Talk:Multiple sclerosis

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Featured article star Multiple sclerosis is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do.
Main Page trophy This article appeared on Wikipedia's Main Page as Today's featured article on November 18, 2005.

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Contents

[edit] Template

I have created a template with the pages related to the multiple sclerosis topic. I propose to put it in all the pages that are directly related to this page (To all pages that have a "see main article..." and to the pages of the borderline forms of multiple sclerosis. Anybody disagrees? --Garrondo 17:28, 3 May 2007 (UTC)

[edit] Schilder's disease

I have created an article in schilder's disease (a borderline form of multiple sclerosis.--Garrondo 11:39, 5 May 2007 (UTC)


[edit] Protected Page

I have an article I would like to suggest as an external link since I do not have permission to edit this page.

"Biology of Demyelinating Disease", a lecture given by Saud Sadiq MD (director of New York MS Research Center New York) on March 11, 2006 at the Columbia University College of Physicians and Surgeons 29th Annual Postgraduate Review Course in Basic and Clinical Nuerosciences.

PDF hosted on on Dr Saud's center's server- http://www.msrcny.org/pdfs/Biology_of_Demy_summary.pdf

3rd party version of speech on University of Columbia server - http://neuroscienceupdate.cumc.columbia.edu/popups/transcript_sadiq.html

Hope someone can post this, he's a leading researcher in the field and good reading. Thanks. (67.82.232.151 21:04, 14 May 2007 (UTC))

Added to the "further reading section". --Garrondo 09:27, 15 May 2007 (UTC)

[edit] I have created an archive

There was too much information in the talk page. I have created an archive with it. The link is at the top of the page. I hope nobody minds --Garrondo 17:37, 17 May 2007 (UTC)

[edit] Multiple sclerosis project

First I want to say that right now I think the MS article is a relly good one and I want to congratulate every one who has collaborated in it.

A proof of this is the related articles that have been created such as the MS treatments or the MS signs and symptoms. All these articles took me to create the MS template a month ago so the traffic between these articles was eased. I think that this template gives all these pages a coherence and creates something like a MS project.

On the other hand I believe that is not worth the effort to create a MS project page since there is not a lot of people writting in these articles; and at the same time this MS discussion page can become the meeting-point for all of us who are interested in improving the MS information in wikipedia.

Therefore this message is a call for all those who want to help in this task as well as list of things we can do since there is still a lot of work to do; specially in the secondary pages recently created.

I'm going to writte some of the improvements I think that can be done. Anybody can add new improvements or if he decides to improve one of them say it in a new comment so the work is divided.

[edit] Possible improvements in the MS-related articles

  • Multiple sclerosis article
    • Schumacher criteria and Poser criteria: Since both of them appear in red somebody can look for them and maybe create an article with the 3 criteria (Present criteria: McDonald; past criteria:Schumacher and Poser)
    • History of multiple sclerosis: I think this part could be ampliated and even an article of its own created. If somebody reads spanish there is an article on this topic in www.neurologia.com. (register is free) with the title "aspectos historicos de la esclerosis multiple"
  • Signs and symptoms article:The following paragraphs could be added
    • Fatigue
    • Sensitive symptoms: Hypoesthesia and pain
    • limb symptoms: weakness
    • Dysarthria and dysphagia
    • Diplopia
    • Bowel difficulties
  • pathophysiology of MS
    • This article needs peer-review from an expert.


[edit] Wikipedians who want to help in the MS-related articles

Sign here all of you who want to help

  • garrondo

Thedjatclubrock :)

[edit] Contradiction

The sentence: "Secondary progressive is the most common type of MS and causes the greatest amount of disability." is at odds with the associated picture which says that progressive-relapsing is the most disabling MS subtype. --Seans Potato Business 16:48, 23 July 2007 (UTC)

The statements are not necessarily contradictory. 'The greatest amount of disability' can refer to numbers affected, while 'most disabling' can refer to effect of the disease within an individual. If that is the distinction intended, of course, it should be made more clear. —Preceding unsigned comment added by 75.165.32.49 (talk) 12:57, 19 September 2007 (UTC)

