref name="pmid16235298"/> Ingen behandlinger har endnu vist sig at have nogen effekt på den primære progressive MS.<ref name="pmid15907149">{{cite journal |author=Leary SM, Thompson AJ |title=Primary progressive multiple sclerosis: current and future treatment options |journal=CNS drugs |volume=19 |issue=5 |pages=369–76 |year=2005 |pmid=15907149 |doi=10.2165/00023210-200519050-00001}}</ref>
Som ved enhver slags behandling har disse behandlinger flere bivirkninger. En af de mest almindelige er irritation ved injektionspunktet for glatiramacetat og de intravenøse behandlinger. Over tid kan der udvikle sig en synlig bule på injektionsstedet som følge af destruktionen af fedtvæv, kendt som [[lipoatrofi]]. Interferoner kan give symptomer, der er lig influenza;<ref name="pmid17131933">{{cite journal |author=Sládková T, Kostolanský F |title=The role of cytokines in the immune response to influenza A virus infection |journal=Acta Virol. |volume=50 |issue=3 |pages=151–62 |year=2006 |pmid=17131933 }}</ref> nogle patienter, der tager glatiramer oplever en reaktion efter injektionen med rødmen, trykken for brystet, hjertebanken, åndenød og angst, som normalt varer mindre end tredive minutter.<ref name="pmid14974077"/> Mere farligt er [[hepatotoxicitet|leverskader]] fra [[interferon]]er og mitoxantron,<ref>Primetherapeutics – serious liver damage per FDA – [http://www.primetherapeutics.com/DrugNews/flash/Avonex.pdf Primetherapeutics]</ref><ref>Betaseron [package insert]. Montville, NJ: Berlex Inc; 2003</ref><ref>Rebif [package insert]. Rockland, MA: Serono Inc; 2005.</ref><ref>Avonex [package insert]. Cambridge, MA: Biogen Inc; 2003</ref><ref name="pmid16750460">{{cite journal |author=Fox EJ |title=Management of worsening multiple sclerosis with mitoxantrone: a review |journal=Clinical therapeutics |volume=28 |issue=4 |pages=461–74 |year=2006 |pmid=16750460 |doi=10.1016/j.clinthera.2006.04.013}}</ref> de immunosuppressive effekter og hjertetoksicitet som mitoxantron også giver anledning til;<ref name="pmid16750460"/> samt den formodede sammenhæng mellem natalizumab og nogle tilfælde af [[progressiv multifokal leukoencefalopati]].<ref>{{cite journal |author=Kleinschmidt-DeMasters BK, Tyler KL |title=Progressive multifocal leukoencephalopathy complicating treatment with natalizumab and interferon beta-1a for multiple sclerosis |journal=N Engl J Med |volume=353 |issue=4 |pages=369–74 |date=2005 |pmid=15947079 |doi=10.1056/NEJMoa051782|url=http://content.nejm.org/cgi/content/abstract/353/4/369
{{cite web| title=Brain Infections Return for Multiple Sclerosis Drug Tysabri| url=http://blogs.wsj.com/health/2008/08/01/brain-infections-return-for-multiple-sclerosis-drug-tysabri| accessdate= 2008-08-01| format= | publisher= | date=2008-08-01 }}</ref>
<!-- === Management of the effects of MS ===
Disease-modifying treatments reduce the progression rate of the disease, but do not stop it. As multiple sclerosis progresses, the symptomatology tends to increase. The disease is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and [[disability]]. Management of these deficits is therefore very important. Both drug therapy and [[neurorehabilitation]] have shown to ease the burden of some symptoms, though neither influences disease progression.<ref name="pmid16168933">{{cite journal |author=Kesselring J, Beer S |title=Symptomatic therapy and neurorehabilitation in multiple sclerosis |journal=Lancet neurology |volume=4 |issue=10 |pages=643–52 |year=2005 |pmid=16168933 |doi=10.1016/S1474-4422(05)70193–9 |doi_brokendate=2009-12-24}}</ref>
As for any patient with neurologic deficits, a [[multidisciplinary]] approach is key to overcoming disability; however, there are particular difficulties in specifying a ‘core team’ because people with MS may need help from almost any health profession or service at some point.<ref name="isbn = 1 86016 182 0">{{cite book |last=The Royal College of Physicians |title=Multiple Sclerosis. National clinical guideline for diagnosis and management in primary and secondary care |publisher=Sarum ColourView Group |year=2004 |location=Salisbury, Wiltshire |isbn=1 86016 182 0 |url=http://www.rcplondon.ac.uk/pubs/books/MS/MSfulldocument.pdf|format=PDF
=== Alternative behandlinger ===
| |||