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Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Index

A


ABLEDATA, 206
Activities of daily living, 200, 201, 202, 205, 215
see also

Assistive technology
Acupuncture/acupressure, 410
Acute disseminated encephalomyelitis, 84, 85, 86
Acute MS, 30, 278, 395
see also

Relapses
Adrenocorticotropic hormone, 290
African Americans, 77, 79, 227, 340-341
Age factors, 17
see also

Children
brain and spinal cord atrophy, 35
children, disease processes, 29
disease process, 29
gender and, 77-78
geographic location and, 77
neuroplasticity, 250
pain, 161
quality of life, 195
Agency for Health Research and Quality, 343-344
AIDS, 87, 220-221, 308
Allergens, 405, 409
Allied health professionals, 11, 190, 362
see also

Exercise and physical therapy
Alpha-fetoprotein, 409-410
Alphasal, 409
Alprostadil, 159
Alternative medicine, 226-229, 405-412 (passim)
acupuncture/acupressure, 410
marijuana, 163, 228-229
Alzheimer's disease, 1, 5, 22, 118, 256, 269, 316, 328, 329, 330, 351
Amantadine, 119, 154
American Academy of Neurology, 47, 184
Americans with Disabilities Act, 188, 193
Amino acids, 82
autoimmune diseases other than MS, 69
baclofen, 132-133, 165, 289
beta-interferon, 49
GABA (gama-aminobutyric acid), 69, 132, 133, 134, 248, 288
glatiramer acetate, 20, 49, 50-52 (passim), 75, 82, 92, 277, 290, 298, 360, 361, 389
N-acetyl aspartate (NAA), 38, 39-40, 64
oligodendrocyte destruction, 350-351
Theiler's murine encephalomyelitis virus (TMEV), 97
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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AMPA/kainate receptors, 243, 244, 287, 290
Amputation, 247, 250
Amytrophic lateral sclerosis (ALS), 13, 14, 115, 330, 339, 365
treatment, 283, 285, 286, 287, 289, 300, 305, 366, 367
Anergix, 394
Animal models, ix , 84, 90-104, 396
bone marrow transplants, 296
brain, 96, 103
encephalomyelitis, 7, 43, 72-73, 84-86, 99;
see also

Experimental autoimmune encephalomyelitis (EAE)
demylenation, 7, 91-99 (passim), 102-103, 357
immune system, general, 7, 21, 48, 91, 97, 103
magnetic resonance imaging, 262
major histocompatibility complex (MHC), 91, 103
neurons, 6, 7, 95
remyelination, 243-244
research recommendations, 4, 6-7, 356-358
spasticity, 131
T cells, autoreactive, 251-252, 355
tolerance strategies, 21
transgenic, 91, 93, 97, 100-104, 280, 355, 356-357
transplantation, 292
viruses, 21, 91, 357-358
mouse hepatitis virus (MHV), 95, 98-100
Theiler's murine encephalomyelitis virus (TMEV), 48, 91, 92, 95-98, 99, 269, 357
Antegren, 294
Antibiotics, 407
Antibodies, 42, 68, 255, 349, 350, 394, 410
see also

Antigens;
Immunoglobulins;
Vaccines
autoantibodies, 66, 73, 74, 92, 93, 251, 255, 266, 355
neutralizing, beta-interferon, 51, 52, 97
T cells, antigen-specific, 60, 70, 93, 252-253, 254, 257-258, 260, 263-265, 279, 280, 354, 355, 397
Antigens, 60, 68, 263
see also

Major histocompatibility complex
astrocytes, 244-245, 350
autoantigens, 5-6, 7, 42, 44, 45, 50, 60, 66, 67, 71-74 (passim), 82, 88, 91, 93, 100, 244, 251-255, 257, 279, 280, 354, 355, 357, 398
superantigens, 67, 92, 93, 95, 254
cerebrospinal fluid (CSF), 42, 45
neutralizing antibodies, 51, 52, 97
Anxiety, 122, 123, 152, 200, 211, 217, 224
see also

Depression
side effects of treatment, 50, 125, 126, 127, 135, 388
treatment, 227, 229
Apoptosis, 7, 98, 243, 254, 255, 259, 269, 281, 284-285, 286, 287, 295, 351, 358-359, 392
Arthritis, 14, 44, 69, 122, 145, 152, 153, 297, 299, 328, 329, 337, 366
Asians, 48, 77, 79, 83, 85, 87
Assistive technology, ix , 199, 205-210, 385-386
catheterization, 143, 206
cognitive impairment, 119, 209
cost and cost-effectiveness, 205, 206, 207, 210
defined, 205
employment, 193, 207-208
environmental control technology, 206, 207
health screening, 222-223
insurance coverage, 206, 209, 222
wheelchairs, 128, 188, 199, 206-207, 209, 220, 222, 386
Astrocytes, 3, 4
antigens, 244-245, 350
biological features of MS, 45, 62, 64, 71, 87
blood-brain barrier, 257
cytokines, 257, 258, 259, 350
disease mechanism research, 241, 245, 253, 257, 258, 259, 267
glial scars, 3, 241, 350
inflammation, 258
research recommendations, 241, 244-245, 253, 257, 258, 259, 267, 349, 350
treatment, 282, 284, 286, 294
Asymptomatic MS, 6, 30, 35-36, 88, 115, 177
Ataxia and tremor, 128, 138-140, 163
assistive technologies, 209
employment and, 191
experimental autoimmune
encephalomyelitis (EAE) vs MS, 92
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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measurement, 201
patient perspectives, 188
relapses, 32
Social Security Administration disability criteria, 401, 402
treatment, 138-140
as side effect, 125, 135, 139
Atrophy, 35, 38, 39, 122, 278, 356
Attention, 118, 154, 200, 403
Autoantigens, 6, 66, 67, 71-74 (passim), 91, 93, 100, 251-255, 257, 279, 280, 354, 355, 357, 398
Autogenous vaccine, 409
Autoimmunity, see
Immune response
Autologous Blood and Marrow Transplant Registry of North America, 313, 314-315
Autopsies
asymptomatic MS, 30
axonal damage and demyelination, 64
brain banks, 316-318, 332, 339
tissue banks, other, 365
Avonex, see
Beta-interferon
Axons, 3, 7, 20
see also

Demyelination;
Myelin;
Remyelination;
Synapses
animal models, 95
atrophy, 35, 38, 39
autopsies, 64
degeneration, 58-59, 64, 92, 241-243, 244, 251, 266-267, 278, 280-281, 283, 291, 349, 350, 356
cognitive impairment, 118
electrical impulse conduction, 20, 56, 57, 58, 65, 242, 247, 255, 349, 350
inflammation, 242, 280-281
N-acetyl aspartate, 38, 39-40, 64
magnetic resonance imaging, 35, 38, 39-41, 241
pain, 163
physiology, 54-65, 246;
see also

“electrical...” supra
plasticity, 58, 65, 245, 246-247, 249-251, 291, 349
research recommendations, 65-70, 241-243, 244, 246-247, 249-251, 255, 266-267, 278, 349, 350
secondary progressive MS, 30
T1-weighted hypointense lesions, density measurements, 40
treatment, 243, 278, 280-281, 283, 288, 289, 291, 358
weakness, 136
Azathioprine, 390

B


B cells, 6, 395
animal models, 91
autoreactive/demyelinating, 6, 60, 68, 70, 71, 74, 93, 251, 253, 255, 355
cerebrospinal fluid (CSF), 42, 74, 265-266
cloning, 42, 93
biomarkers, 265-266
experimental autoimmune encephalomyelitis (EAE), 93
B lymphocytes, see
B cells
Back pain, 145, 160, 165
Baclofen, 132-133, 165, 289
Bacteria, 15, 67, 78, 283, 366
Barthel Index, 198, 200, 205, 215
Beck Depression Inventory, 121, 122
Bee venom, 408
Behavioral factors
see also

Functional status;
Patient perspectives
patient adherence to therapy, 51-52
measurement, 197
modification therapy, 123, 153
Social Security Administration disability criteria, 403
Bentyl, 144-145
Benzodiazapines, 133, 165
Beta-interferon, 35, 48-51, 60, 277, 284, 298, 307, 361, 392
animal studies, 92
Avonex/Rebif, 49, 50, 388, 396
Betaseron, 49, 51, 53, 388
cognitive impairment, 119
depression, 52, 123, 126-127
neutralizing antibodies, 51, 52, 97
side effects of, 49, 52, 123, 126-127, 388
Biological markers, 42, 44-45, 262-267, 308, 366-367
B cells, 265-266
cerebrospinal fluid (CSF), 30, 41-42
clinical studies, 261, 262
cytokine production, 259, 263-264
demyelination, 44, 45
disease subtypes, 261, 262-267
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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fatigue, 155
immune response, general, 42, 44, 45, 47, 263-266
oligoclonal bands, 42, 44, 46, 74, 87, 90, 164, 260, 266, 354
Biotechnology, 280, 289
see also

Stem cell therapy
private sector, 341-343
transgenic animals, 91, 93, 97, 100-104, 280, 355, 356-357
Black holes, see
T1-weighted hypointense lesions
Bladder and bowel dysfunction, ix, 124, 140-148
back pain, 165
catheterization, 143, 206
constipation, 125, 135, 140, 145, 146, 147, 154
diarrhea, 125, 135, 145, 154
measurement, 198, 199, 201, 202
relapses, 32, 34
research recommendations 143, 147
spasticity and, 142, 143, 144
treatment, 140, 142-145, 146-147, 400
as side effect, 135, 145, 154
Blood-brain barrier
clinical factors, 37, 38, 45
depression, 126
disease mechanisms, 60, 63, 67, 70, 75, 76, 245, 257-258, 263
imaging, 37, 38, 356
research recommendations, 18, 350
treatment, 278, 288
Bone marrow transplants, 294, 296-298, 313, 314, 339
see also

Stem cell therapy
Botox, 134-135
Botulism A toxin, 133, 134, 149
Bowel dysfunction, see
Bladder and bowel dysfunction
Brain, vii , ix , 26, 283-284, 285, 350, 409
see also

Alzheimer's disease;
Blood-brain barrier;
Brain stem;
Cerebellum;
Cerebral cortex;
Cerebrospinal fluid;
Cerebrum;
Imaging technology;
Parkinson's disease;
Thalamus
AMPA/kainate receptors, 243, 244, 287, 290
animal studies, 96, 103
encephalomyelitis, 7, 43, 72-73, 84-86, 99;
see also