[edit] Genes

http://content.nejm.org/cgi/content/full/NEJMoa073493 - hot off the press, some genetic risk factors, including HLA-DR, and interleukin 2 and 7 signalling. JFW | T@lk 08:53, 30 July 2007 (UTC)

doi:10.1016/S0140-6736(07)61194-5 Lancet study suggesting we now give interferon after the first demyelinating event. JFW | T@lk 07:28, 7 August 2007 (UTC)

I have added the SNP study, but could not get into the Lancet website and will therefore integrate those results later. Obviously, they are going to be controversial. Are we going to treat every demyelinating episode as MS - there are labelling issues, cost issues, etc etc. JFW | T@lk 18:43, 13 August 2007 (UTC)

[edit] DNA vaccine against multiple sclerosis

Based on these results, a phase 2b trial�a randomized clinical trial in approximately 290 patients�of BHT-3009 is already under way. �If successful in MS, antigen-specific DNA vaccines can be developed for prevention or treatment of related diseases, such as type 1 diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis and myasthenia gravis,� the authors conclude. [1] [2] Brian Pearson 14:12, 14 August 2007 (UTC)

[edit] The missing link: Bacterial infections.

Many Lyme patients were firstly diagnosed with other illnesses such as Juvenile Arthritis, Rheumatoid Arthritis, Reactive Arthritis, Infectious Arthritis, Osteoarthritis, Fibromyalgia, Raynaud's Syndrome, Chronic Fatigue Syndrome, Interstitial Cystis, Gastroesophageal Reflux Disease, Fifth Disease, Multiple Sclerosis, scleroderma, lupus, early ALS, early Alzheimers Disease, crohn's disease, ménières syndrome, reynaud's syndrome, sjogren's syndrome, irritable bowel syndrome, colitis, prostatitis, psychiatric disorders (bipolar, depression, etc.), encephalitis, sleep disorders, thyroid disease and various other illnesses. see

Source: Canadian Lymes Association

This material may apply to a variety of illnesses. Like my research has suggested the testing for this one possible cause is difficult, and if overlooked then the patient has very little chance of cure.

--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 03:43, 1 September 2007 (UTC)

[edit] Therapies for multiple sclerosis good article candidate

I have nominated the article as a good article candidate. I would be thankful to anybody who who helped in the good article review (See: Wikipedia:Good article candidates If you have not contributed significantly to this article, feel free to evaluate it according to the good article criteria and then pass or fail the article as outlined on the candidates page. --Garrondo 13:27, 5 September 2007 (UTC)

Therapies for multiple sclerosis is alredy a Good article. If will try to iprove it with everybodies help and nominate it to featured article--Garrondo 09:03, 19 September 2007 (UTC)

[edit] More info

Hi I am a sixth grader at Kennett Middle School and my reading class is reasearching disabilities. I am doing my report on Multiple Sclerosis. This topic interests me VERY much and i was wondering if you could give anymore info that i maybe don't have. Thank You.

visit our website at www.kcsd.org —Preceding unsigned comment added by 204.108.230.104 (talk) 14:09, 10 October 2007 (UTC)

[edit] A simple eye scan, window to multiple sclerosis

Johns Hopkins neurologist Peter Calabresi, M.D., lead author of the study, which appears in the October 2007 issue of Neurology. “MRI is an imperfect tool that measures the result of many types of tissue loss rather than specifically nerve damage itself. With OCT we can see exactly how healthy these nerves are, potentially in advance of other symptoms.” [3] Brian Pearson 04:57, 16 October 2007 (UTC)

[edit] no mention of TCH as a treatment?

could the info in this article be relevant? 129.12.234.250 18:56, 16 October 2007 (UTC)

Only approved treatments in main article. In the Therapies for multiple sclerosis article cannabis appears with different citations in the alternative treatments section. Garrondo 08:12, 17 October 2007 (UTC)

