Neurology
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Multiple sclerosis (MS), a neurologic disorder that affects 400,000 persons in the United States, consists of an inflammatory and a neurodegenerative phase. Treatment options now approved by the FDA specifically target the inflammatory phase of MS and include immunomodulators (i.e., interferon betas and glatiramer acetate) and an immunosuppressant, mitoxantrone. ⋯ Only mitoxantrone is approved for the treatment of worsening relapsing-remitting MS, secondary progressive MS, and progressive-relapsing MS. Early treatment with these disease-modifying agents is desirable to reduce the progression of the disease and to limit long-term disability.
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Immunomodulating agents have beneficial effects in the treatment of multiple sclerosis (MS), decreasing the frequency of relapses, the progression of disability, and MRI measures of disease activity. Despite the efficacy of these agents, many patients continue to show progression of disability, breakthrough relapses, and active disease on MRI. Therefore, clinicians have employed a variety of combinations of agents in an attempt to decrease disease activity in those with active disease despite standard immunomodulatory therapy. ⋯ Other combinations that appear safe in preliminary studies include IFNbeta-1a and methotrexate, IFNbeta-1a and azathioprine, and mitoxantrone plus methylprednisolone. The decision to use combination therapy in patients with a suboptimal response to monotherapy should be considered early and not be delayed until disability becomes advanced. This review discusses the available data regarding the combination of standard immunomodulatory therapy with immunosuppressive agents.
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Comparative Study
Role of motor evoked potentials in diagnosis of cauda equina and lumbosacral cord lesions.
To determine the diagnostic value of motor evoked potentials (MEPs) in the diagnosis of lumbosacral cord disorders. ⋯ Motor evoked potential recording is an accurate and easily applicable test for the diagnosis of lumbosacral spinal cord lesions.