Experimental autoimmune encephalomyelitis
asymptomatic MS, 35, 36
atrophy, 35, 38, 39, 122, 278, 356
banks, 316-318, 332, 339
depression, 122
employment and, 191
fatigue, 152-153, 155
hippocampus, 249, 293
laughing and crying, 119
N-acetyl aspartate, whole-brain, 39
optic neuritis, 148
self-repair mechanisms, 2, 26
spasticity, 129, 130
stroke, 115, 120-121, 130, 162, 200, 287, 291
surgery, 132, 134, 139-140, 147, 411, 412
T cells, brain-specific, 60, 70, 93, 252-253, 254, 257-258, 260-261, 263-265, 279, 280, 354, 355, 397
weakness, 130
Brain stem, 31, 34, 48, 201
evoked potentials, 47
lesions, general, 30
sexual dysfunction, 157
spasticity, 130
T1-weighted hypointense lesions, 40
weakness, 130
British Society of Rehabilitation Medicine, 217-218

C


Calcium, 45, 69, 134, 249, 253, 267, 288, 349, 407
Cambridge Multiple Sclerosis Basic Score, 202
Canaboids, see
Marijuana
Canada, 221, 339
CaP CURE, 13, 333, 339, 340, 345, 346, 365
Capsaicin, 144-145
Catheterization, 143, 206
Caucasians, 77, 82, 83-84
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Cellular processes, vii, 1, 3, 4, 241
see also

Astrocytes;
Axons;
B cells;
Cytokines;
Genetic factors;
Glia;
Immune response;
Inflammation;
Lesions;
Macrophages;
Myelin;
Neurons;
Oligodendrocytes;
Stem cell therapy;
T cells;
Transplantation
apoptosis, 7, 98, 243, 254, 255, 259, 269, 281, 284-285, 286, 287, 295, 351, 358-359, 392
endothelial cells, 245, 257, 258, 265, 287, 391
research recommendations, 3, 4, 6, 7-8, 348, 349, 356
Centers for Disease Control and Prevention, 367
Cephalon, 395
Cerebellum, 48, 201
ataxia and tremor, 128
biological markers, 30, 41-42
evoked potentials, 45
lesions, general, 30
relapses, 32, 34
spasticity, 130
T1-weighted hypointense lesions, 40
Cerebral cortex, 401
cognitive impairment, 119
depression, 122
evoked potentials, 47
neuropasticity, 247-249, 250
Cerebrospinal fluid (CSF), 41-42, 43, 44, 397, 401
B cells, 42, 74, 265-266
chlamydia, 90
clinically isolated syndromes, 30, 278
diagnosis, 30, 41-42
herpes virus, 89
oligoclonal bands, 42, 44, 46, 74, 87, 90, 164, 260, 266, 354
tissue banks, 215, 316
T cells, 252, 265
Cerebrum, 32, 401
magnetic resonance imaging, 115
symptoms due to abnormalities, 115
T1-weighted hypointense lesions, 40
Chelation therapy, 410
Chemokines, 62, 75, 76, 82, 83, 258, 264, 265, 266, 270, 350
Chemotherapy, 360
Children
disease process, 29
patient relations with, 187
Chinese medicine, traditional, 229, 410
Chlamydia, 90
2-Chlorodeoxyadenosine, 390
Cholorazone, 409
Ciliary neurotrophic factor, 45, 285
Cladribine, 395
Clinical studies and trials, 8-9, 30, 277-278, 298-312, 340-341, 393, 395, 396, 398
amytrophic lateral sclerosis (ALS), 283, 285, 289
animal studies vs , 90
ataxia and tremor, 138-140, 163
biological markers, 261, 262
bladder and bowel dysfunction, 143
cognitive impairment, 120
cost and cost-effectiveness, 8-9, 303-304, 365
databases, 261, 312-315, 339, 361
depression, 123-126, 127
disease subtypes, 261, 262
fatigue, 153, 155
functional status and quality of life, 194, 306
funding, 9, 50, 298, 300, 306, 310, 341
headache, 164
immunomodulatory agents, 48, 50-51, 52
individual patient care, 9-10
magnetic resonance imaging (MRI), 277, 278, 304, 306, 307, 308, 309-311
marijuana, 229
measurement instruments, 203, 204
neuroplasticity, 247-248
optic neuritis, 148-149, 247-248
outcome measures, 194, 195
pain, 160, 162, 163, 165-166
primary prophylasis, 277
progressive MS, altering, 278
racial/ethnic factors, 340-341
rehabilitation, 213, 214-216
relapse prevention, 277, 290-291
research recommendations, 4, 8-10, 24, 277-278, 352, 353, 359-361
standards, 20
stem cell therapy, 300-301
workshop agendas, 381
Clonazepam, 133, 134
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Cloning, 6, 93, 100, 356-357
B cells, 42, 93
T cells, 94, 252, 254, 264, 355
transgenic animals, 91, 93, 97, 100-104, 280, 355, 356-357
Cognitive impairment, 30, 115-120
assistive technologies, 119, 209
asymptomatic MS, 35
clinician attitudes toward, 116
depression and, 118, 122, 123
emotional impairment vs, 116, 119-120
employment, 115-116, 191, 404
functional MRI (fMRI), 41
language skills, 117, 118
laughing and crying, 118-119
memory, 116-117, 119, 122, 178, 200, 209
magnetization transfer imaging and, 40
measurement, 40, 117, 119, 120, 198-202 (passim), 204-205
rehabilitation, 212
relapses, 32
research recommendations, 119-120
Social Security Administration disability criteria, 402
treatment, 123
Communication, 191, 198, 201, 206, 216-221, 386
see also

Language skills;
Patient education
aids, 208-209
diagnosis, 12, 17, 179-180, 216-219
Internet, 12, 206, 208-209, 218, 221
physicians and other caregivers, 10, 25, 216-219, 223, 318, 363, 381
Computer applications
see also

Databases/registries
assistive technology, 208, 209
ataxia and tremor, 138
bladder dysfunction, 143
cognitive impairment, 119
general information dissemination, 12
Internet, 12, 206, 208-209, 218, 221
Confidentiality, 361
Constipation, 125, 135, 140, 145, 146, 147, 154
Coordination loss, see
Ataxia and tremor
Copaxone, see
Glatiramer acetate
Cost and cost-effectiveness factors
assistive technology, 205, 206, 207, 210
clinical trials, 8-9, 303-304, 365
erroneous research claims, 15, 306
health care modes, 210-211
quality-adjusted life years (QALYs), 53-54
transgenic animal studies, 101
treatment, 52, 53-54, 210-211
Cramps, see
Muscle spasms and cramps
Crying, see
Langhing and crying
Cyclophosphamide, 390
Cylert, 154
Cytokines, 21, 42, 44, 60, 62, 64, 68, 74-76, 257-260, 264-265, 355
see also

Beta-interferon;
Tumor necrosis factor
astrocytes, 257, 258, 259, 350
biomarkers, 259, 263-264
glia, 75, 76, 87
immune-based therapy, 259-260, 278-279, 281, 282, 285, 289, 290, 391, 392, 397
inflammatory/anti-inflammatory, 21, 75, 76, 87, 242, 257, 258, 259-260, 281, 391, 392
interleukin, 49, 60, 61, 103, 258, 259-260, 264-265, 392, 397, 398
neuropoietic, 74, 285
oligodendrocytes, 75, 259
transforming growth factor (T.F.), 60, 114, 258, 259, 265, 282, 285, 391
transgenic animal models, 102, 103
treatment, 259-260, 278-279, 281, 282, 285, 289, 290, 391, 392, 397
Cytospaz, 144-145

D


Daclizumab, 397
Dantrium/Dantrolene, 133, 134-135, 165
Databases/registries, 345
see also

Internet
brain banks, 316-318, 332, 339
clinical data, general, 261, 312-315, 339, 361
confidentiality, 361
health status assessment, 361-362
genomic, 352
pharmaceuticals, 394-399
tissue banks, 215, 316-318, 332, 339, 365
transplant, 312-315, 345
DDAVP, 144-145
Decadron, 150
Deltasone, 150
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Demographic factors, 222, 269, 352
see also

Educational attainment;
Gender factors;
Geographic factors;
Race/ethnicity
rural areas, 188, 344
urban areas, 188
Demyelinating disorders, general, 84-87, 166, 243, 380
Demyelination, 3, 5-6, 8, 18, 19, 20, 56-62, 64, 65, 241-245, 283, 291
see also

Beta-interferon;
Interferon;
Oligodendrocytes;
Remyelination
animal models, 7, 91-99 (passim), 102-103, 357
astrocytes, 245
asymptomatic MS, 35
ataxia and tremor, 138
atrophy, 39
B cells, 6, 60, 68, 70, 71, 74, 93, 251, 253, 255, 355
biomarkers of MS, 44, 45
cognitive impairment, 118
dietary deficiency, 84
diffusion tensor imaging (DTI), 6, 41, 64, 356
electrical impulse conduction, 20, 56, 57, 58, 65, 242, 278
evoked potentials, 43-44
experimental autoimmune encephalomyelitis (EAE), 7, 92
eye movements, 149
funding for research, 22
immune system, general, 4, 5-6, 65-76
infectious agents, 7, 88, 89, 90, 91
magnetic resonance imaging (MRI), 41
molecular plasticity of axons, 246-247, 349
myelin basic protein, 5-6, 42, 44, 50, 60, 66, 71, 72-73, 82, 257, 354, 389, 398
oligodendrocytes, 7-8
optic nerve, 115
pain, 163, 166
patient diagnosis information, 218
research recommendations, 268-269, 349, 354-355
spasticity, 130
T cells, 6, 21, 42, 66-76, 82, 86, 92, 93, 98, 99, 244, 251-257, 263, 279-280, 354, 355, 388, 389, 395, 397, 398
animal models, 251-252, 355
suppressor cells, 17, 50, 73, 78, 257, 279-280
treatments, 49, 50, 257, 279-280, 303, 388, 389, 390, 391, 395, 397, 398
see also

Major histocompatibility complex
toxins, 84
virus-induced, 7, 88, 89, 90, 91, 95-98, 99-100, 357-358
Theiler's murine encephalomyelitis virus (TMEV), 48, 91, 92, 95, 96, 99, 269, 357
Dental therapy, 15, 367, 411-412
Department of Defense, 314
Deporpanex, 408
Depression, ix, 120-128
see also