[edit] What a wonderful article

A recent, (happily resolved but a bit frightening) health scare had me turning to this article for information. While obviously no one should rely on the internet for "medical advice" this even-handed, informative, challenging-but-still-accessible article was by far the shortest path I found on the web to well-sourced information about MS. Good work by all! Articles like this remind me of why Wikipedia is so awesome. Dina 17:15, 19 October 2007 (UTC)

That's why it's a featured article. JFW | T@lk 14:17, 26 October 2007 (UTC)

[edit] Therapies for multiple sclerosis nominated for FA

I have nominated the article for featured article after working on it after it become a GA. If it gests the rank it will be the second article on a multiple sclerosis topic to be a FA (hopefully it will not be the last). If anybody thinks the article is good enough please vote for it. Any comments for improvement will also be welcomed.Garrondo 13:56, 25 October 2007 (UTC)

[edit] Ribbon symbolism

I think that if large organisations choose an awareness ribbon for a disease, we should probably mention that in the article, much like the breast cancer and HIV/AIDS ribbons. JFW | T@lk 08:33, 21 November 2007 (UTC)

Garrondo (talk · contribs) seems to disagree.[4] Let's discuss this. JFW | T@lk 10:07, 21 November 2007 (UTC)
Firstly I have doubts that information on organisations that work for MS really fit in an article about the disease... The article is about the disease, and I´m not sure that the colour of the ribbon is a necessary or useful information to understand multiple sclerosis. A second concern is that the organisation mentioned is not international but a national organisation and therefore does have to represent worlwide movements. Nevertheless I would like to hear other editors. If people feel its important its fine for me to leave it; but even then I think it should be rewritten so as not to occupy more than two or three lines and have an encyclopedic style. --Garrondo (talk) 11:07, 21 November 2007 (UTC)

If this is a stunt by one smaller organisation I agree the ribbon doesn't need to be mentioned. JFW | T@lk 19:56, 24 November 2007 (UTC)


Magickpumpkin (talk) 02:02, 25 November 2007 (UTC) I'm the one who added the ribbon info for MS. I had no idea it would cause such a problem with you. I do not work for or necessarily support any specific MS organization. I AM SOMEONE WHO HAS BEEN CRIPPLED BY THE DISEASE. I just thought that someone looking up multiple sclerosis here on Wikipedia might like to know about the ribbons and how they can show their support for those suffering with the disease. Having the disease (and not just talking about it) makes me want to make sure that the human aspect is not forgotten and is presented along with the "cold hard encyclopedic facts". This was my first and (after this experience) probably my last Wikipedia contribution. Those of you who feel you "own" the Wikipedia MS page can add the info back or not, and since you do this all the time I'm sure you will do a better job at it than me. It would be nice to see them mentioned. Magickpumpkin (talk) 02:02, 25 November 2007 (UTC)

Hey... try to calm down: We all see that it was a good faith edit and what you have seen is a common discussion for consensus in wikipedia. This shouldn´t make you leave wikipedia, since I am sure you have a lot to offer to wikipedia articles. Have you thought for example on writting an article on MS movement around the world...? The fact that some of us don`t think it should be in the main MS page doen´t mean we think is not a valuable contribution. Have you seen for example if that information is in the association article that propossed the ribbon (See multiple sclerosis organizations). I am sorry if you felt attacked by me or others since I´m sure it was nobody intentions. Secondly I want to assure you that nobody owns the article, there are simply some people that have put more interest in it than other people and it has been these people as me the ones that have given their opionion if they feel the info is suitable for the article. Most of us have made several contributions that have also been reverted and after a discussion some of them are in the article and some others are not: this is how wikipedia works, by consensus. Thirdly I want you to know that you are not the only editor with the disease, there are editors that also have it and even some of them have also stated that it´s not the place for that information. Of course most editors that have contributed to this article do not have MS, but many of us is not that we simply talk about it, as you say, but we are also related to it in real life in different way. Some of us work with MS patients (I´m a psychologist who investigates cognition in MS; but there are also doctors, neurologists...), other have close relatives... I hope to see you soon around. --Garrondo (talk) 10:32, 25 November 2007 (UTC)

