Multiple Sclerosis Therapeutics

This book comprehensively reviews the current state of clinical trial methods in multiple sclerosis treatment, providing investigators, sponsors and specialists with current knowledge of outcome measures and study designs for disease and symptom management. The status of the rapidly evolving field of disease-modifying drugs is presented, with emphasis on the most promising therapies currently being tested. Experts discuss disease and symptom management for MS subtypes, including neuromyelitis optica and pediatric MS. In addition, key scientific advances in MS pathology, genetics, immunology and epidemiology are presented. The fourth edition has been extensively revised, featuring more than 50% new material. All chapters have been substantially updated to provide current information on rapidly evolving topics and this volume contains 15 new chapters, reflecting the growth of the field in recent years. This book is an essential reference for practitioners caring for MS patients, investigators planning or conducting clinical trials, and clinical trial sponsors.

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.

Since the publication of the previous edition of this volume, there has been substantial progress in a number of areas of multiple sclerosis (MS) research. Although immunosuppressive treatments continue to be developed and refined, more targeted immunomodulatory therapies are surfacing as we learn more about how the immune system works in health an

This textbook examines the most important aspects of multiple sclerosis that impact on clinical trial design, on the development of new disease therapies and on patient care. The international team of contributors discuss the clinical course of multiple sclerosis, its clinical heterogeneity, the presence of subclinical disease activity which occurs during the early stages of the disease. Multiple sclerosis presents clinical challenges: from unexpected and irregular relapses to profressive deterioration.

"Multiple Sclerosis International Federation"--Cover.

Special populations, societal and family issues, and related disorders that are often mistaken for MS are also covered. Dedicated chapters on neuromyelitis optica and acute disseminated encephalomyelitis incorporate newer diagnostic criteria. Because comorbidities often make the management of MS-related disability more complex, the book addresses these comorbidities as part of a comprehensive management plan. To enhance the clinical utility, critical-to-know information and management pearls are boxed for quick reference and most chapters include lists of "Key Points" for clinicians, and for patients and families. Illustrations, tables, graphs, assessment scales, and up-to-date MRI imaging inform the text throughout. The treatment chapters include specific recommendations where available and highlight areas of controversy.

This revised textbook examines the most important aspects of multiple sclerosis that impact on clinical trial design, on the development of new disease therapies, and, most importantly, on patient care. An international team of contributors discusses the clinical course of multiple sclerosis, its clinical heterogeneity, and the presence of subclinical disease activity which occurs during the early stages of the disease. There have been substantial advances in the field since the first edition was published in 1999. There are new chapters on functional imaging, the issues involved in long-term follow-up studies, cyclophosphamide, sex hormones and pregnancy-related factors, complementary and alternative treatments, management of cognitive impairment, treatment of pain, and rehabilitative approaches. Chapters on MS pathogenesis, imaging, the interferons, glatiramer acetate, mitoxantrone, IVIg, plasma exchange, stem cell transplantation, combination therapies, and newly-emerging treatments have been updated. This book is essential for any clinician who works with MS patients.

Multiple sclerosis is one of the major current problems in neurol ogical practice. It remains incompletely understood, yet is a common cause of chronic disability in developed Western so cieties: Patients with the disease have difficulty understanding what has happened to them and become bewildered by the con trast between the evidently large body of knowledge concerning the clinical manifestations and course of the disease, and the conflicting views they so often receive from different specialists as to the best current management of their disease. As in so many disorders for which treatment is only partially effective, at best, "alternative" therapies abound. Dr. Rudick and Dr. Goodkin have extensive experience in the day-to-day management of multiple sclerosis at the Mellen Center for Multiple Sclerosis Treatment and Research, attached to the Cleveland Clinic. In this book they have assembled a group of experts from several countries and have provided a comprehensive review of the results of different treatments of the disease. Each treatment is considered in the light of its proposed scientific basis or mode of action, and in relation to ethical and trial design issues. This information deserves to be made widely available. As the treatment of multiple sclerosis enters a new era as a result of the new understanding of the cellular mechanisms of demyelination and the molecular biology of the immune response, this information about current treatments assumes additional importance. The book is of interest to all physicians concerned with the management of patients with the disease.

This revised textbook examines the most important aspects of multiple sclerosis that impact on clinical trial design, on the development of new disease therapies, and, most importantly, on patient care. An international team of contributors discusses the clinical course of multiple sclerosis, its clinical heterogeneity, and the presence of subclinical disease activity which occurs during the early stages of the disease. There have been substantial advances in the field since the first edition was published in 1999. There are new chapters on functional imaging, the issues involved in long-term follow-up studies, cyclophosphamide, sex hormones and pregnancy-related factors, complementary and alternative treatments, management of cognitive impairment, treatment of pain, and rehabilitative approaches. Chapters on MS pathogenesis, imaging, the interferons, glatiramer acetate, mitoxantrone, IVIg, plasma exchange, stem cell transplantation, combination therapies, and newly-emerging treatments have been updated. This book is essential for any clinician who works with MS patients.