Anxiety
beta-interferon, 52, 123, 126-127
cognitive impairment and, 118, 122, 123
crying, 118-119
exercise and, 224
fatigue and, 153, 155
interferon therapy, 52
measurement, 121-122, 200, 202
sexual dysfunction and, 156
spousal attitudes, 186
suicide, 122-123, 388
treatment, 123-128, 153, 400
as side effect, 123, 125-127, 135, 150, 154, 388
Desipramine, 123
Deskar, 395
Desmopressin, 144-145
Detrol, 144-145
Dexamethasone, 150
Diabetes mellitus, 280, 328, 353
Diagnosis, 3, 42-48, 216-217, 357
see also

Autopsies;
Biological markers;
Imaging technology;
Symptoms
atrophy, 39, 356
cerebrospinal fluid (CSF), 30, 41-42
cognitive impairment, 116, 120
criteria, 43, 46, 47-48, 50, 66, 121, 127, 217-218, 349, 401-404
depression, 121
disease subtype identification, 261-262
electromyocardiogram, 138
evoked potentials, 42, 43-47, 56, 148, 157
Expanded Disability Status Scale, 40, 117-118, 121, 157, 178, 201, 202, 204-205, 212-213, 214, 304, 306, 385-386
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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fatigue, 152-153
immune status, 257
patient perspectives, 12, 17, 179-180, 216-219
relapses, 32, 33, 34
research recommendations, 348, 349
Social Security Administration disability criteria, 401-404
weakness, 138
Diarrhea, 125, 135, 145, 154
Diazepam, 133
Dicyclomine hydrochloride, 144-145
Diet, 77, 84, 225-226, 386, 405-407
bowel dysfunction, 146-147
protein, 147, 225
vitamins, 225, 406, 409
Differential sequence analysis, 5, 260, 353, 354
Diffusion tensor imaging (DTI), 6, 41, 64, 356
Diffusion-weighted magnetic resonance imaging, 38, 40-41
Dimethyl sulfoxide, 409
Disability, see
Americans with Disabilities Act;
Expanded Disability Status Scale (EDSS)
Disability and Impact Profile, 198
Discrimination, 188
Disease management and measurement, viii, 2, 4, 8, 177-276, 304-305
see also

Assistive technology;
Diagnosis;
Exercise and physical therapy, Functional status;
Imaging technology;
Pain and pain management;
Patient perspectives;
Quality of life;
Rehabilitation;
Side effects of treatment;
Symptoms;
Treatment
ataxia and tremor, 138-140
bladder and bowel dysfunction, 198, 199, 201, 202
cognitive impairment, 40, 117, 119, 120, 198-202 (passim), 204-205
depression, 121-122, 197, 198, 200, 202
Expanded Disability Status Scale, 40, 117-118, 121, 157, 178, 201, 202, 204-205, 211, 212-213, 214, 304, 306, 385-386
experimental autoimmune encephalomyelitis (EAE), 137, 163, 225-226
family factors, 197, 198, 199
children, relations with, 187
spouses, 185, 186
fatigue, 152-155, 197, 198, 199, 202
rehabilitation, 211, 212-216
research recommendations, 4, 8, 9-10, 189-190
social factors, measurement, 197, 198, 200, 202, 204
standards, 261, 363, 382, 401-404
visual impairment measurement, 198-203 (passim)
walking difficulties, measurement, 199, 201, 204, 385-386
Disease markers, see
Biological markers
Disease mechanisms, 54-90, 177-178, 351
see also

Etiology and pathology
astrocytes, 241, 245, 253, 257, 258, 259, 267
bladder dysfunction, 142, 145
blood-brain barrier, 60, 63, 67, 70, 75, 76, 245, 257-258, 263
experimental autoimmune encephalomyelitis (EAE), 72, 74, 84, 86, 91-94, 102, 103
major histocompatibility complex, 61, 68, 76, 80-82, 83, 244, 251, 252, 256, 257, 260-261, 264, 268
research recommendations, 241-277, 348
spasticity, 130-132
tumor necrosis factor (TNF), 258, 259, 260, 264-265, 266, 268
Disease variants, 360, 363
see also

Primary progressive MS;
Progressive MS;
Relapsing-remitting MS;
Secondary progressive MS
asymptomatic MS, 6, 30, 35-36, 88, 115, 177
biological markers, 261, 262-267
magnetic resonance imaging, 261-262
monogenetic MS, 5, 269, 351
Ditropan XL, 144-145
Dizziness, 115, 125, 135, 145, 150, 154, 400
DNA, 316, 352
see also

Genomics
autoantigens, 253
B cells, 74
infectious agents, 260
magnetic resonance imaging (MRI), 268
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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microarrays, 256-257, 265, 269-271, 316, 354, 355
polymerase chain reaction, 5, 260, 265, 353, 354, 355
treatments, 50, 257
transgenic animals, 91, 93, 97, 100-104, 280, 355, 356-357
vaccines, 279
Dorsal column, 162, 248, 410-411
Drug treatment, see
Pharmaceuticals
Dysesthetic pain, 162-163, 165, 166, 250, 400

E


EAE, see
Experimental autoimmune encephalomyelitis
Economic factors, see
Cost and cost-effectiveness factors;
Employment;
Funding;
Socioeconomic status
EDSS, see
Expanded Disability Status Scale
Education, see
Information dissemination;
Patient education;
Professional education
Educational attainment, patients, 189, 190, 191, 192, 199, 219, 221
Electromyocardiogram, 138
Electrophysiology, general, 8, 306
axons and myelin, general, 54-65, 246
electrical impulse conduction, 20, 56, 57, 58, 65, 242, 247, 255, 349, 350
dorsal column stimulation, 410-411
evoked potentials, 42, 43-47, 56, 130, 148, 157
weakness, 136
Elavil, 124-125
Eliprodil, 392, 393
Emotional impairment, 116, 119, 181-182, 183, 211
see also

Anxiety;
Depression
assistive technology, 206-207
cognitive impairment vs, 116, 119-120
diagnosis, emotional response, 17, 179-180
exercise and, 224
laughing and crying, 118-119
measurement, 197, 198, 200, 202
rehabilitation, 215
side effect of treatment, 123, 125-127, 135, 150, 154, 388
Employment, 9, 14, 177, 178, 190-193, 197, 202
assistive technology, 193, 207-208
bladder and bowl dysfunction, 140
cognitive impairment, 115-116, 191, 404
depression, 122
fatigue, 191, 193, 205
gender factors, 191
researchers, 334-336
Social Security Administration disability criteria, 404
Encephalomyelitis, 7, 43, 72-73, 84-86, 99
see also

Experimental autoimmune encephalomyelitis
acute disseminated encephalomyelitis, 84, 85, 86
postinfectious encephalomyelitis, 86, 99
transverse myelitis, 30
Endothelial cells, 245, 257, 258, 265, 287, 391
Enolase, 42, 45
Environmental control technology, 206, 207
Environmental factors in causation, 67, 77, 78, 352
familial, 79
geographic, 76-77
toxins, 15, 84, 85
Environmental Status Scale, 202
Enzyme-linked immunosorbent assay, 265
Epidemiology, vii, 76-79, 190, 312, 352
see also

Demographic factors;
Incidence and prevalence
functioning and quality of life studies, 10, 11, 362
infections, 77, 78-79, 86
Epilepsy, 1, 22 , 328
Ethnicity, see
Race/ethnicity
Ethylenediamine tetraacetic acid, 410
Etiology and pathogenesis, 8, 54-76
see also

Animal models;
Clinical studies and trials;
Demyelination;
Diseases mechanisms;
Immune response;
Infections;
Pain and pain management;
Viruses
committee task, 25, 26
erroneous research claims, 15, 306-367
infections, general, 33, 67, 78-79, 84, 85, 86, 87-90, 150, 252, 260-261
laughing and crying, 119
newly proposed pathogens, 14-15
research management, 14-15
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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research recommendations, 3, 4, 5-6, 14-15, 348-358, 361-362, 366-367
spasticity, 129-130
Europe, 17, 390, 392, 393
beta-interferon, 49, 51
Internet, 221
magnetic resonance imaging (MRI), 308
major histocompatibility complex, 82
Netherlands, brain bank, 317-318, 339
United Kingdom, 23-24, 217-218, 317-318, 329, 339
Evoked potentials, 42, 43-47, 56, 130, 148, 157
Executive function, 116
Exercise and physical therapy, 215-216, 224-225
acupressure/qigong, 410
back pain, 165
coping skills, 182
insurance coverage, 221-222
neuroplasticity, 291-292
posture, 128, 132, 138, 139, 192, 208
quality of life, 196
research recommendations, 8, 190
spasticity, 131
stress and, 184-185
Expanded Disability Status Scale (EDSS), 40, 201, 202, 204-205, 211, 304, 306, 385-386
cognitive impairment, 117-118
depression, 121
outline of, 385-386
quality of life, 178
rehabilitation, 212-213, 214
sexual dysfunction, 157
Experimental autoimmune encephalomyelitis (EAE)
disease management and measurement, 137, 163, 225-226
disease mechanisms, 72, 74, 84, 86, 91-94, 102, 103
inflammation, 93-94
research strategies, 252, 253, 254-255, 257, 258, 260, 263, 268, 269, 270-271, 278, 357
symptom characterization and management, 137, 163
treatment, 280, 285, 286, 288, 395
Eye pathologies, see
Optical pathologies

F


Family factors, 178, 185-187, 190, 210, 362
assistive technology, 206
children, relations with, 187
cognitive impairments, 116
depression, 127
diagnosis, 217
genetic, 9, 11, 79, 80, 83
measurement, 197, 198, 199
monogenetic MS, 5, 269, 351
research recommendations, 351, 352
spouses, 185, 186
Fampridine, 394
Fatigue, viii, ix, 17, 149-155, 178
see also

Weakness
assistive technology, 207
clinician attitudes toward, 116
cognitive impairment and, 118
defined, 151
depression and, 121, 122
employment and, 191, 193, 205
functional MRI (fMRI), 41
measurement, 152-155, 197, 198, 199, 202
Social Security Administration disability criteria, 402
treatment, 153-154, 155, 400
as side effect, 125, 135, 145, 154
Federal government
see also

Legislation;
National Institutes of Health
Agency for Health Research and Quality, 343-344
Centers for Disease Control and Prevention, 367
Department of Defense, 314
National Center for Infectious Diseases, 367
National Institute on Disability and Rehabilitation Research, 206
Social Security Administration, 193, 401-404
Females, see
Gender factors
Fluoxetine hydrochloride, 153
Food and Drug Administration, 49(n), 300, 308, 343, 381, 395
Orphan Drug Act, 49(n), 342-343, 396, 399
Foreign countries, see
International perspectives
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Functional Assessment of Multiple Sclerosis, 198
Functional Independence Measure (FIM), 200, 205, 211, 305
Functional magnetic resonance imaging (fMRI), 6, 38, 41, 166
Functional status, 2, 20
see also

