Treatment
Historically, acute MS was a fatal disease, with death occurring within a year of onset, often secondary to extensive brain stem demyelination. Treatment recommendations, based on anecdotes, include plasma exchange in conjunction with high-dose glucocorticoids(e.g., 1 to 2 g/day of methylprednisolone for 10 days followed by a slow taper). For patients who survive the acute attack, follow-up treatments include immunosuppression (monthly mitoxantrone or cyclophosphamide) either alone or in combination with IFN beta or GA (glatiramer acetate). Prognosis
Marburg variant of MS is an acute fulminant demyelinating process which in most cases progresses inexorably to death within 1–2 years. However, there are some reports of Marburg MS reaching stability by three years. See also
Malignant multiple sclerosis
Tumefactive multiple sclerosis

References


== External links ==
In a marathon, several percent of runners may be affected. Wearing footwear which fits helps prevent runners toe.If the shoe is too loose on the midfoot, the foot can slide forwards in the shoe, especially when going downhill. This may jam the toes into the end of the toebox. If the foot is sliding forwards because the shoe is too loose around the midfoot, it may be restrained by lacing the shoe carefully, or placing bulky padding between the tongue and the lacing, or by wrapping a strap in a figure-eight around the foot and ankle (image). : 86–87, 128, 142  Excessively tight or uneven fit around the midfoot may, however, cause tendon problems. : 125 Separately, if there is not enough space around the toes, the toes will also hit the toebox repeatedly. Feet become longer and wider when weight is put on them, because the arches flatten, and the toes also splay and bend. : p15, 18, 72–73  At the end of a long journey on foot, the arches flatten, the metatarsals spread, and the foot swells more than after a short one. : 52  The toes also need vertical space; a toe cap which is low enough to press on the top of the toe may also cause bruising under the nail, especially if the toe cap is stiff. If the toebox is pointed, the toes may be wedged forwards into the area with inadequate height. : 52–53, 135 Toenails which protrude unevenly may concentrate force on the toenail; properly-cut nails are therefore also important.Some susceptible runners may also have Mortons toe.