IN SUPPORT OF MAGICKPUMPKIN: Please pay more attention to MAGICKPUMPKIN comments. MS is a disease and not only a research subject. Neurologists are usually very research-oriented and do not always understand the dimension of the patient in the way a traditional doctor does. Sometimes I wonder if they are (hippocratic oath's) doctors at all!! I understand that neurology is a fertile field for research and that is why it attracts so many research-oriented doctors. But this is a very heavy issue for most neuro patients. What's more, the MAIN features of MS as a disease from a patient's viewpoint (like the uncertainty of not knowing how it is going to evolve) are not actually approached in this article, that focuses on MS as a biological phenomenon. I am NOT crazy for this article. —Preceding unsigned comment added by 200.126.210.169 (talk) 03:15, 29 January 2008 (UTC)

[edit] MS Therapies

That is because doctors who treat MS usually treat MS with medication. If you have evidence that other modalities are equally or more effective, please provide it. JFW | T@lk 19:56, 24 November 2007 (UTC)

One thing is true: even if there is a secondary article on therapies the part on the main article should treat all the aspects of the secondary article and not only disease-modifying treatments. What I propose is to rewritte the full section as a complete summary of the secondary article. However it will not be easy to summarise all that information. --Garrondo (talk) 09:11, 29 November 2007 (UTC)

[edit] Intro

Recent edits have blown the intro completely out of proportion. We need to be more selective with the amount of information in it. I dispute, for example, the need to mention Uhthoff's phenomenon so prominently. JFW | T@lk 19:56, 24 November 2007 (UTC)

There has been a lot of movement in the article the past few days, and many changes have been made. The introduction has become way too long and there has been also some concerns on the NPOV of the article. I think is the moment for all of us interested in the article to coordinate and review at least the introduction and the therapies part. I think that no big edits should be done at the moment without reaching a consensus here first and also each one of us should state their oppinions on the article... If people is interested I´ll do so in the following days. Regards to everybody. --Garrondo (talk) 15:45, 25 November 2007 (UTC)
I agree too. In fact, I think it was already huge before the changes. Let's say now. I do not have too much time to write anything, but I just want to support hereby all your efforts trying to reduce the introduction.--Juansempere (talk) 19:02, 26 November 2007 (UTC)
I have tried to summarised all contents of the article while simplifying the lead. --Garrondo (talk) 11:59, 5 December 2007 (UTC)

[edit] Cochrane reviews on MS therapies

The links below from the Cochrane Library. The conclusions are that none of the pharmaceutical treatments have been proved to have long-term effect. Glatiramer acetate not shown to have any effect. Only rehab is without side-effects. Mitoxantrone is very toxic. The text is quoted from the headline (hopefully w/o breaching copyright).

It would be good if the article reflected these findings.

Therapy with glatiramer acetate for multiple sclerosis

"[No] definite evidence that glatiramer acetate can prevent relapses or slow progression of the disease"

Interferon in relapsing-remitting multiple sclerosis

"Interferons can help to reduce disability and attacks for people with multiple sclerosis ... not enough evidence about their usefulness in the long term."

Mitoxantrone for multiple sclerosis

"[Mitoxantrone] was moderately effective in the short-term treatment of MS ... little information on the long term effects of MX"

Multidisciplinary rehabilitation for adults with multiple sclerosis

"Strong evidence that inpatient rehabilitation can lead to improvement in activity (disability) and [] ability to participate in society ... no reduction in actual impairment."