Assistive technology;
Exercise and physical therapy;
Expanded Disability Status Scale;
Impairment;
Quality of life;
Rehabilitation
activities of daily living, 200, 201, 202, 205, 215
defined, 199-200
epidemiology, 10, 11, 362
insurance coverage, 222
longitudinal studies, 10, 361
measurement, 177, 193-194, 196, 197, 198, 199-205
Expanded Disability Status Scale (EDSS), 40, 121, 157, 178, 201, 202, 204-205, 211, 212-213, 214, 304, 385-386
Functional Assessment of Multiple Sclerosis, 198
Functional Independence Measure (FIM), 200, 205, 211, 305
Impairment Scale for the European Database for Multiple Sclerosis, 202
Incapacity Status Scale, 201-202
Minimal Record of Disability, 201, 202
Multiple Depression Inventory, 121
Multiple Sclerosis Functional Composite Scale (MSFC), 201, 203, 304, 306, 362
Multiple Sclerosis Impact Scale, 198
Multiple Sclerosis Quality-of-Life Inventory, 198
Sickness Impact Profile, 197, 198
standards, 194, 363
neuroplasticity, 246, 250
patient perspectives, 17, 179, 180, 194-195
remission, 246
research recommendations, 8, 10-11, 362-363
Social Security Administration disability criteria, 401
standards, 194, 363
workshop agendas, 382
Functional System Scales, 201
Funding, 325-333, 345, 362-363
assistive technology, 206
bone marrow transplant registries, 314
brain banks, 316, 317
clinical trials, 9, 50, 298, 300, 306, 310, 341
genetics and genomics, 268-269, 352
interdisciplinary research, 13, 365
MS Society, viii, 22, 23-24, 326-327, 329, 332, 338-339, 343-344, 362-363
NIH, vii, 22, 23, 314-315, 316, 325, 327, 332, 334
personal and social issues, 11
research centers, 322-333
researchers, 334-335, 364

G


GABA (gama-aminobutyric acid), 69, 132, 133, 134, 248, 288
Gabapentin, 134, 165
Gadolinium, 30, 37, 38-39, 46, 277, 305, 306, 356
Ganglionectomy, 411
Gay and lesbian populations, 156
Gender factors
see also

Sexual dysfunction
age and, 77-78
autoimmune disease, general, 23, 67
employment, 191
experimental autoimmune encephalomyelitis (EAE) vs MS, 92
gay and lesbian populations, 156
hysterectomy, 412
incidence and prevalence, vii-viii, 17, 67, 77-78
menstrual cycles, 49, 353
MS Society-funded research, 23
pain, 158
pregnancy/postpartum period, 78, 409-410
prevalence, vii-viii, 17, 67, 77-78
research recommendations, 270, 353
roles, 185, 191-192
spousal, 185, 186, 191-192
suicide, 122-123
Gene therapy, 1, 4, 5, 6, 25, 102, 283, 286, 289, 345, 355, 357, 380
see also

Beta-interferon;
Stem cell therapy
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Genetic factors, vii, 17-18, 79-84, 91-92, 262-263
see also

Biotechnology;
Cloning;
DNA;
Gender factors;
Major histocompatibility complex;
Mutations;
Race/ethnicity;
Transgenic animals;
Transplantation
animal models, ix
autoimmune disease, general, 67
DR-2
gene expression, 3, 62, 64, 256, 270-271, 316, 349, 354
cytokine, 60, 75
transgenic animal models, 101, 102
viruses, 96-97
migration, 77, 78
monogenetic MS, 5, 269, 351
non-MS demyelinating diseases, 85
pain, 162-163
polymorphisms, 80, 82, 269, 272, 352-353
research recommendations, 3, 4, 5, 268-272, 349, 351-353
funding, 268-269, 352
RNA, 101, 256, 265, 270-271, 316, 367
twin studies, 79
workshop agendas, 380
Genomics, 22, 80, 82
infectious agents, 260;
see also

“viral” infra
microarrays, 256-257, 265, 269-271, 316, 354, 355
research recommendations, 5, 12, 260, 268-272, 351, 352, 353, 365
funding, 268-269, 352
transgenic animal models, 101
viral, 86, 87, 90, 95-97, 98-99
Geographic factors, 17, 18, 76-77, 79, 88, 269
Glatiramer acetate, 20, 49, 50-52 (passim), 75, 82, 92, 277, 290, 298, 360, 361, 389
Glia, 102, 103, 251, 256, 356
see also

Astrocytes
bladder and bowel control, 143, 146
blood-brain barrier, 258
calcium binding, 45
cerebrospinal fluid (CSF), 41
gliosis (scaring), 3, 35, 45, 62, 64-65, 241, 244, 248, 350, 392
fatigue, 152
inflammatory cytokines, 75, 76, 87
microglia, 64, 96, 97, 102, 103, 251, 258, 293, 294
mylenation, 71
oligodendroglia, 60
pain, 160
transplantation, 29
treatment, 281, 284, 285, 286, 290, 293, 294, 392
viruses, 96, 97, 98
Glucocorticoids, 164, 165, 390, 392
Government role, see
Federal government;
State law
Group therapy, see
Support groups
Guidelines, see
Standards
Guy's Neurological Disability Scale, 202

H


Headaches, 125, 135, 145, 150, 154, 159, 160, 164, 165
Health care, 210-212, 221-229, 327, 343-344, 362
see also

Allied health professionals;
Assistive technology;
Exercise and physical therapy;
Pharmaceuticals;
Rehabilitation;
Treatment
standards, 261, 363, 382
Health insurance, 52, 191, 193, 211, 221-223
assistive technology, 206, 209, 222
Medicaid, 222-223
Medicare, 222
Health status assessment, 196-198, 199, 361-363
see also

Functional status;
Quality of life
diagnostic criteria, 43, 46, 47-48, 50, 66, 121, 127, 349, 401-404
needs measurement, 200
quality-adjusted life years (QALYs), 53-54
research recommendations, 361-363
Social Security Administration disability criteria, 401-404
Hepatitis virus, 95, 98-99, 100
Herpes virus, 89-90, 354
High-field strength magnetic resonance imaging, 38, 41
Hippocampus, 249, 293
Hiprex, 144-145
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Historical perspectives, vii, 1
cognitive impairment, 116
discrimination against disabled, 188
epidemiological studies, 76-77
quality of life measurement, 194
research, 1, 19-24, 241
HLA, see
Major histocompatibility complex
Homosexuality, see
Gay and lesbian populations
Hospital Anxiety and Depression Scale, 122
Human leukocyte antigen, see
Major histocompatibility complex
Human T-lymphocyte virus (HTLV), 85, 87, 99
Huntington's disease, 100, 292, 305, 329, 331, 339
Hyoscyamine, 144-145
Hyperbaric oxygen, 411
Hypnosis, 229
Hysterectomy, 412

I


Imaging technology, 1, 3, 20, 31, 36-41, 305
see also

Magnetic resonance imaging
brain banks, 318
depression, 127
diffusion tensor imaging (DTI), 6, 41, 64, 356
disease subtype identification, 261-262
magnetization transfer imaging (MTI), 6, 40, 64, 356
photon emission computer tomography, 155
positron emission tomography (PET), 6, 120, 356
relapsing-remitting MS, 37, 40
research recommendations, 4, 6, 349, 355-358, 361
spinal cord, 1, 35-36, 43, 356
workshop agendas, 379-380
Imipramine, 144-145
Immune-based therapy, 48-54, 252, 257, 272, 279-280, 353, 392-398
see also

Beta-interferon;
Transplantation
autoantigens, 253-254
clinical studies, 48, 50-51, 52
cost of, 52, 53-54
cytokines, 259-260, 278-279, 281, 282, 285, 289, 289, 290, 391, 392, 397
magnetic resonance imaging in evaluation of, 48, 50, 51
neuronal plasticity, 245-246
relapses, 50, 51-52, 277-278
T cell therapy, 49, 50, 257, 279-280, 303, 388, 389, 390, 391, 395, 397, 398
vaccines
acute disseminated encephalomyelitis, 84
MS, 279, 280, 390, 397, 409
Immune response, vii, 4, 5-6, 17, 18, 21, 42, 65-76, 84, 242, 251-260
see also

Antibodies;
Antigens;
B cells;
Blood-brain barrier;
Chemokines;
Cytokines;
Infections;
Infectious agents;
Inflammation;
Major histocompatibility complex;
Marcophages;
T cells;
Transplantation
animal models, general, 7, 21, 48, 91, 97, 103
biomarkers, 42, 44, 45, 47, 263-266
cascade of events, 4, 5-6, 68, 70, 243, 278, 288, 354-355
gender factors, 23, 67
immunoglobulins, 42, 44, 47, 60, 73, 74, 83, 93, 260, 266, 354, 392, 393, 395, 410
macrophages, 45, 60, 64, 67, 71, 74, 75, 99, 103, 251, 253, 254, 263, 287, 392, 398
oligodendrocytes, 8, 65, 73, 253, 254, 359
postinfectious encephalomyelitis, 86
research recommendations, 268-269, 278, 350-351, 354-355
workshop agendas, 379-380
Immunobiological revitalization, 410
Immunoglobulins, 42, 44, 47, 60, 73, 74, 83, 93, 260, 266, 354, 392, 393, 395, 410
Impairment
see also

Assistive technology;
Ataxia and tremor;
Bladder and bowel dysfunction;
Cognitive impairment;
Depression;
Emotional impairment;
Expanded Disability Status Scale;
Fatigue;
Functional status;
Language skills;
Pain and pain Management;
Rehabilitation;
Spasticity;
Visual impairments;
Walking difficulties;
Weakness
defined, 204, 362
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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disease progression, 29, 31
employment, 191
immunomodulatory treatments, 50, 51-52
measurement of, general, 201, 202, 298, 304
quality-adjusted life years (QALYs), 53-54
patient attitude toward, 115
patient education, 220
progressive MS, 35
relapsing MS, 32-33, 35, 39, 51-52
secondary progressive MS, 39
Social Security Administration disability criteria, 401-404
T1-weighted hypointense lesions, 40
Impairment Scale for the European Database for Multiple Sclerosis, 202
Incapacity Status Scale, 201-202
Incidence and prevalence, vii, 17
see also

