) about 200 ("Take the FDA Consumer") Dealing with Depression

As depression is reportedly the most common psychiatric disorder in multiple sclerosis (MS) patients, those caring for MS patients who express any sort of suicidal ideation should be closely monitored and referred for a psychological evaluation. Frequently, MS patients experiencing bouts with depression or suicidal thoughts are not assessed, under assessed, and/or consequently not diagnosed. Unlike some of the other aspects accounting MS, yet similar to some MS, depression can be effectively treated. Numerous reasons contribute to MS patients experiencing depression, according to Wallin. These may include:

The psychosocial effects of MS disability.

The direct effect of lesions on brain structures that are involved in regulating and maintaining mood state

The untoward effects of interferon (IFN)- ? For treating MS, which may be associated with mood changes.

Immune dysfunction. (Wallin)

Early intervention for depression, Wallin stresses, is vital as relief from depression related to MS can prevent declines in a MS patient's quality of life. It may also prevent a person attempting or completing suicide. (Wallin)

Surgical Treatments Deep brain stimulation (DBS), a variation of a surgery from the 1960s, is sometimes still used to treat tremors in MS patients. Surgeries in the past destroyed the thalamus (thalamotomy) or another part of the brain, the globus pallidus (pallidotomy). Today, instead of these type surgeries, which carry significant risk, due to the intentional destruction of part of the brain, deep brain stimulations are performed. When treating MS with DBS, a medical specialist places an electrode with the tip of the electrode in the thalamus (for tremor and multiple sclerosis). The medical specialist leaves the electrode for deep brain stimulation in the brain, connected by a wire to a pacemaker-like device. he/she then implants the stimulating device under the skin over the chest of the MS patient.

The device delivers electrical shocks to help to relieve tremors accompanying MS. (Doctors)

Doctors)

Doctors at the Mellen Center for Multiple Sclerosis Research at the Cleveland Clinic relate the following questions/answers regarding the surgical treatment of DBS:

Can Deep Brain Stimulation Cure MS?

No. Electrical stimulation does not cure multiple sclerosis nor does it prevent the disease from getting worse; it helps to relieve the symptom of tremor related to MS.

Is Deep Brain Stimulation Considered Experimental?

Deep brain stimulation is not experimental. The FDA has approved DBS to treat Parkinson's disease, essential tremor and dystonia. Dystonia is a type of movement disorder characterized by abnormal postures and twisting motions.

The FDA has not specifically approved deep brain stimulation of the thalamus to treat multiple sclerosis. However, this does not mean that the treatment is experimental or that it would not be covered by insurance. There are many examples of treatments that are used every day and are standard and accepted but that have not been approved by the FDA.

Deep brain stimulation is a way to inactivate parts of the brain without purposefully destroying the brain. Therefore, the risks are much lower. In Who Should Consider Deep Brain Stimulation?

There are many important issues to be addressed when considering deep brain stimulation. These issues should be discussed with a movement disorders expert or a specially trained neurologist.

Before considering surgery, you should have tried medication first. Surgery should not be undertaken if medications are able to control your symptoms. However, surgery should be considered if you do not achieve satisfactory control through medications. If you are unsure if DBS is right for you, consult a movement disorders expert or a neurologist who has experience with movement disorders.

Where Should the Operation Be Performed?

The surgery should be performed in a center where there is a team of experts to care for you. This means neurologists and neurosurgeons who have experience and specialized training in doing these types of surgeries.

Another thing to consider when deciding where to go for the surgery is to find out how the target (that is the thalamus) is localized. Different centers may perform the surgeries in different ways. It is clear that the chances of benefit and the risks of complications are directly related to how close the electrode is to the correct target. (Doctors)

Treatment Options

Treatment options for MS, according to the Mayo Clinic, in addition to DPS, include may include medications, physical and occupational therapy, as well as, experimental therapies. Currently, two primary strategies are recommended for MS:

Managing the symptoms accompanying MS;

Treatment of MS prior to permanent damage contributing to onset of symptoms.

