Multiple Sclerosis of Lumbar Spine

Multiple Sclerosis of Lumbar Spine
Multiple sclerosis (MS) is a recurring, potentially incapacitating disease that influences the central nervous system, which compose the brain and spinal cord. Multiple sclerosis is commonly thought to be an autoimmune disease, a condition in which the immune system attacks components of the body as if they're foreign.
In multiple sclerosis, the body incorrectly directs antibodies and white blood cells against proteins in the myelin sheath, a fatty substance that protects nerve fibers in the brain and spinal cord. This results in inflammation and harm to the sheath and eventually to the nerves that it surrounds. The result may be multiple areas of scarring (sclerosis). Ultimately, this injury can slow down or obstruct the nerve signals that control muscle coordination, strength, sensation and vision.
Multiple sclerosis influences approximately 300,000 people in the United States and possibly more than 1 million people around the world — including twice as many women as men. The majority of people experience their initial signs or symptoms between ages 20 and 40.
Multiple sclerosis is erratic and differs in severity. In a number of people, multiple sclerosis is a mild disease, but it can lead to permanent disability in others. Treatments can change the direction of the illness and ease symptoms.
Signs and symptoms
Signs and symptoms of multiple sclerosis differ extensively, depending on the site of affected nerve fibers. Multiple sclerosis symptoms may include:
Numbness or weakness in one or more extremity, which characteristically occurs on one side of the body at a time or the bottom half of the body Partial or total loss of vision, typically in one eye at a time, frequently with pain throughout eye movement

Double vision or blurring of visionMultiple Sclerosis of Lumbar Spine
Multiple sclerosis (MS) is a recurring, potentially incapacitating disease that influences the central nervous system, which compose the brain and spinal cord. Multiple sclerosis is commonly thought to be an autoimmune disease, a condition in which the immune system attacks components of the body as if they're foreign.
In multiple sclerosis, the body incorrectly directs antibodies and white blood cells against proteins in the myelin sheath, a fatty substance that protects nerve fibers in the brain and spinal cord. This results in inflammation and harm to the sheath and eventually to the nerves that it surrounds. The result may be multiple areas of scarring (sclerosis). Ultimately, this injury can slow down or obstruct the nerve signals that control muscle coordination, strength, sensation and vision.
Multiple sclerosis influences approximately 300,000 people in the United States and possibly more than 1 million people around the world — including twice as many women as men. The majority of people experience their initial signs or symptoms between ages 20 and 40.
Multiple sclerosis is erratic and differs in severity. In a number of people, multiple sclerosis is a mild disease, but it can lead to permanent disability in others. Treatments can change the direction of the illness and ease symptoms.
Signs and symptoms
Signs and symptoms of multiple sclerosis differ extensively, depending on the site of affected nerve fibers. Multiple sclerosis symptoms may include:
Numbness or weakness in one or more extremity, which characteristically occurs on one side of the body at a time or the bottom half of the body
Partial or total loss of vision, typically in one eye at a time, frequently with pain throughout eye movement
Double vision or blurring of vision
Tingling or pain in parts of the body
Electric-shock sensations that occur with particular head movements
Tremor, lack of coordination or unsteady gait
Fatigue
Dizziness
In certain cases, people with multiple sclerosis may also develop muscle stiffness or spasticity, slurred speech, paralysis, or problems with bladder, bowel or sexual function. Mental alterations, such as forgetfulness or difficulties with concentration, also may occur.
Causes
The central nervous system includes millions of nerve cells that send their electrical signals to and from the brain along wire-like extensions of the cells called axons, or nerve fibers. Myelin is the fatty substance that coats and protects these fibers, comparable to the way insulation protects electrical wires.
In people with multiple sclerosis, the immune system incorrectly damages the cells that manufacture the myelin sheath. As a result, myelin becomes inflamed and enlarged and separates from the nerve fibers. The removed myelin may ultimately be damaged. Rigid or hardened (sclerosed) patches of scar tissue develop over the fibers. After nerve impulses reach a injured region, some impulses are blocked or delayed from traveling to or from your brain. Eventually, this procedure leads to deterioration of the nerves themselves, which probably accounts for the permanent disabilities that may arise in MS.
Doctors and researchers don't recognize what causes this autoimmune response. Something appears to activate the condition in vulnerable people.
Hereditary factors may make some people more vulnerable to multiple sclerosis. But genetic inclination is only a fraction of the explanation. An amount of researchers consider the disorder is associated to a protein that imitates the myelin protein, which may be introduced into the body by a virus. Other researchers think that the immune system overreacts toward myelin proteins in people with MS, which leads to an abnormal predisposition to acquire autoimmune disease.
A period of disease activity (exacerbation) may be activated by a viral infection, such as a cold or flu, or by modifcations in the immune system throughout the initial six months following a pregnancy.
Patterns of MSWhatever the multiple sclerosis cause or trigger, the illness occurs in four main prototypes:

Relapsing remitting. This category of multiple sclerosis is distinguished by noticeably distinct outbreaks, followed by periods of remission. The flare-ups normally develop abruptly, last a few weeks or months, and then progressively vanish. The majority of people with MS have this type at the time of diagnosis.