Laetoli (talk) 03:58, 27 November 2007 (UTC)

I have taken a look to the articles provided and I have added the references on drugs to therapies subarticle and my main article proposal on therapies. The don´t change substantially what is alredy in article but I have added the following info: effects are modest and there is little info on long term effects of treatments. I have also added a more recent ref on a review on glatiramer which shows that it has some effect since it was this one the most critized by the Cochrane review. --Garrondo 16:43, 4 December 2007 (UTC)
I agree with Laetoli that the conclusions of these scientifically-based and widely-accepted Cochrane reviews get some prominence. All the more so as MS varies widely in severity, and the very modest benefits (if any are achieved) of glatiramer acetate and interferons need to be weighed against the drudgery and cost of weekly or even daily injections.io-io (talk) 01:02, 26 January 2008 (UTC)

[edit] Treatment for an attack (suggested edit)

I suggest the following edit to replace the section "Treatment for an attack". I've separated plasmapheresis from corticosteroids as might be confused. Also added side effects + references. Hypertension sx and plasmapheresis rx need refs - can only find FDA, Aetna & MSSoc refs eg. http://www.aetna.com/cpb/medical/data/200_299/0264.html - are these acceptable citations?

==>

Relapsing-remitting symptomatic attacks can be treated with high dose intravenous corticosteroids, such as methylprednisolone, to shorten their duration and severity[1]. Steroids have been shown to make no difference to the long-term course of the disease.[2] Potential side effects include osteoporosis[3], impaired memory[4] and high blood pressure (hypertension).

Plasma exchange (also known as plasmapheresis) can be used to treat acute relapses that do not to respond to steroid treatments.

<== Laetoli (talk) 16:22, 27 November 2007 (UTC)

I don´t think they are... but I´ll try to find some references in pubmed that go in that line. I have also added the side effects of steroids to the therapies subarticle and to my proposal of the therapies section on main article. Garrondo 16:38, 4 December 2007 (UTC)

[edit] Treatments

I have summarised the article on treatments and replaced the section of the main article. I think it improves what was in the article: Its longer and more complex but doesn´t leave out important sections of the secondary article as are sintomatic or alternative treatments. Feel free to edit it. I have also added references provided by laetoli. —Preceding unsigned comment added by Garrondo (talk • contribs) 16:35, 4 December 2007 (UTC)

[edit] Can we protect this?

I don't know if this has been discussed or not, but this page seems to receive a lot of vandalism. It seems to only be anonymous users who are vandalising it tho... can we get this protected so only register users can edit it? Darkage7 (talk) 02:29, 16 January 2008 (UTC)

[edit] Epidemiology

This section has a very poor diagram of the earth showing risk factors per country. The diagram itself is of poor resolution and some sectons of the key cannot be read at all. It requires replacing with a high quality up to date version

It also gives no information on Argentina, Chili, Mongolia, Madagascar and other countries coloured with "blank / white" and are scaled as "other risk factors". —Preceding unsigned comment added by 200.126.210.169 (talk) 22:37, 28 January 2008 (UTC)

[edit] lead

The lead should be no more than 4 paragraphs. I've tried simplifying the language and style, in accord with guidelines. Please see WP:Lead. Leadwind (talk) 21:50, 1 February 2008 (UTC)

[edit] formerly known as Encephalomyelitis Disseminata ?

I'm a layman, but I worked in a hospital for a month and everybody there referred to it as Encephalomyelitis Disseminata. That might be because they didn't always want to let the patients in on what they had, so that might be a weak argument. I did believe it was a still used term (I can't say if MS or ED is the more recent term). Anybody have an idea? Or maybe the "formerly known" was meant to only refer to "disseminated sclerosis" ? I did find a german page noting that doctors often refered to the illness as ED, but I'm not sure if thats valid as a source (and of course it refers to the german speaking community. Regards Sean Heron (talk) 07:15, 14 March 2008 (UTC)

[edit] Contradiction in Prognosis

The prognosis section, first paragraph described how life expectancy has improved to "nearly the same" as the healthy, yet the second citation is from 2005 and describes how 50% of MS patients die from its complications and fully 15% by suicide. It would seem that within the 50% there is a majority who die from organ failure bought upon by extreme cognitive impairment, similar to how Alzheimer's kills, but then the impairment in MS arrives much earlier. Therefore the conclusions conflict - anyone reconcile these 2 abstracts? ....io-io (talk) 23:18, 20 March 2008 (UTC)