Epidemiology
age factors, 17
benign relapsing MS, 30
bladder and bowl dysfunction, 140
cognitive impairment, 116, 119
depression, 120-121, 123, 127
disability defined, 203-204
gender factors, vii-viii, 17, 67, 77-78
genetic susceptibility, 79
geographic factors, 17, 18
pain, 158, 161, 165
primary progressive MS, 30, 34
progressive relapsing MS, 30, 34
race/ethnicity, 48, 76, 77, 78, 79, 83, 269, 352-353
relapsing-remitting MS, 30, 33
secondary progressive MS, 30, 34
sexual dysfunction, 155-156
spasticity, 128
suicide, 122-123
weakness, 128
Infections, 33, 67, 78-79, 84, 85, 86, 87-90, 150
see also

Encelphalomyelitis;
Viruses
asymptomatic MS, 88
bacterial, 15, 67, 78, 283, 366
bladder and bowel dysfunction, 143, 165, 400
epidemiology, 77, 78-79, 86
methenamine infection, 144-145
oligodendrocytes, 88, 93, 99
research recommendations, 260-261
T cell infection, 252
Inflammation, 30, 41, 68, 71, 255
anti-inflammatory agents, 20, 49, 76, 148-149, 165, 281, 286, 388, 391, 392, 395, 400;
see also

Beta-interferon;
Interferon
astrocytes, 244
asymptomatic MS, 35
ataxia and tremor, 138
axons, 242, 280-281
biomarkers of MS, 44, 45
cytokines, 21, 75, 76, 87, 242, 257, 258, 259-260, 281, 349, 388, 391, 392
demyelination, 59, 60, 62, 93, 251, 349, 357
experimental autoimmune encephalomyelitis (EAE), 93-94
major histocompatibility complex (MHC/HLA), 61, 68, 76, 80-82, 83, 91, 103, 244, 251, 252, 256, 257, 260-261, 264, 268, 351
optic neuritis, 30, 32, 34, 48, 85, 148-149, 150, 160, 164, 247-248, 400
pain, 160, 165, 166
T cells, 6, 67, 69, 71-76 (passim), 95, 253, 255, 257, 258, 264, 268, 355, 391, 398
Theiler's murine encephalomyelitis virus (TMEV), 95-96
Information dissemination, 11-12
see also

Databases/registries;
Internet;
Patient education;
Professional education
committee task statement, 25
computers, general, 12
Informed consent, 51-52
Interdisciplinary approach
care, 211
rehabilitation, 212
research, 13-14, 332-333, 364-367
Interferon, 20, 92, 260, 290, 392, 398
see also

Beta-interferon
depression as a side effect, 123, 126-127
Interleukin (IL), 49, 60, 61, 103, 258, 259-260, 264-265, 392, 397, 398
International Bone Marrow Transplant Registry, 313, 314-315
International Classification of Impairments, Disabilities, and Handicaps, 198
International Federation of Multiple Sclerosis
International Multiple Sclerosis Trials Research and Resource Center, 312
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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International perspectives, 17, 18
see also

Europe
alternative medicine, 227, 229
beta-interferon, 49, 51, 52, 53
brain banks, 317-318
Canada, 221, 339
Chinese medicine, traditional, 229
clinical trials, 308, 312
committee study methodology, 24-25
costs of therapy, 52, 53, 211
Internet use, 221
migration, 77, 78
number of persons affected, vii
prevalence, Japan, 48
transplant registries, 313
Internet, 12, 221
assistive technology, 206, 208-209
diagnosis, patient information, 218
Insulin, 69, 278, 280, 285-286, 353, 392, 395
diabetes mellitus, 280, 328, 353
Insurance, see
Health insurance
Ion channels, 8, 56, 65, 166, 243, 246, 359
see also

Potassium channels;
Sodium channels
Isoniazid, 139

J


Japanese, 48, 77, 83, 85, 87

K


Klonopin, 134-135
Kurtzke Expanded Disability Status Scale, see
Expanded Disability Status Scale

L


Language skills, 117, 118, 191, 201, 202, 383, 386
assistive technology, 208-209
Laughing and crying, 118-119
Le Gac therapy, 407
Legislation
Americans with Disabilities Act, 188, 193
Orphan Drug Act, 49(n), 342-343, 396, 399
Rehabilitation Act, 188
state law, 188
Technology-Related Assistance for Individuals With Disabilities Act, 188
Lesbians, see
Gay and lesbian populations
Lesions, 6, 394, 398
see also

Demylenation
active lesions , 60-61
asymptomatic MS, 35
bowel dysfunction, 146
chronic lesions, 62, 64
clinical and biological features, 29
cognitive impairment, 118
depression, 122
diagnostic criteria, 43, 46
disease subtype identification, 261-262
evoked potentials, 43-45
gene expression, 3, 256
gliosis, 3, 35, 45, 62, 64-65, 241, 244, 248, 350, 392
magnetic resonance imaging, 6, 36-41
gadolinium-enhancing, 30, 37, 38-39, 46, 277, 305, 306, 356
neurons, 3, 6, 241-243
neuroplasticity, 58, 64, 65, 147, 245-251
optic neuritis, 148
pain, 164, 166
relapses, 33
relapsing-remitting MS, 30, 37, 57
sexual dysfunction, 156
T1-weighted hypointense lesions (blackholes), 35, 38, 40, 41, 61, 310, 356
T2-weighted hyperintense lesions, 38, 39, 40, 46, 310
Leukarrest, 395
Leukemia, 74, 87, 297
Leukodystrophies, 85
Leukoencephalopathy, see
Progressive multifocal leukoencephalopathy
Leustatin, 395
Life expectancy, 29, 223
quality-adjusted life years (QALYs), 53-54
Linomide, 392
Lioresal, 134
Longitudinal studies
see also

Databases/registries
cytokines, 75, 259
functioning and quality of life, 10, 361
Lymphocytes, see
B cells;
T cells
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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M


Macrophages, 45, 60, 64, 67, 71, 74, 75, 98, 99, 103, 251, 253, 254, 263, 287, 392, 398
Magnesium, 407
Magnetic resonance imaging (MRI), 43, 396, 398
animal models, 262
axonal degeneration, 35, 38, 39-41, 241
asymptomatic MS, 35
brain banks, 317
cerebrum, 115
clinical trials, 277, 278, 304, 306, 307, 308, 309-311
clinically isolated syndromes, 30
cognitive impairment, 118, 119, 120
cytokine production as biomarker and, 259
demyelination, 41
diagnostic criteria, 43
diffusion-weighted MRI, 38, 40-41
disease subtype identification, 261-262
evoked potentials vs 47
functional MRI (fMRI), 6, 38, 41, 166
gadolinium-enhancing, 30, 37, 38-39, 46, 277, 305, 306, 356
high-field-strength MRI, 38, 41
immunomodulatory agents, effectiveness, 48, 50, 51
magnetic resonance spectroscopy (MRS), 6, 38, 39-40, 356
N-acetyl aspartate, 38, 39-40
pain, 163
patient perspectives, 180
relapsing-remitting MS, 37, 39
research recommendations, 261-262, 265, 267-268, 305, 307, 308, 309-311, 356
technical principles, 36, 38-41 (passim)
Magnetic transfer imaging (MTI), 6, 40, 64, 356
Magnetotherapy, 411
Major histocompatibility complex (MHC/HLA)
disease mechanisms, 61, 68, 76, 80-82, 83, 244, 251, 252, 256, 257, 260-261, 264, 268
animal models, 91, 103
racial/ethnic factors, 82, 83-84
research recommendations, 244, 251, 252, 256, 257, 260-261, 264, 268, 297, 351-352
treatment, 297, 351, 390, 391, 394
Mandelamine, 144-145
Marijuana, 163, 228-229
Marital partners, see
Spouses
Medicaid, 222-223
Medical Outcomes Study, 197, 199, 200
Medicare, 222
Memory, 116-117, 119, 122, 178, 200, 209
Men, see
Gender factors
Menstrual cycles, 49, 353
Mental change, see
Cognitive impairment
Mental health, ix
see also

Anxiety;
Depression;
Emotional impairment;
Psychological factors;
Stress
adaptation, 2, 9-12, 26, 177, 180-190, 193, 206, 207-208, 212-213, 218, 219, 221
patient attitude toward own, 115
rehabilitation, 212-213
Social Security Administration disability criteria, 403-404
suicide, 122-123, 388
Metabolic therapy, 407
Metalloproteins, 42, 45, 258, 265, 269, 392, 397
Methenamine infection, 144-145
Methotrexate, 390, 392
Methylprednisolone, 148, 150, 278
MHC, see
Major histocompatibility complex
Microglia, 64, 96, 97, 102, 103, 251, 258, 293, 294
Minimal Record of Disability, 201, 202
Mitoxantrone, 47, 50, 51, 390, 395
Mobility control technology, 206-207
wheelchairs, 128, 188, 199, 206-207, 209, 220, 222, 386
Modafinil, 154
Molecular biology, general, 6, 7
see also

Amino acids;
Biotechnology;
Genetic factors;
Genomics;
Proteins
axon plasticity, 246-247
demyelination, 65, 246-247
hyperexcitability, 8, 131, 166, 248, 359
neuronal plasticity, 245-246
research recommendations, 3, 6, 7, 8, 65, 278-279, 348, 349, 356
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Monoamines
spasticity, 130, 131, 132, 133
weakness, 135, 137, 138
Monogenetic MS, 5, 269, 351
Mouse hepatitis virus (MHV), 95, 98-100
MRI, see
Magnetic resonance imaging
MS Quality-of-Life-54, 199
MSP-771, 398
Multidisciplinary approach, see
Interdisciplinary approach
Multiple Depression Inventory, 121
Multiple Sclerosis Functional Composite Scale (MSFC), 201, 203, 304, 306, 362
Multiple Sclerosis Impact Scale, 198
Multiple Sclerosis Quality-of-Life Inventory, 198
Muscle spasms and cramps, 69, 135, 144, 145, 161, 163, 164-165
see also

Spasticity;
Weakness
Muse, 159
Mutations, 6, 79, 80
B cells, 74
chemokine receptors, 82
cystic fibrosis, 6
T cells, 264
transgenic animals, 91, 93, 97, 100-104, 280, 355, 356-357
viruses, 97, 253
Myelin, 3, 5-6, 8, 18, 19, 20
see also

Demyelinating diseases, general;
Demylenation;
Oligodendrocytes;
Remyelination
gene products, autoimmune agents, 21
myelin basic protein, 5-6, 42, 44, 50, 60, 66, 71, 72-73, 82, 257, 354, 389, 398
see also

Glatiramer acetate
MOG (myelin oligodendrocyte glycoprotein), 73, 74, 93, 253, 255
oral, 392
physiology, 54-65, 242, 349
research recommendations, 65-70, 349
signs and symptoms of MS, 115
spasticity, 131
Myotrophin, 395