Primary progressive. People with this less common type of multiple sclerosis experience a gradual weakening, lacking periods of remission. People with this form of MS are typically older than 40 when signs or symptoms start.

Secondary progressive. More than half the people with relapsing remitting MS ultimately go through a phase of continuous worsening referred to as secondary progressive MS. Abrupt relapses may occur, superimposed upon the continuous weakening that distinguishes this kind of multiple sclerosis.
Progressive relapsing. This is primary progressive MS with the addition of sudden incidents of new symptoms or deteriorating existing ones. This type is comparatively unusual.
Risk factors
These factors may increase the risk of developing multiple sclerosis:
Heredity. Multiple sclerosis is more frequent in people of Northern European ancestry. There also seems to be a hereditary factor to the condition, even though the risk to children of people affected by MS is fewer than 5 percent over their life span. Researchers believe that the inclination to acquire multiple sclerosis is inherited, but the illness is noticeable only when environmental causes are present.
Environmental factors. Environmental factors have some affect on multiple sclerosis. Many viruses and bacteria have been suspected of causing MS, most recently the Epstein-Barr virus, known also for causing infectious mononucleosis. Some studies have recommended that developing infection at a critical period of exposure may lead to conditions favorable to the growth of MS a decade or more later.
Geographical factors. Multiple sclerosis is more frequent in countries with moderate climates, including Europe, southern Canada, northern United States, and southeastern Australia. The cause is unidentified.
Screening and diagnosis
Multiple sclerosis can be complicated to diagnose. Many other conditions may create symptoms comparable to multiple sclerosis, but with a dissimilar prognosis and treatment.
There are no definite tests for multiple sclerosis. Eventually, the diagnosis relies on a determination that the clinical symptoms, radiological studies and laboratory studies suggest MS, and that no additional condition offer a improved explanation for them. The physician may base a multiple sclerosis diagnosis on the following:

Medical history. The physician evaluates the signs and symptoms and their pattern.
Neurological examination. This exam thoroughly checks numerous elements of the nervous system, including the reflexes, muscle strength, muscle tone, and sensations of pain, heat, touch and vibration. The doctor may also monitor the gait, posture, coordination and equilibrium, and ask questions to establish the clearness of thinking, decisions and memory.
Magnetic resonance imaging (MRI) scan. The cylinder-shaped MRI scanner produces tissue-slice images on a computer from data created by a strong magnetic field and radio waves. The doctor can observe these images from any direction or plane.
This imaging procedure may disclose MS lesions, which are caused by myelin loss. An intravenous dye, gadolinium, will highlight "active" lesions that have developed within the past two months and this may help physicians identify whether the MS is in an active period, even if no symptoms are present demonstrating an attack of MS. Newer MRI methods can offer yet greater detail concerning the amount of nerve fiber damage or permanent myelin loss and revitalization.
Spinal tap (lumbar puncture). In this process, a doctor removes a minute sample of cerebrospinal fluid from within the spinal canal for laboratory analysis. This sample can demonstrate abnormalities related with multiple sclerosis, such as atypical levels of white blood cells or proteins. This method can also help rule out viral infections and additional conditions that can cause neurological symptoms comparable to those of MS.
Evoked potential test. This examination measures the electrical signals sent by the brain in reaction to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which short electrical impulses are applied to the legs or arms.
Treatment
If the attacks are mild or occasional, the physician may monitor the condition.
Medications for relapsing MSFor a relapse type of the illness, the doctor may suggest treatment with disease-modifying medications initially in the course of disease. These medications for multiple sclerosis treatment include:

Beta interferons. Interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) are genetically engineered duplicate of proteins that arise naturally in the body. They help battle viral infection and control your immune system.
These medications decrease but don't eliminate flare-ups of multiple sclerosis. It's unsure which of their various events lead to a decrease in disease activity and what their lasting benefits are. Beta interferons aren't used in combination with one another; only one of these medications is used at a time.
The Food and Drug Administration (FDA) has approved beta interferons only for people with relapsing forms of MS who can still walk. Beta interferons don't reverse injury and haven't been established to considerably change lasting growth of permanent disability. Some people acquire antibodies to beta interferons, which may cause them to be less efficient. Other people can't bear the side effects, which may consist of symptoms comparable to those of the flu (influenza).
Doctors normally suggest beta interferons for people who have more than one attack of MS a year and for those who don't recuperate well from flare-ups. The treatment may also be used for people who have a substantial increase of new lesions as seen on an MRI scan, even when there may not be major new symptoms of disease activity.
The FDA has approved the use of numerous beta interferons for people who've experienced a single attack that suggests multiple sclerosis, and who may be at risk of future attacks and developing distinct MS. Risk of MS may also be recommended when an MRI scan of the brain demonstrate lesions that forecast a high risk of adaptation to specific MS. Debate exists as to whether these people should take these costly and frequently problematic drugs for unspecified times, especially because some people do well both in the short term and long term without treatment. Some doctors choose to monitor people at high risk with follow-up exams and MRI scans to record any continuing inflammatory disease activity before suggestting long-term treatments such as beta interferon.

Glatiramer (Copaxone). This medication is an option to beta interferons for relapsing remitting MS. Doctors think that glatiramer works by blocking the immune system's attack on myelin. Side effects may include flushing and shortness of breath after injection.

Natalizumab (Tysabri).. It works by blocking the addition of immune cells to brain blood vessels — a essential step for immune cells to cross into the brain — therefore decreasing the immune cells' inflammatory action on brain nerve cells.
This drug was revealed to considerably decrease the occurrence of attacks in people with relapsing MS.
Because of the drug's risks, of a an uncommon, frequently deadly, brain disorder called progressive multifocal leukoencephalopathy. It's usually suggested only for people whose condition hasn't reacted to other types of MS treatments. Also, there has been no report directly comparing natalizumab to existing treatments to confirm whether it's better than existing treatments.
Other medications. Mitoxantrone (Novantrone) is a chemotherapy drug used for many cancers. This drug is also FDA-approved for treatment of aggressive types of relapsing remitting MS, as well as particular types of progressive MS.
Mitoxantrone may cause severe side effects, such as heart damage, after long-term use, so it's normally not used for longer than two to three years. And it's normally used for people with severe attacks or quickly developing disease who don't react to other treatments. Careful observation is critical for anybody on this medication.
Medications for progressive MSSome medications may reduce symptoms of progressive MS. They include:
Corticosteroids. Doctors most frequently recommend short courses of oral or intravenous corticosteroids to decrease inflammation in nerve tissue and to shorten the extent of flare-ups. Extended use of these medications, nevertheless, may cause side effects, such as osteoporosis and high blood pressure (hypertension), and the advantage of long-term treatment in multiple sclerosis isn't recognized.
Muscle relaxants. Baclofen (Lioresal) and tizanidine (Zanaflex) are oral treatments for muscle spasticity . Baclofen may briefly intensify weakness in the legs. Tizanidine controls muscle spasms without causing the legs to feel weak, but can be related with drowsiness or a dry mouth.

Medications to reduce fatigue. To help resist exhaustion, the doctor may recommend an antidepressant medication, the antiviral drug amantadine (Symmetrel) or a medication for narcolepsy called modafinil (Provigil). All drugs prescribed for this reason appear to work because of their stimulant properties.
Other medications. Many medications are used for the muscle stiffness, depression, pain and bladder control problems related with multiple sclerosis. Drugs for arthritis and medications that repress the immune system may slow down MS in some cases.

Multiple Myeloma of Thoracic Spine

Multiple Myeloma of Thoracic Spine

Multiple myeloma is a malignancy of the plasma cells. Plasma cells are a type of white blood cell present in the bone marrow.
In multiple myeloma, a collection of abnormal plasma cells (myeloma cells) increase, elevating the amount of plasma cells to a more than normal level. The outcome can be erosion of the bones. The disease also obstructs the function of the bone marrow and immune system, which can lead to anemia and infection. Multiple myeloma may also cause kidney problems.
The disease is called multiple myeloma because myeloma cells can occur in numerous bone marrow locations in the body.

