By F. Jaffar. University of Arkansas at Pine Bluff.
It is important anyway that some periodic monitoring of your MS is undertaken purchase 50 mg luvox fast delivery, to give you further information about likely developments in the disease purchase 50mg luvox with amex, and to assess your eligibility for newer drugs, or possibly trials of experimental drugs, that is if you wish to participate. In this case a neurological examination will determine, over the course of time, how many episodes of MS have occurred, how many individual areas of the nervous system have been affected, and the rate at which new areas are being affected. You may also have an MRI scan, which records similar information about changes in plaques, plaque location and severity, but which may, from your point of view, be little related to your symptoms. Your clinical history is also vital when your neurologist is dealing with any new episode of MS that occurs. Other support Many people with MS will need professional support services and assistance at some time, to manage the changes in their lifestyles, and to monitor effects of any new drugs. Depending on the precise nature of your MS and its effects, such services may include nursing, physiotherapy, occupational therapy, speech therapy, psychological assessment and support, counselling and advice on housing, employment, ﬁnancial and other similar issues (see later chapters). Such professional support services for all the many consequences of MS have not previously been adequate, in fact often woefully inadequate and ill coordinated. Despite serious ﬁnancial constraints, there are now many attempts underway locally to provide better coordinated services and support. MEDICAL MANAGEMENT OF MS 29 Rehabilitation ‘Rehabilitation’ is perhaps the new watchword of longer term care in MS. Regional Rehabilitation Units have been created in recent years for the support of people with many conditions, but there are also an increasing number of more specialist MS rehabilitation units or programmes. At present there are only a limited number of places available on these rehabilitation programmes, and there is a selection process involved, usually on the basis of who might be expected medically to get the most beneﬁt. During inpatient rehabilitation you would normally be in a hospital or rehabilitation centre as a patient for some weeks, depending on the programme, your MS and how you progress. In this time you might be offered: • regular assessment and monitoring of your condition • carefully targeted drug therapies as appropriate • intensive physiotherapy and occupational therapy • nursing care • possibly speech therapy, and • psychological and counselling support. Within a structured programme the aim will be to tailor aspects of this programme to your individual situation and needs. Following the time spent as a patient, you would probably have periodic further assessments to determine how you are progressing. Increasingly MS clinics are being opened in major centres providing support for more people with MS than is available on a lengthy inpatient basis.
Pain 47:231–239 Terenzi MG purchase luvox 100 mg overnight delivery, Rees H generic 50 mg luvox amex, Roberts MHT (1992) The pontine parabrachial region mediates some of the descending inhibitory effects of stimulating the anterior pretectal nucleus. Brain Res 594:205–214 Terenzi MG, Zagon A, Roberts MHT (1995) Efferent connections from the anterior pretectal nucleus to the diencephalon and mesencephalon in the rat. Brain Res 701:183–191 Thipeswamy T, Morris R (2001) Evidence that nitric oxide-induced synthesis of cGMP occurs in a paracrine but not an autocrine fashion and that the site of its release can be regulated: studies in dorsal root ganglia in vivo and in vitro. Nitric Oxide 5:105–115 Thipeswamy T, Morris R (2002) The roles of nitric oxide in dorsal root ganglion neurons. Ann N Y Acad Sci 962:103–110 Thomas PK, Lascelles G (1966) The pathology of diabetic neuropathy. Q J Med 35:489–509 Thompson SWN, Woolf CJ, Sivilotti LG (1993) Small caliber afferents produce a heterosy- naptic facilitation of the synaptic responses evoked by primary afferent A ﬁbers in the neonatal rat spinal cord in vitro. J Neurophysiol 69:2116–2128 Todd AJ (2002) Anatomy of primary afferents and projection neurones in the spinal dorsal hornwithparticularemphasisonsubstancePandtheneurokinin1receptor. ExpPhysiol 87:245–249 Todd AJ, Lewis SG (1986) The morphology of Golgi-stained neurons in lamina II of the rat spinal cord. J Anat 149:113–119 Todd AJ, Spike RC (1993) The localization of classical transmitters and neuropeptides within neurons in laminae I–III of the mammalian spinal dorsal horn. Prog Neurobiol 41:609–638 Todd AJ, Sullivan AC (1990) Light microscope study of the coexistence of GABA-like and glycine-like immunoreactivities in the spinal cord of the rat. J Comp Neurol 296:496–505 Todd AJ, Spike RC, Russel G, Johnston HM (1992) Immunohistochemical evidence that Met- enkephalin and GABA coexist in some neurons in rat dorsal horn. Brain Res 584:149–156 Todd AJ, Spike RC, Polgar E (1998) A quantitative study of neurons which express neu- rokinin 1 or somatostatin sst2a receptor in rat spinal dorsal horn. Neuroscience 85:459– 473 Todd AJ, McGill MM, Shehab SA (2000) Neurokinin 1 receptor expression by neurons in laminae I, III and IV of the rat spinal dorsal horn that project to the brainstem.