N


N-acetyl aspartate, 38, 39-40, 64
National Center for Infectious Diseases, 367
National Institutes of Health
brain banks, 316
funding, vii, 22, 23, 314-315, 316, 325, 327, 332, 334
researchers, 334, 335, 337
National Institute on Disability and Rehabilitation Research, 206
National Multiple Sclerosis Society, viii, 1, 2, 14, 15, 19, 23, 26, 348
beta-interferon, 50
brain banks, 316
clinical trials, 9, 50, 298, 300, 306, 310
cognitive impairment, 116
committee task statement, 25, 347
diagnostic criteria, 43, 50
everyday living, 11
functional measurement instruments, 201, 203, 306
funding, viii, 22, 23, 326-327, 329, 332, 338-339, 343-344, 362-363
research centers, 322
researchers, 335-336, 338-339
National Rehabilitation Information Center, 206
Nausea and vomiting, 49, 125, 135, 145, 150, 154, 159
Neopterin, 45
Nerve growth factor (NGF), 284, 285, 286
Netherlands, brain bank, 317-318, 339
Neurelan, 394
Neurofilaments, 45
Neurons, vii, 1, 3, 4, 8, 21, 75, 241, 244, 255-256
see also

Apoptosis;
Axons;
Demyelination;
Glia;
Oligodendrocytes;
Remyelination;
Synapses
animal models, 6, 7, 95
bladder and bowel dysfunction, 143
cerebrospinal fluid (CSF), 41
enolase, 42, 45
hyperexcitibility, 8, 131, 166, 248, 359
lesions, 3, 6, 241-243
N-acetyl aspartate, 38, 39-40, 64
pain, 163
plasticity, 64, 147, 245-251, 291-292
repair, 3, 4, 21, 143
research recommendations, 3, 4, 6, 7-8, 147, 243, 349, 350, 356
spasticity, 130, 131, 133, 163
treatment, 281, 283, 287, 392
weakness, 136, 137, 138
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Neurontin, 134-135
Neuropathic pain, 161-163
Neuroprotection strategies, 1, 58, 241-272 (passim), 305, 392, 397
see also

Vaccines
research recommendations, 4, 7-8, 278, 280-290, 305, 358-359
workshop agendas, 381
Neurotrophins and neurotrophic factors, 45, 64, 74, 75, 250, 257, 259
treatment, 282-287 (passim), 292, 350
Neutralizing antibodies, 51, 52, 97
Nitric oxide, 48, 259, 279, 287
N-methyl aspartate (NMDA), 248, 249, 287, 292
Norepinephrine, 124, 130, 136-137
Nottingham Health Profile, 197
Novantrone, see
Mitoxantrone
Numbness and tingling, 32, 115
Nutrition, see
Diet
Nystatin, 407

O


Octacosanol, 408
Oligoclonal bands, 42, 44, 46, 74, 87, 90, 164, 260, 266, 354
Oligodendrocytes, 3, 4, 8, 55, 60, 62, 64, 65, 73
see also

Myelin
amino acids, 350-351
cytokines, 75, 259
infectious agents, 88, 93, 99
immune response, general, 8, 65, 73, 253, 254, 359
myelin oligodendrocyte glycoprotein (MOG), 73, 74, 93, 253, 255
research recommendations, 241, 243-244, 253, 254, 266, 278, 349-351
toxins, 84
transgenic animal models, 102
treatment, 278, 282, 283, 284-285, 286, 287, 290, 294, 358-359, 393, 395
Optical pathologies, 148-149
see also

Visual impairments
neurotrophins, 285
Optic neuritis, 30, 32, 34, 48, 85, 148-149, 150, 160, 164, 247-248, 400
Orotein/Orgotein, 408
Orphan Drug Act, 49(n), 342-343, 396, 399
Oxybutynin Chloride, 144

P


Paclitaxel (Taxol), 390, 396
Pain and pain management, viii, ix, 158, 159-166, 178, 388, 389
back pain, 145, 160, 165
clinical studies, 160, 162, 163, 165-166
clinician attitudes toward, 116
demyelination, 163, 166
depression and, 122
dysaesthesia, 162-163, 165, 166, 250, 400
functional MRI (fMRI), 41
genetic factors, 162-163
headaches, 125, 135, 145, 150, 154, 159, 160, 164, 165
incidence and prevalence, 158, 161, 165
inflammation, 160, 165, 166
marijuana, 229
measurement instruments, 197, 199, 200, 203
muscle spasms and cramps, 69, 135, 144, 145, 161, 163, 164-165
neuropathic, 161-163
optic neuritis, 148, 160, 164
paraesthesia, 8, 135, 250, 400
patient attitude toward, 115, 197, 199
pharmaceuticals, 8, 133, 138-139, 161-169 (passim), 359
radicular pain, 163
research recommendations, 4, 8, 165-166, 350
spasticity, 129, 133, 135, 161-162, 163, 164-165
treatment, 8, 133, 160, 161-166 (passim), 359
Painful tonic spasms, 160, 161-162, 165
Palosein, 408
Pamelor, 124-125
Pancorphen, 408
Pancreas, 69, 408
see also

Diabetes mellitus;
Insulin
Papaverine, 159
Paraesthesia, 8, 135, 250, 400
Parkinson's disease, 1, 5, 14, 22, 328, 329
research recommendations, 269, 342, 343, 351, 366
symptoms, 120, 139
treatment, 139, 285, 287, 289, 292, 305
Pathogenesis, see
Animal models;
Etiology and pathogenesis
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Patient education, 51, 127, 138, 156, 206, 210, 212, 216-221, 318, 363, 383
diagnosis, 12, 17, 179-180, 216-219
Patient perspectives, viii, 2, 17, 20, 25, 26, 177, 178-190, 194-195
see also

Employment;
Functional status;
Psychological factors;
Quality of life;
Social factors
adherence to therapy, 51-52
assistive technology, 205-207
confidentiality, 361
diagnosis, 12, 17, 179-180, 216-219
discrimination, 188
educational attainment, 189, 190, 191, 192, 199, 219, 221, 383
impairments, attitudes toward, 115
informed consent, 51-52
magnetic resonance imaging, 180
measurement instruments, 197, 198, 200
pain, 115, 197, 199
rehabilitation, 212-213
research recommendations, 9-11, 189-190, 362, 363
support groups, 210
symptoms, description by, 115
unpredictability/uncertainty, 9, 156, 177, 179, 180, 182, 193, 218, 220, 240, 348, 363
Pavabid, 159
Paxil, 124-125
Pemoline, 153
Peripheral nervous system, 69, 281
Pharmaceuticals, 1, 20, 347, 387-400, 406-410
see also

Beta-interferon;
Clinical studies and trials;
Immune-based therapy;
Interferon;
Neuroprotective strategies;
Side effects of treatment;
Stem cell therapy;
Transplantation;
specific agents
amytrophic lateral sclerosis (ALS), 283, 285, 286, 287, 289, 300, 305, 366, 367
anti-inflammatory agents, 20, 49, 76, 148-149, 165, 281, 286, 388, 391, 392, 395, 400;
see also

Beta-interferon;
Interferon
anxiety, 227, 229
approved medications, tabular list, 388-389
astrocytes, 282, 284, 286, 294
ataxia and tremor, 138-139
axonal function, 243, 278, 280-281, 283, 288, 289, 291, 358
bladder and bowel dysfunction, 140, 142-145, 146-147, 400
blood-brain barrier, 278, 288
chemotherapy, 360
cognitive impairment, 119, 123
cytokines, 278-279, 281, 282, 285, 289, 290, 391, 392, 397
databases, 394-399
depression, 121, 123-128, 153, 400
eye movements, 149, 150
fatigue, 153-154, 155, 400
glatiramer acetate, 20, 49, 50-52 (passim), 75, 82, 92, 277, 290, 298, 360, 361, 389
glia, 281, 284, 285, 286, 290, 293, 294, 392
Internet, 221
major histocompatibility complex, 297, 351, 390, 391, 394
marijuana, 163, 228-229
neurons, 281, 283, 287, 392
oligodendrocytes, 278, 282, 283, 284-285, 286, 287, 290, 294, 358-359, 393, 395
optic neuritis, 148-149, 150
pain and sensory disturbance management, 8, 133, 138-139, 161-169 (passim), 359
patient perspectives, 180
adherence to therapy, 51-52
polymorphisms, 272, 352
private sector, 341-343
relapse limiting, 278
remyelination, 65, 281-283, 286, 306, 358, 359, 393
research recommendations, 4, 8-9, 278, 299, 341-343, 347, 348, 353, 359-360
sexual dysfunction, 158, 159, 400
sodium channels, 7, 288, 291, 358, 407
spasticity, 130, 132-135, 164-165, 289, 400
tumor necrosis factor (TNF), 281, 284, 286, 395
weakness, 132, 133, 137
workshop agendas, 380, 381
Photon emission computer tomography, 155
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Physical therapy, see
Exercise and physical therapy
Physicians
MS Society-funded research, 23
patient relations, 10, 179, 223-224
Pirfenidone, 392, 395
Policy issues, 2
see also

Cost and cost-effectiveness factors;
Funding;
Research management
assistive technologies, 210
Polymerase chain reaction (PCR), 5, 260, 265, 353, 354, 355
Polymorphisms, 80, 82, 269, 272, 352-353
Positron emission tomography (PET), 6, 120, 356
Postinfectious encephalomyelitis, 86, 99
Posture, 128, 132, 138, 139, 192, 208
Potassium channels, 56-58, 147, 246, 394
Prednisome, 150
Pregnancy/postpartum period, 78, 409-410
Prevalence, see
Incidence and prevalence
Primary progressive MS, 35, 310
diagnostic criteria, 43
N-acetyl aspartate, 39
relapses, 32, 34
Privacy, see
Confidentiality
Pro-Banthine, 144-145
Procaine hydrochloride, 409
Professional education, 10, 25, 209, 210, 338
MS Society of Great Britain and Northern Ireland, 23-24
researchers, 12-13, 332-333, 338, 364
researchers, recruitment, 334-338, 364
Prognosis, 308, 351
Devic's pattern, 48
life expectancy, 29, 223
quality-adjusted life years (QALYs), 53-54
progressive MS, 35
relapse features, 34
Progressive MS, 202
accumulated deficit, 29, 31
altering, 278
cognitive impairment, 117
disease progression, 31
immunomodulatory agents, 48, 394, 397
prevalence, 34
relapses, 32
see also