This paper - http://www.ncbi.nlm.nih.gov/pubmed/11321195?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA - describing in excess of 5% mortality over just 15 years, would seem to also cast doubt on the nearly-equal life expectancy statement....io-io (talk) 23:31, 20 March 2008 (UTC)
There is not such controversy: In both of them state the same suicide rate, and people with MS do live similar number of years, however, they usually die from MS complications, but this usually happens at older ages, while in earlier years usual death causes are heart attacks or tumors, as in the rest of the population. Finally I have to point that there is no such "extreme cognitive impairment" bringing organ failure in MS. There are few cases of dementia in MS and even then is usually a frontal dementia, and still milder than in Alzheimer. --Garrondo (talk) 08:38, 21 March 2008 (UTC)
I was guessing about the organ failure because I cannot think exactly what MS "complications" they are dying from ? To me this is a very puzzling statistic, the 50% number is way higher than I thought it could be. Also, with a 15% suicide rate, this I would think would occur equally in younger years......in any case it is not clear what is meant by the conlusion about nearly-similar life-spans....perhaps you have access to the full papers?....io-io (talk) 16:14, 21 March 2008 (UTC)
Here is a recent study in a developed country showing that MS patients live an average 10 years shorter - this is large when you consider that 15% never even have a 2nd relapse.....although they also say the situation has improved - http://www.ncbi.nlm.nih.gov/pubmed/14960501....io-io (talk) 21:28, 21 March 2008 (UTC)
Probably de most dangerous MS complication is dysphagia (swallowing problems), and the infections it brings. Similarly problems related to inmobility are also common. I was reading your abstract, and probably due to my english, I'm not sure if I understood the following sentence: Thus, the 10-year excess mortality was almost halved in comparison with that in the middle of the 1900s. Does it mean that rigth now excess mortality is aproximately 5 years? If its so, then I would not change the article, since I don´t feel five years less is much differente of what it is alredy said (almost the same). --Garrondo (talk) 11:21, 22 March 2008 (UTC)
Yes, I read a UK treatment guide since. Patients also die from sepsis, triggered by the same causes, which is why I had referred to organ failure. To answer your question (personally, I wish I was fluent in 2 languages), the term 10-year "excess mortality" would not mean a 10-year shortening-of-life (if so, it would have been called "mean reduced lifespan"), but it should mean the surplus (as a number) or ratio (as a fraction or percentage) of deaths to controls (general population) measured over 2 different periods, each of 10 years duration, 1 measued in the 50s and 1 in the 90s probably. As to mortality, a 5yr-10yr average shortening is worse than prostate cancer or some of the leukemias, such as AML I think. I forget what the article says exactly, however, most of this effect is clearly in later years, as one of the papers we discussed did state....io-io (talk) 18:42, 22 March 2008 (UTC)
The RA page estimates a 5-10 year shortening by "most sources".io_editor (talk) 16:15, 6 April 2008 (UTC)

[edit] Disease modifying treatments

To me this is the only poor section or sub-section on the page, as it wanders between the 6 drugs, and then comes back to their names again (colored text, etc) for dosing, and then later again for safety, etc, all of which makes for difficult reading if you do not know what they are. Suggestions: list their awkward names (using bullets) followed immediately by dosing schedule etc, which would avoid drug name repetition; or, simply delete the safety comments as it is really beyond the scope. In either case, avoid repeating the drug name.io_editor (talk) 16:32, 6 April 2008 (UTC)

[edit] Comment

i was diagnosed with MS of the spine. in this article it only imply's you can get it in the brain. mine is located in my spine not my brain —Preceding unsigned comment added by Kriskip (talk • contribs)

First line of the lead: Multiple sclerosis is an autoimmune condition in which the immune system attacks the central nervous system (CNS): central nervous system is both brain and spinal cord.
Second paragraph of the lead: MS affects the areas of the brain and spinal cord known as the white matter.
I believe its clear enough that it affects both brain and spinal cord. --Garrondo (talk) 08:54, 11 June 2008 (UTC)