Signs and symptoms
Even though multiple myeloma may not cause symptoms early in the disease, it's probable that signs and symptoms will appear as the disease develops.
Signs and symptoms of the disease can differ from person to person. Common multiple myeloma symptoms include:
Bone pain.
Presence of abnormal proteins — which can be created by myeloma, cells — in the blood or urine. These proteins — which are antibodies or parts of antibodies — are called monoclonal, or M, proteins. Frequently revealed through a routine exam, monoclonal proteins may indicate multiple myeloma, but also can indicate other conditions.
High level of calcium in the blood. This can occur when calcium from affected bones dissolves into the blood.
If there is high calcium level in the blood, the signs and symptoms are:
Excessive thirst and urination
Constipation
Nausea
Loss of appetite
Mental confusion
Anemia can occur as myeloma cells restore oxygen-carrying red blood cells in the bone marrow, which may lead to an additional frequent symptom — fatigue.
Other signs and symptoms of multiple myeloma may include:
Bone pain, mainly in the back or ribs
Unexplained bone fractures
Recurring infections — such as pneumonia, bladder or kidney infection, or sinusitis
Weight loss
Weakness or numbness in the legs

Causes
Though the exact cause isn't identified, physicians do know that multiple myeloma begins with one abnormal plasma cell in the bone marrow — the spongy, blood-producing tissue that fills in the middle of most of the bones. This abnormal cell then begins to increase.
Because abnormal cells don't mature and then die as normal cells do, they accumulate, finally overpowering the production of healthy cells. Healthy bone marrow consists of a minute amount of plasma cells, fewer than 5 percent. However in people with multiple myeloma, the number of plasma cells often increases to more than 10 percent.
Because myeloma cells may flow in low numbers in the blood, they can inhabit other bone marrow locations in the body, even distant from where they began. Uncontrolled plasma cell development can harm bones and surrounding tissue. It can also hinder with the immune system's capability to fight infections by reducing the body's production of normal antibodies.

Risk factors
Multiple myeloma isn't contagious. Most people who develop multiple myeloma have no obvious identifiable risk factors for the disease.
Some factors that may increase the risk of multiple myeloma include:
Age. The majority of people who acquire multiple myeloma are older than 50, with most diagnosed around age 70. Few cases occur in people younger than 40.
Sex. Men are more likely to develop the disease than are women.
Race. Blacks are about twice as likely to develop multiple myeloma, as are whites.
History of a monoclonal gammopathy of uncertain importance. Every year 1 percent of the people with MGUS in the United States acquire multiple myeloma. MGUS is more frequent in adults over age 50. This condition, like multiple myeloma, is marked by the presence of M proteins — created by abnormal plasma cells — in the blood. However, in MGUS, the quantity of the abnormal proteins isn't high enough to cause damage, and no injury to the bones occurs.
Obesity. The risk of multiple myeloma is increased if you're overweight or obese.
Other factors that may increase your risk of developing multiple myeloma include exposure to radiation and working in petroleum-related industries.

Screening and diagnosis
The doctor may initially discover signs of multiple myeloma before there are symptoms — through blood and urine examinations conducted through a routine physical exam. If there are no symptoms, these lab tests may be repeated every few months so that the physician can follow whether the disease is progressing and establish the best time to begin treatment.
Blood and urine tests A blood test called serum protein electrophoresis separates the blood proteins and can detect the presence of M proteins, called an "M spike," in the blood. Parts of M proteins may also be detected in a test of the urine — when found in urine; they're referred to as Bence Jones proteins.
If the doctor discovers M proteins, there is a need for additional blood tests to determine blood cell counts and levels of calcium, uric acid, and creatinine. The physician may also order other blood tests to check for beta2-microglobulin — another protein produced by myeloma cells — or to assess the percent of plasma cells in your bone marrow.
Other tests needed They may include:
Imaging. X-rays of the skeleton can demonstrate whether the bones have any thinned-out regions, common in multiple myeloma. If a closer view of your bones is needed, the doctor may use magnetic resonance imaging (MRI) or computerized tomography (CT) scanning.
Bone marrow examination. The doctor may also order a bone marrow examination by using a needle to remove a tiny sample of bone marrow tissue. The sample is then examined below a microscope to test for myeloma cells.
Staging and classification These tests can help verify whether this is multiple myeloma or another condition. If tests indicate this is multiple myeloma, the outcome from these tests permit the doctor to categorize the disease as stage 1, stage 2, or stage 3. People with stage 3 myeloma are more likely to have one or more signs of progressive disease, including larger numbers of myeloma cells and kidney failure.

Complications
Multiple myeloma can result in several complications:
Impaired immunity. Myeloma cells hinder the manufacture of antibodies required for normal immunity. Having multiple myeloma may cause more infections, such as pneumonia, sinusitis, bladder, or kidney infection, skin infections and shingles.
Bone problems. Multiple myeloma also can affect the bones, leading to erosion of bone mass and fractures. The condition may cause compression of your spinal cord. Signs of this medical emergency include weakness, or even paralysis, in the legs.
Impaired kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure. Higher calcium levels in the blood associated to eroding bones can obstruct the kidneys' capability to filter the blood's waste. The proteins created by the myeloma cells can cause related problems, particularly if dehydrated.
Anemia. As cancerous cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.