Primary progressive MS;
Secondary progressive MS
Progressive multifocal leukoencephalopathy, 86-87
Promazine hydrochloride, 407
Proneut, 409
Propantheline bromide, 144-145
Prostin VR, 159
Proteins, 56, 265, 278, 282, 397
see also

Cytokines;
Ion channels;
Neurotrophins and neurotrophic factors;
Potassium channels;
Sodium channels
autoantigens, 6, 71, 253, 354
biomarkers, 42, 45
cerebrospinal fluid (CSF), 42, 44
experimental autoimmune encephalomyelitis (EAE), 254, 255
myelin proteins, 5-6, 42, 44, 50, 60, 66, 71, 72-73, 82, 257, 354, 389, 398
transgene, 7
superantigens, 67, 92, 93, 95, 254
bowel dysfunction, 147
diet, 147, 225
genetic predisposition to MS, 67
major histocompatibility complex, 252, 257
metalloprotiens, 42, 45, 258, 265, 269, 392, 397
myelin basic protein, 5-6, 42, 44, 50, 60, 66, 71, 72-73, 82, 257, 354, 389, 398
proteomics, 256
transgenic animal models, 101, 102
Proteolytic enzymes, 410
Protocols, see
Standards
Provigil, 154
Prozac, 124-125, 154
Psychological factors, 178-186, 363
see also

Anxiety;
Depression;
Mental health;
Patient perspectives;
Stress
asymptomatic MS, 35
employment, 191-192
sexual dysfunction, 155, 156
unpredictability/uncertainty, 9, 156, 177, 179, 180, 182, 193, 218, 220, 240, 348, 363
Psychosocial factors, see
Social factors
Pyridoxine, 139
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Q


Quality-adjusted life years (QALYs), 53-54
Quality of life, 9, 20, 115, 165, 183, 204, 211, 327, 353-361, 383
see also

Disease management and measurement;
Functional status;
Health status assessment;
Impairment;
Pain and pain management;
Patient perspectives;
Rehabilitation;
Symptoms
assistive technology, 209
clinical studies, 194, 306
cognitive impairment, 120
epidemiological studies, 10, 11, 362
information communication to patient, 219
interdisciplinary research, 14, 365-366
longitudinal studies, 10, 361
measurement, 177-178, 193-199, 203, 220
rehabilitation, 212-213
standards, 194, 363
workshop agendas, 382
Qigong, 410

R


Race/ethnicity, 76, 77, 78, 79, 83, 269, 352-353
African Americans, 77, 79, 227, 340-341
alternative medicine, 227
Asians, 48, 77, 79, 83, 86, 87
Caucasians, 77, 82, 83-84
clinical trials, 340-341
major histocompatibility complex, 82, 83-84
optic and spinal MS, 48
Radicular pain, 163
Ranvier nodes, 55-57
Rebif, see
Beta-interferon
Recreation and leisure, 209
Registries, see
Databases/registries
REHABDATA, 206
Rehabilitation, 210, 211, 212-216, 382, 383
see also

Assistive technology;
Exercise and physical therapy
Rehabilitation Act, 188
Relapses, 30, 31-35, 202, 290-291
acute disseminated encephalomyelitis, 86
assistive technology, 205
atrophy, 35, 39
clinical studies on prevention, 277, 290-291
depression, 123
diagnosis, 32, 33, 34
immunomodulatory treatments, 50, 51-52, 277-278
intervals between, 33, 34
T2-weighted hyperintense lesions, 39
unpredictability/uncertainty, 9, 156, 177, 179, 180, 182, 193, 218, 220, 240, 348, 363
Relapsing-remitting MS, 30, 303, 310
accumulated deficit, 29, 31
acute attacks, 32
cognitive impairment, 117
disease progression, 31
experimental autoimmune encephalomyelitis (EAE) vs MS, 92, 93-94
imaging technology, 37, 40
inflammatory demyelination, 62
immunomodulatory agents, 48
lesions, 30, 37, 57
magnetization transfer imaging and, 40
N-acetyl aspartate, 39
prevalence, 30
T2-weighted hyperintense lesions, 39
Remissions, 290-291
functional recovery, 246
magnetic resonance imaging (MRI), 38
sodium channels, 246-247
Remyelination, 3, 58, 64, 65, 246, 349, 350
see also

Demylenation
beta-interferon, 49
bladder and bowel dysfunction, 143
funding for research, 22
oligodendrocytes, 243-244
treatment, 65, 281-283, 286, 306, 358, 359, 393
Representational difference analysis, 5, 260, 353, 354
Research management, 12-15, 22-24, 325-346, 347-348, 362-367
see also

Clinical studies and trials;
Databases/registries;
Funding
erroneous research claims, 15, 306-367
interdisciplinary research, 13-14, 332-333, 364-367
Researchers, 333-339, 344, 362
physician-scientists, 338, 345
recruitment, 334-338, 364
training, 13-14, 332-333, 338
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Riluzole, 287, 392
Risk factors
see also

Diet;
Demographic factors;
Environmental factors in causation;
Epidemiology;
Gender factors;
Geographic factors;
Infections;
Race/ethnicity
genetic, general, 17, 18, 76-77, 79-84, 380
suicide, 123
workshop agendas, 380
Riutek, 396
RNA, 101, 256, 265, 270-271, 316, 367
Robert Wood Johnson Foundation, 178
Rodilemid, 409
Roquinimex, 392
Rural areas, 188, 344

S


S-100 protein, 45
Secondary progressive MS, 30, 310, 304
disease progression, 31, 35
magnetization transfer imaging and, 40
N-acetyl aspartate, 39
relapses, 32
T2-weighted hyperintense lesions, 39
Seizures, 69, 87, 89, 176, 400
Semliki forest virus, 95
Sensory impairment, 201, 359
see also

Numbness and tingling;
Pain and pain management;
Visual impairments
employment and, 193
evoked potentials, 42, 43-47, 56, 148, 157
functional MRI (fMRI), 41
relapse indicators, 34
relapsing-remitting MS, 33
sexual dysfunction, 156, 157
treatment, 4, 8
Sequence screening, 5, 260, 353
Serotonin, 124, 127, 136-137, 154
Sexual dysfunction, ix, 155-158, 197
depression and, 121, 125
measurement, 198, 199, 202
relapses, 32
research recommendations, 156
treatment, 158, 159, 400
as side effect of, 125, 145, 154, 156, 159
SF-36, 196-197, 198, 199, 200
Sickness Impact Profile, 197, 198
Side effects of treatment, 289-290, 361, 392, 408
anxiety, 50, 125, 126, 127, 135, 388
approved medications, tabular list, 388-389
ataxia and tremor, 125, 135, 139
beta-interferon, 49, 52, 123, 126-127, 388
bladder and bowel dysfunction, 135, 145, 154
depression/emotional impairment, 123, 125-127, 135, 150, 154, 388
fatigue, 125, 135, 145, 154
immunomodulatory agents, 48-52 (passim)
T-cell therapies, 49
nausea and vomiting, 49, 125, 135, 145, 150, 154, 159
optic neuritis and abnormal eye movements, 150
sexual dysfunction, 125, 145, 154, 156, 159
spasticity, 135
visual impairments, 145
Sildenafil citrate, 159
Snake venom, 408
Social factors, ix, 2, 178, 180-183, 185-190, 191
see also

Employment;
Family factors
assistive technology, 205, 210
bladder and bowl dysfunction, 140
depression, 121, 127
disability defined, 203-204
disease management, 177
measurement, 197, 198, 200, 202, 204
rehabilitation, 212-213
research recommendations, 9, 10, 11, 14
support groups, 210
Social Security Administration, 193, 401-404
Society of Neuroscience, 13
Socioeconomic status, 191, 193
see also

Employment
Sodium channels, 56-57, 58, 65
astrocytes, 350
disease mechanisms, 242, 245, 246-247
remissions, 246-247
research recommendations, 7, 349, 350
symptoms and symptom management, 130, 147, 162-163
treatment, 7, 288, 291, 358, 407
Solu-Medrol, 150
Sparine, 407
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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Spasms, see
Muscle spasms and cramps
Spasticity, ix, 87, 128-135
bladder dysfunction and, 142, 143, 144
defined, 128
employment and, 191
marijuana, 228
neurons, 130, 131, 133, 163
pain, 129, 133, 135, 161-162, 163, 164-165
research recommendations, 133
spinal cord, 129, 130, 131-133
Theiler's murine encephalomyelitis virus (TMEV), 95-96
treatment, 130, 132-135, 164-165, 289, 400
Spatial perception, 116
Speech, see
Language skills
Spinal cord, 20, 26, 32, 35-36, 48, 96, 278
see also

Cerebrospinal fluid
asymptomatic MS, 35, 115
atrophy, 35, 38, 39
bladder and bowel dysfunction, 143
depression, 122
dorsal column, 162, 248, 410-411
evoked potentials, 45, 47
imaging technology, 1, 35-36, 43, 356
neuroplasticity, 248
race/ethnicity, 48
sexual dysfunction, 157
spasticity, 129, 130, 131-133
surgical spinal cord relaxation, 411
T1-weighted hypointense lesions, 40
traumatic injury, 65, 130, 131, 137, 147, 162, 228
vertebra, 35, 143, 146, 176, 411
weakness, 136-137, 138
Spouses, 185, 186, 191-192
Standards
brain and tissue banks, 316, 318
clinical care, 261, 363, 382
clinical trials, 20, 298, 299, 300, 303, 306-312, 359-360
diagnosis, informing patients, 217-218
diagnostic criteria, 43, 46, 47-48, 50, 66, 121, 127, 349, 401-404
functional status and quality of life, 194, 363
health care referrals, 363
neurological disability, 261
Social Security Administration disability criteria, 401-404
T-cell biomarkers, 264
St. John's wort, 406-407
State law, 188
Stem cell therapy, 1, 20, 243, 358
bone marrow transplants, 294, 296-298, 313, 314, 339
clinical studies, 300-301
research recommendations, 4, 8, 65, 292-298, 300, 332, 357, 359
transgenic animal models, 101
Steroids, 148-149, 290
Stress, 181-182, 184-185, 198, 199, 215, 220
see also

Anxiety;
Depression
unpredictability/uncertainty, 9, 156, 177, 179, 180, 182, 193, 216, 217, 218, 220, 240, 348, 363
Stroke, 115, 120-121, 130, 162, 200, 287, 291
Subclinical MS, see
Asymptomatic MS
Suicide, 122-123, 388
Superantigens, 67, 92, 93, 95, 254
Superoxide dimutase, 408
Support groups, 210
Surgery, 132, 134, 147, 302, 318, 410-412
amputation, 247, 250
ataxia and tremor, 139-140
Symmetrel, 154
Sympathectomy, 411
Symptoms, 2, 7, 26, 32, 43, 115-177, 198, 201, 281, 348
see also