The Mayo Clinic utilizes a multidisciplinary approach and offers expertise to help best manage neurological diseases such as MS. Treatment techniques may include:

Glatiramer, which blocks the immune system's attack on myelin, has to be injected, once a day, subcutaneously once daily.
Medications for Treatment of MS Symptoms

Corticosteroids reduce inflammation in nerve tissue and decrease flare-ups' length.. Prolonged use of these medications, however, may cause side effects such as osteoporosis and high blood pressure (hypertension).

Muscle Relaxants: Tizanidine (Zanaflex) and baclofen (Lioresal), oral medications treat muscle spasticity. MS patients may experience painful or uncontrollable muscle spasms and/or stiffening, especially in their legs.

Medications to Reduce Fatigue may include amantadine (Symmetrel), the antiviral drug or modafinil (Provigil), a medication for narcolepsy, both possess stimulant properties

Other Medications may be prescribed to treat accompanying pain, bladder and/or bowel control issues, or depression.

Physical and Occupational Therapy strive to help preserve a MS patient's independence by strengthening exercises, and utilizing devices to assist with daily tasks.

Counseling sessions such as individual or group therapy may help MS patients and their family members cope with MS in more positive ways, as well as, help them know how to best counter related emotional stress.

Special Therapies include:

Plasma Exchange involves "removing some blood and mechanically separating the blood cells from the fluid (plasma). Blood cells then are mixed with a replacement solution...[and] returned to the body." Plasma Exchange, however, "is only for people with sudden, severe attacks of MS-related disability who don't respond to high doses of steroid treatment." ("Multiple Sclerosis" Mayo Clinic)

Learning to "see" the best way to deal with MS and its accompanying symptoms, this researcher suggests, evolves from not only learning as much as possible about treatment options, but also follow through with day-to-day healthy counters to symptoms. Exercise and positive life-style choices this researcher contends from research, can be serve as extra effective efforts to help ensure one with MS does not experience debilitating, destructive depression. A person with MS, as well as, those who care for him/her could benefit from remembering to note a message that can be dissected from this paper's introduction: "A swollen, pale optic nerve could be a symptom of multiple sclerosis." ("The Eyes Have it;" 50) Although this particular symptom would likely be recognized by a medical specialist, noting other everyday not so subtle symptoms, however, symptoms, does not require a medical degree. As the resource for the introductory posits, this researcher suggests: "The Eyes Have it." Dealing with MS requires, this researcher purports, the ability to train the spirit's eyes to see beyond symptoms that may darken one's spirit. The eyes have it - the ability to make a point to see hope for life, despite challenges MS may present.

APPENDIX a Take the FDA Consumer Quiz

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How's your knowledge of health-related topics such as multiple sclerosis, arthritis, stroke, and skin cancer?

Find out by taking our quiz.

Hint: The answers to all these questions can be found in the March-April 2005 issue of FDA Consumers)

Take any of our past quizzes

1. At what age is multiple sclerosis most frequently diagnosed?

a. () during the teen-age years b. () between 10 and 12 c. () between 60 and 70 d. () between 20 and 50 e. () 80 and over 2. Studies have shown that people with multiple sclerosis who exercise:

a. () often have relapses triggered by exercise b. () have more fatigue c. () have less fatigue

3. How many people in the United States are diagnosed with multiple sclerosis every week?

a. () between 50 and 100 b. () about 200 c. () about 300 d. () more than 500

4. How many Americans are limited in their everyday activities because of arthritis?

a. () 80,000 b. () 8 million c. () 750,000 d. () 2.5 million

5. Traditional non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, act by blocking the production of a family of chemicals known as:

a. () estrogen b. () prostaglandins c. () testosterone

6. Approximately how many people in the United States have a stroke each year?

a. () 100,000 b. () 300,000 c. () 450,000 d. () 700,000

7. What should you do if you think you are having a stroke?

a. () call your family doctor to schedule an appointment b. () call 911 immediately for emergency help c. () wait to see if the symptoms go away d. () lie down and…