Treatment
Normally, for multiple myeloma if there are no symptoms, there is no need for treatment. Though, the doctors will probably monitor the condition at variable periods, checking for signs — such as rising levels of M protein in the blood or urine — that indicate the disease is progressing. If it is, treatment may be needed to help avoid symptoms. In people diagnosed with asymptomatic multiple myeloma, the risk of developing symptoms is about 10 percent a year for the first five years after knowledge of the disease.
For the symptoms, treatment can help ease pain, manage complications of the disease, stabilize the condition, and slow down the development of the disease.

Standard treatments for myeloma

Although there's no cure for multiple myeloma, with good treatment consequences most patients typically return to near-normal activity. The appropriate multiple myeloma treatment depends on the needs, medical status, and general health of the patient. They also may desire to consider accepted clinical trials as an alternative.
Standard treatment options include:
Chemotherapy. Chemotherapy involves using medicines — taken orally as a pill or given through an intravenous (IV) injection — to destroy myeloma cells. Chemotherapy is frequently given in cycles over a period of months, followed by a rest period. Regularly chemotherapy is terminated through what is called a plateau phase or remission, through which the M protein level remains steady. There may be a need for chemotherapy again if the M protein level starts to increase. Common chemotherapy drugs used to treat myeloma are melphalan (Alkeran), cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil).
Corticosteroids. Corticosteroids such as prednisone and dexamethasone (Decadron) have been used for decades to treat multiple myeloma. They are normally given as pills. Some research recommends that high doses of steroids may not be required, and that lower doses may be safer and more effective.

Stem cell transplantation. This treatment involves using high-dose chemotherapy — typically high doses of melphalan — along with transfusion of previously collected undeveloped blood cells (stem cells) to substitute diseased or damaged marrow. The stem cells can come from you or from a donor, and they may be from either blood or bone marrow. Factors such as the risk of your disease progressing, the patient’s age and their general health play a part in determining whether stem cell transplantation may be right for them.
Thalidomide (Thalomid). Thalidomide, a drug originally used as a sedative and to treat morning sickness in the 1950s, was removed from the market after it was established to cause severe birth defects. Nevertheless, the drug received approval from the Food and Drug Administration (FDA) again in 1998, first as a treatment for skin lesions caused by leprosy. Thalidomide is currently FDA-approved in combination with the corticosteroid called dexamethasone for the treatment of recently diagnosed cases of multiple myeloma. This drug is given orally. This is used for candidates for stem cell transplantation for their initial therapy.

Bortezomib (Velcade). Velcade was the first accepted drug in the latest class of medications called proteasome inhibitors. It is given intravenously. It works by blocking the action of proteasomes, which causes cancer cells to die. One study demonstrates that bortezomib had more than twice the response rate of a frequently used drug, dexamethasone. The FDA for use in a treatment approves Bortezomib for people with multiple myeloma who have received at least one previous treatment.
Lenalidomide (Revlimid). Lenalidomide is chemically comparable to thalidomide, but appears to be more powerful and cause fewer side effects. It is given orally. Lenalidomide is FDA-approved for use in combination with dexamethasone as a treatment for people who have received at least one earlier treatment for multiple myeloma. This is commonly used on patients initially considered for stem cell transplantation.
Radiation therapy. This treatment uses high-energy penetrating waves to damage myeloma cells and prevent their development. Radiation therapy may be used to target myeloma cells in a particular area — for example, to more rapidly minimize a tumor that's causing pain or destroying a bone.

Treating complications

Because multiple myeloma can cause a number of complications, you may also need treatment for those particular conditions. For example:
Back pain. Taking pain medication or wearing a back brace can help ease the back pain with multiple myeloma.
Kidney complications. People with severe kidney damage may need dialysis.
Infections. Antibiotics may be needed to help treat infections or to help decrease the risk of them.
Bone loss. Medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), which attach to the surface of the bones and help stop bone loss. Treatment with these drugs is related to the risk of damage to the jawbone. If taking these medications, don't have dental procedures done without conferring with the doctor first.
Anemia. If there is constant anemia, the physician may prescribe erythropoietin injections. Erythropoietin is a naturally occurring hormone made in the kidneys that stimulates the manufacture of red blood cells. Research suggests that the use of erythropoietin may increase the risk of blood clots in some people with myeloma.

Information from mayoclinic.com