Ataxia and tremor;
Bladder and bowel dysfunction;
Cognitive impairment;
Depression;
Emotional impairment;
Fatigue;
Impairment;
Nausea and vomiting;
Pain and pain management;
Seizures;
Sensory impairment;
Spasticity;
Weakness
asymptomatic MS, 6, 30, 35-36, 88, 115, 177
experimental autoimmune encephalomyelitis (EAE) vs MS, 92, 137, 163
management, 4, 8, 115-166, 359
monosymptomatic MS, 43, 277, 278
Parkinson's disease, 120, 139
patient perspectives, 17, 179, 220
sodium channels, 130, 147, 162-163
Synapses, 69, 71, 242, 249, 291
bowel dysfunction, 146
spasticity, 130-135 (passim)
weakness, 136, 137
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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T


T cells, 44, 76, 244
antigen-specific, 60, 70, 93, 252-253, 254, 257-258, 260-261, 263-265, 279, 280, 354, 355, 397
autoreactive, 6, 21, 42, 66-76, 82, 86, 92, 93, 98, 244, 251-257, 263, 279-280, 354, 355, 388, 389, 395, 397, 398
animal models, 251-252, 355
suppressor cells, 17, 50, 73, 78, 257, 279-280
see also

Major histocompatibility complex ;
”treatments” infra
biological markers, 263-265
brain-specific, 254, 257, 260-261
cerebrospinal fluid, 252, 265
cloning, 94, 252, 254, 264, 355
human T-lymphocyte virus (HTLV), 85, 87, 99
infection, 252
inflammation, 6, 67, 69, 71-76 (passim), 95, 253, 255, 257, 258, 264, 268, 355, 391, 398
mutation, 264
receptors, 81, 82, 86
research recommendations, 6, 254, 350, 354, 355
superantigens, 67, 92, 93, 95, 254
treatments, 49, 50, 257, 279-280, 303, 388, 389, 390, 391, 395, 397, 398
vaccines, 279
Taxol (Paclitaxel), 390, 396
Technology-Related Assistance for Individuals With Disabilities Act, 188
Thalamus
ataxia and tremor, 139-140
evoked potentials, 47
neuroplasticity, 248
thalamotomy/thalamic stimulation, 411
Thalidomide, 397
THC, see
Marijuana
Theiler's murine encephalomyelitis virus (TMEV), 48, 91, 92, 95-98, 99, 269, 357
Therapies, see
Treatment
Tingling, see
Numbness and tingling
Tissue banks, 215, 316-318, 332, 339, 365
Tizanidine (Zanaflex), 130, 132-133, 134-135
TM27, 397
Tofranil, 124, 144-145
Tolterodine tartrate, 144-145
Toxins, 15, 84, 85
botulism A, 133, 134, 149
nitric oxide, 279
venom, 408
Transcutaneous nerve stimulation, 411
Transforming growth factor (T.F.), 60, 114, 258, 259, 265, 282, 285, 391
Transgenic animals, 91, 93, 97, 100-104, 280, 355, 356-357
Transmission-disequilibrium tests, 269, 352
Transplantation, 45, 80, 267, 280, 281, 283, 289, 292-298, 302, 305
see also

Major histocompatibility complex;
Stem cell therapy
bone marrow, 294, 296-298, 313, 314, 339
glia, 29
registries, 312-315, 345
workshop agendas, 381
Transverse myelitis, 30
Treatment, 4, 20, 48-54, 277-324, 387-400, 405-412
see also

Assistive technology;
Beta-interferon;
Clinical studies and trials;
Exercise and physical therapy;
Gene therapy;
Glatiramer acetate;
Immune-based therapy;
Interferon;
Neuroprotection strategies;
Pharmaceuticals;
Rehabilitation;
Remyelination;
Side effects of treatment;
Surgery;
Transplantation
amytrophic lateral sclerosis (ALS), 283, 285, 286, 287, 289, 300, 305, 366, 367
animal models, 103
anxiety, 227, 229
astrocytes, 282, 284, 286, 294
ataxia and tremor, 138-140
axonal function, 243, 278, 280-281, 283, 288, 289, 291, 358
bladder and bowel dysfunction, 140, 142-145, 146-147, 400
blood-brain barrier, 278, 288
cognitive impairment, 119, 123
committee task statement, 25
cost and cost-effectiveness, 52, 53-54, 210-211
assistive technology, 205, 206, 207, 210
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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cytokines, 278-279, 281, 282, 285, 289, 290, 391, 392, 397
dental therapy, 15, 367, 411-412
depression, 121, 123-128, 153, 400
DNA, 50, 257
evoked potentials, evaluation of, 45
experimental autoimmune encephalomyelitis (EAE), 280, 285, 286, 288, 395
eye movements, 149, 150
family caregivers, 186-187
fatigue, 153-154, 155, 400
glia, 281, 284, 285, 286, 290, 293, 294, 392
historical perspectives, 21
hypnosis, 229
major histocompatibility complex, 297, 351, 390, 391, 394
metabolic therapy, 407
neurons, 281, 283, 287, 392
oligodendrocytes, 278, 282, 283, 284-285, 286, 287, 290, 294, 358-359, 393, 395
optic neuritis, 148-149, 150
pain, 8, 133, 160, 161-166 (passim), 359
Parkinson's disease, 139, 285, 287, 289, 292, 305
patient perspectives, 180
polymorphisms, 272, 352
remyelination, 65, 281-283, 286, 306, 358, 359, 393
research recommendations, 4, 8-9, 278, 299, 341-343, 347, 348, 351, 358-361
sexual dysfunction, 158, 159, 400
sodium channels, 7, 288, 291, 358, 407
spasticity, 130, 132-135, 164-165, 289, 400
symptom-specific therapies, 2
T cells, 49, 50, 257, 279-280, 303, 388, 389, 390, 391, 395, 397, 398
tumor necrosis factor (TNF), 281, 284, 286, 395
ultrasound, 411
weakness, 132, 133, 137
workshop agendas, 380, 381
Tremor, see
Ataxia and tremor
Trigeminal neuralgia, 161
T1-weighted hypointense lesions (black holes), 35, 38, 40, 41, 61, 310, 356
T2-weighted hyperintense lesions, 38, 39, 40, 46, 310
Tumor necrosis factor (TNF)
biological features of MS, 60, 75, 92, 103
disease mechanism research, 258, 259, 260, 264-265, 266, 268
treatment strategies, 281, 284, 286, 395
Twin studies, 79

U


Ultrasound, 411
United Kingdom, 23-24, 217-218, 317-318, 329, 339
Urban areas, 188

V


Vaccines
acute disseminated encephalomyelitis, 84
MS, 279, 280, 390, 397, 409
Variants of MS, see
Disease variants
Venom, 408
Vertebra, 35, 143, 146, 176
surgery, 411
Viagra, 159
Viruses, 15, 70, 77, 78-79, 85, 86-87, 89-90, 95-100, 357
AIDS, 87, 220-221, 308
animal models, 21, 91, 357-358
mouse hepatitis virus (MHV), 95, 98-100
Theiler's murine encephalomyelitis virus (TMEV), 48, 91, 92, 95-98, 99, 269, 357
antiviral antibodies, 42, 44, 154;
see also

Beta-interferon
autoantigens, 253
chlamydia, 90
demyelination, 7, 88, 89, 90, 91, 95-98, 99-100, 357-358
Theiler's murine encephalomyelitis virus (TMEV), 48, 91, 92, 95, 96, 99, 269, 357
genomics, 86, 87, 90, 95-97, 98-99
glia, 96, 97, 98
hepatitis, 95, 98-99, 100
herpes, 89-90, 354
human T-lymphocyte virus (HTLV), 85, 87, 99
mouse hepatitis virus (MHV), 95, 98-100
mutations, 97, 253
Suggested Citation:"Index." Institute of Medicine. 2001. Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: The National Academies Press. doi: 10.17226/10031.
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retroviruses,
immunotherapy, 257
see also

“AIDS” supra
Semliki forest virus, 95
Visual evoked potentials, 44-45, 47
Visual impairments, 115, 148-149 see
Optical pathologies
assistive technology, 208
cognitive impairment and, 118
employment, 191
experimental autoimmune encephalomyelitis (EAE) vs MS, 92
measurement, 198-203 (passim)
side effects of drug treatment, 145
Social Security Administration disability criteria, 402-403
spasticity and, 130
spatial perception, 116
Vitamins, 225, 406, 409
Voluntary health organizations, 344, 346
Vomiting, see
Nausea and vomiting

W


Walking difficulties, 32, 35
measurement, 199, 201, 204, 385-386
wheelchairs, 128, 188, 199, 206-207, 209, 220, 222, 386
Weakness, ix, 128-130, 136-138, 388
see also

Fatigue
relapses, 32
research recommendations, 137-138
treatment, 132, 133, 137
Wellbutrin, 124-125
Wheelchairs, 128, 188, 199, 206-207, 209, 220, 222, 386
White persons, see
Caucasians
Women, see
Gender factors
World Federation of Neurology, 300
World Health Organization, 203-204, 212
World Wide Web, see
Internet

Y


Yeast, 407, 408

Z


Zanaflex (tizanidine), 130, 132-133, 134-135
Zenapax, 397
Zoloft, 124-125
Zostrix, 144-145
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Multiple Sclerosis: Current Status and Strategies for the Future Get This Book
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Multiple sclerosis is a chronic and often disabling disease of the nervous system, affecting about 1 million people worldwide. Even though it has been known for over a hundred years, no cause or cure has yet been discovered-but now there is hope. New therapies have been shown to slow the disease progress in some patients, and the pace of discoveries about the cellular machinery of the brain and spinal cord has accelerated.

This book presents a comprehensive overview of multiple sclerosis today, as researchers seek to understand its processes, develop therapies that will slow or halt the disease and perhaps repair damage, offer relief for specific symptoms, and improve the abilities of MS patients to function in their daily lives.

The panel reviews existing knowledge and identifies key research questions, focusing on:

  • Research strategies that have the greatest potential to understand the bio- logical mechanisms of recovery and to translate findings into specific strategies for therapy.
  • How people adapt to MS and the research needed to improve the lives of people with MS.
  • Management of disease symptoms (cognitive impairment, depression, spasticity, vision problems, and others).

The committee also discusses ways to build and financially support the MS research enterprise, including a look at challenges inherent in designing clinical trials. This book will be important to MS researchers, research funders, health care advocates for MS research and treatment, and interested patients and their families.

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