About Multiple Sclerosis

Multiple sclerosis is a central nervous system disease that affects millions worldwide. Although most individuals do not become severely disabled, more than half experience spasticity, which tightens muscles and can complicate daily life. Medtronic developed a unique technology to help control severe spasticity in some individuals.

Of the estimated 400,000 people in the United States and 2.5 million worldwide with multiple sclerosis,1 over half suffer from spasticity.2 If you experience severe spasticity connected to your multiple sclerosis, and respond positively to a screening test, our treatment may help you lead a fuller life.

Definition

Multiple sclerosis is a chronic, often disabling disease of the central nervous system (the brain or spinal cord).

Causes

The exact cause of multiple sclerosis is unknown. It is believed to be an autoimmune disease in which the body attacks its own myelin, a fatty tissue that helps nerve fibers conduct electrical impulses.1

Risk Factors

Scientists don’t know what causes multiple sclerosis. Most agree that several factors are involved, including genetics, gender, and environmental triggers (possibilities include viruses, heavy metals [toxicology], and trauma).1 Multiple sclerosis is most common in Caucasians (especially Northern Europeans), women, and individuals with a genetic predisposition.1

Symptoms

The symptoms of multiple sclerosis can be unpredictable and vary widely from person to person. However, more than half of people with multiple sclerosis experience spasticity:2

  • 34% have spasticity that affects their daily living
  • 17% reported that spasticity frequently affects activities
  • 13% reported a need to modify daily activities due to spasticity
  • 4% reported that spasticity prevents daily activities

Diagnosis

Several tests and procedures are used to diagnose multiple sclerosis, including a complete medical history, nervous system functioning, and diagnostic test.

Two basic signs are required to confirm multiple sclerosis:1

  • Evidence of the disease in different parts of the nervous system
  • Evidence of at least two separate flare-ups of the disease

Types of Multiple Sclerosis

Your clinician may diagnose you with one of many different types of multiple sclerosis. Since 1996, multiple sclerosis has been categorized in the following ways:1

  • Relapsing-Remitting (very common as initial diagnosis)
  • Primary-Progressive (relatively rare)
  • Secondary-Progressive (half of all Relapsing-Remitting individuals develop this within 10 years)
  • Progressive-Relapsing (relatively rare)

Multiple sclerosis occurs most commonly in adults, but it is also diagnosed in children and adolescents.1

About Spasticity due to Multiple Sclerosis

Spasticity is caused by damage or injury to the part of the central nervous system (the brain or spinal cord) that controls voluntary movement. This damage disrupts important signals between the nervous system and muscles, creating an imbalance that increases muscle activity or spasms.

Spasticity can make movement, posture, and balance difficult. It may affect your ability to move one or more of your limbs, or to move one side of your body. Sometimes spasticity is so severe that it gets in the way of daily activities, sleep patterns, and care giving. In certain situations, this loss of control can be dangerous for the individual.

References

  1. National MS Society. MS The Disease. Available at: www.nationalmssociety.org. Accessed 04/05/08.
  2. Rizzo MA et al. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Multiple Sclerosis. 2004; 10: 589-95.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088.

Safety Information – ITB Therapy

Please follow your doctor's instruction closely because a sudden stop of intrathecal baclofen therapy can result in serious illness (baclofen withdrawal symptoms) such as high fever, changed mental status, muscle rigidity, and in rare cases multiple organ-system failure and death. It is very important that your doctor be called right away if you experience any of the above symptoms.

It is important for you to keep your scheduled refill visits so you don't run out of medication (baclofen) and to understand the early symptoms of baclofen withdrawal. Some patients are at more risk than others for baclofen withdrawal; consult with your doctor.

People who suffer from severe spasticity resulting from cerebral palsy, multiple sclerosis, stroke, traumatic brain injury, or spinal cord injury may be a candidate for ITB Therapy. If you have spasticity due to spinal cord injury or multiple sclerosis you must first fail oral baclofen. If you have experienced a traumatic brain injury you must first wait 1 year after the injury to be considered for ITB Therapy. A screening test will help show if you will respond to the intrathecal baclofen. You should not receive ITB Therapy if you have an infection, are allergic to baclofen, or your body size is too small to hold the implantable pump.

The implanted pump and catheter are surgically placed beneath the skin. Surgical complications that you may experience include infection, meningitis, spinal fluid leak, paralysis, headache, swelling, bleeding, and bruising.

The most common and/or serious drug-related side effects of ITB Therapy include loose muscles, sleepiness, upset stomach, vomiting, headaches, and dizziness. Pump failure may cause overdose or underdose of intrathecal baclofen. The signs and symptoms of overdose include drowsiness, lightheadedness, respiratory depression (difficulty breathing), seizures, loss of consciousness, and coma. Once the infusion system is implanted, device complications include catheter or pump moving within the body or eroding through the skin. The catheter could leak, tear, kink, or become disconnected, resulting in underdose or no baclofen infusion. Symptoms of underdose include increase or return in spasticity, itching, low blood pressure, lightheadedness, and tingling sensation. These symptoms are often early indications of baclofen withdrawal. The pump could stop because the battery has run out or because of component failure. The pump will sound an alarm when the pump needs to be filled with baclofen, replaced or if there is a problem with the pump. Always inform any healthcare personnel that you have an implanted infusion system before any medical or diagnostic procedure such as MRI or diathermy.

For more information, please read the Lioresal® Intrathecal (baclofen injection) Full Prescribing Information and the SynchroMed Infusion System Information.

This therapy is not for everyone. Please contact your doctor. A prescription is required.

Lioresal® is a registered trademark of Novartis Pharmaceuticals Corporation.

Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.

Last updated: 3 Aug 2008

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