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Baclofen The Dependable Skeletal Muscle Relaxant For Ms Patients

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Baclofen: The Dependable Skeletal Muscle Relaxant for MS Patients


Multiple Sclerosis (MS) affects approximately 250,000 to 350,000 people in the United States. This estimate suggests that approximately 200 new cases are diagnosed each week with this disease. This degenerative (marked by gradual deterioration of organs and cells along with loss of function) disease affects more women than men, and most people show the first signs between the ages 20 to 40 years old. It is chronic and potentially incapacitating.

Multiple Sclerosis (MS) affects the central nervous system or the brain and spinal cord areas in the body. Believed to be an autoimmune disorder, MS is a condition where the patient’s immune system produces antibodies against their own body. These antibodies and WBCs (white blood corpuscles) are then directed against proteins in the “myelin” sheath. The myelin sheath is made up of fatty substances that protect the nerve fibers in the spinal cord and brain. This attack usually results in injury and swelling to the myelin sheath and ultimately to the surrounding nerves. The injury leads to scarring or sclerosis in multiple areas of the central immune system, thus damaging the nerve signals and control muscle coordination. The disease also eventually impairs vision and muscular strength.

The nature of MS is unpredictable and it can vary in severity from person to person. While some patients who suffer from the said disease only experience mild illness, other MS cases can also lead to permanent disability. Treatments for MS can help in modifying the course of this illness while relieving symptoms.
Determining the real cause of MS still remains elusive even if scientists have already learned a great deal about MS in recent years. It is known that MS is a form of autoimmune disease --- one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger such as a virus infection.

Pain and spasticity are two of the most common symptoms from which people with MS suffer. Spasticity is a muscle problem characterized by tight or stiff muscles that may interfere with voluntary muscle movements. Spasticity is a muscle problem characterized by tight or stiff muscles that may interfere with voluntary muscle movements. A recent survey of members by the MS Society found that 54% reported pain as a current symptom, while 74% reported experiencing spasticity. The importance of these symptoms is not simply because of their frequency, but also because of the impact they have on the patient's daily life. As the disease progresses, so does the spasticity, resulting in muscle spasms, immobility, disturbed sleep, and pain. Disability resulting from spasticity often forces patients to need extensive nursing care.

Pain can be caused by a variety of factors including spasticity itself, in addition to neuronal damage due to the disease process. Not uncommonly, it may be musculoskeletal in origin, arising as a result of abnormal posture following the disability caused by MS.

There are several treatment options for MS. However, one medication that was commonly cited by different and numerous research is called Baclofen. This medication can help decrease the spasticity of MS patients. Baclofen is a muscle relaxant commonly used to decrease spasticity related to spinal cord injuries, or other neurological diseases such as MS.

Spasticity is caused by an imbalance of electrical signals coming from the spinal cord through the nerves to the muscle. This imbalance causes the muscle to become hyperactive, resulting in involuntary spasms. Baclofen works by restoring the normal balance and reducing muscle hyperactivity. In this way, it allows for more normal muscle movements.

Baclofen, also known under the brand name Lioresal, can be taken as a pill or delivered directly into the intrathecal space, an area in the spine. The space contains the cerebrospinal fluid (CSF) which surrounds the spinal cord and nerve roots. Most often, MS patients receive intrathecal baclofen, since oral Baclofen can cause unpleasant side effects. Since the medication does not circulate throughout the body, only tiny doses are required to be effective, therefore the side effects are minimal. Through intrathecal Baclofen it will deliver the right drug right to the target spot in the spinal cord.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision the MS patient and the doctor will make. Skeletal muscle relaxants such as Baclofen are used to relax certain muscles in the body and relieve the stiffness, pain, and discomfort for MS patients. However, these medicines do not take the place of rest, exercise or physical therapy, or other treatment that a doctor may recommend.


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BONUS : Balancing Hope And Reality To Plan A Dignified Death

Dealing with the end of life and the decisions that accompany it bring critical challenges for everyone involved-patients, families, friends and physicians. In fact, "managing" the progression toward death, particularly when a dire diagnosis has been made, can be a highly complex process. Each person involved is often challenged in a different way.

Communication is the first objective, and it should start with the physicians. In their role, physicians are often tasked to bridge the chasm between lifesaving and life-enhancing care; thus, they often struggle to balance hopefulness with truthfulness. Determining "how much information," "within what space of time" and "with what degree of directness for this particular patient" requires a skillful commitment that matures with age and experience.

A physician's guidance must be highly personalized and must consider prognosis, the risks and benefits of various interventions, the patient's symptom burden, the timeline ahead, the age and stage of life of the patient, and the quality of the patient's support system.

At the same time, it's common for the patient and his or her loved ones to narrowly focus on life preservation, especially when a diagnosis is first made. They must also deal with shock, which can give way to a complex analysis that often intersects with guilt, regret and anger. Fear must be managed and channeled. This stage of confusion can last some time, but a sharp decline, results of diagnostic studies, or an internal awareness usually signals a transition and leads patients and loved ones to finally recognize and understand that death is approaching.

Once acceptance arrives, end-of-life decision-making naturally follows. Ongoing denial that death is approaching only compresses the timeline for these decisions, adds anxiety, and undermines the sense of control over one's own destiny.

With acceptance, the ultimate objectives become quality of life and comfort for the remainder of days, weeks or months. Physicians, hospice, family and other caregivers can focus on assessing the patient's physical symptoms, psychological and spiritual needs, and defining end-of-life goals. How important might it be for a patient to attend a granddaughter's wedding or see one last Christmas, and are these realistic goals to pursue?

In order to plan a death with dignity, we need to acknowledge death as a part of life-an experience to be embraced rather than ignored when the time comes. Will you be ready?

Mike Magee, M.D., is a Senior Fellow in the Humanities to the World Medical Association, director of the Pfizer Medical Humanities Initiative, and host of the weekly Web cast "Health Politics with Dr. Mike Magee."
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