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Progress Continues Against Multiple Sclerosis
< March 30, 2005 > -- March is National MS Education and Awareness Month, providing an opportunity for physicians and health professionals to spread the word about multiple sclerosis, its symptoms, and the therapies available to combat it. 
MS is a complicated neurological disorder that attacks the central nervous system. According to the Multiple Sclerosis Foundation, between 350,000 and 500,000 Americans suffer from the disease, as do an estimated 2.5 million people worldwide.
Symptoms include trouble with balance, muscle spasms, pain, or sensations in the limbs such as tingling, crawling, swelling, numbness, and coldness. Vision may blur or appear double. Persons may have cognitive problems where they cannot find the right word, and do not feel as sharp as they once did.
MS is a frustrating disease, difficult to diagnose and difficult to treat. Its cause remains elusive and, thus, so does an ultimate cure, experts say.
"Basically, we don't know the true cause of MS," says Dr. Jennie Q. Lou, an associate professor of occupational therapy and public health at Nova Southeastern University in Fort Lauderdale, Fla. "How can you prevent something you don't know the cause of?"
In a promising new development, researchers report that a simple blood test may one day detect MS before its debilitating symptoms take hold, according to a report in the Journal of Molecular Neuroscience.
Scientists from Wake Forest University Baptist Medical Center have identified three protein components that are present in people with MS, but not in those without the condition. The finding could lead to a blood test to identify the disease, which currently requires a round of tests and exams to arrive at a definitive diagnosis.
MS occurs when immune cells begin attacking a layer of insulation known as myelin that surrounds the axons, or nerve fibers, of the brain and spinal cord.
As myelin is damaged, disruptions occur within the central nervous system as messages between the brain and various parts of the body are lost or misinterpreted.
The disease causes scattered patches of scarring on the brain and spinal cord, also known as plaques. These "many scars" are where multiple sclerosis gets its name, as well as its unpredictable nature.
"Based on where the plaques are located in the system, the patient can have a wide range of signs and symptoms," Dr. Lou says.
Diagnosis of MS usually occurs between 20 to 40 years of age. It is usually a progressive disease, and about 15 percent of those diagnosed with MS will become severely disabled. However, it does not significantly affect life span.
Until recently, most of the treatments available to combat MS dealt more with slowing or stopping progression of the disease, says Dr. Ben Wade Thrower, medical director of the MS Center at Shepherd Center in Atlanta.
"Pre-1993, all of the treatments were immunosuppressives, since MS is an autoimmune condition," Dr. Thrower says. These treatments included steroids and chemotherapy, which often caused damage to the body even as they slowed the progression of MS.
But in the mid-1990s, a new series of medications called immunomodulators became available. The three medications - Avonex®, Betaseron®, Copaxone® - are commonly known as the "ABC drugs," Dr. Lou notes.
"Rather than suppressing the immune system globally, these go after a specific part of the immune system that's overactive relative to MS," Dr. Thrower explains.
More recently, two other medications - Novantrone® and Rebif® - have been approved by the US Food and Drug Administration (FDA) for use in treating MS. However, these medications are considered backups for treating patients who are not responding to the ABC drugs, Dr. Lou says.
A five-year, $30 million study funded by the National Institutes of Health (NIH) currently is under way to examine whether Copaxone can be combined with Avonex to more successfully halt the progression of MS.
Beyond holding back the disease, MS research has focused on two other areas, Dr. Thrower says: Better management of symptoms, and the more elusive goal of repairing the damage wrought by neurological disorders.
"Some of the symptoms can be difficult to treat," Dr. Thrower says. "Unfortunately, symptoms such as cognitive dysfunction and pain have been under recognized by the medical community."
Physicians have found that a drug intended to treat narcolepsy can help MS patients deal with the crippling fatigue that affects nearly four out of five people with the disease.
"We're using a drug called Provigil® for fatigue management," Dr. Thrower says. "Fatigue is usually one of the most bothersome symptoms for a person with MS, so it's a pretty big deal to get that under control."
Another medication called Fampridine-SR shows some promise as a treatment for exertional weakness and heat sensitivity, Dr. Thrower notes. The medication currently is in clinical trials.
Ultimately, however, physicians would like to be able to not only stop MS and treat its symptoms, but also attack the disease directly.
"This is kind of the holy grail of all neurology," Dr. Thrower says. "Neural repair. How do you go in and repair the damage?"
Researchers are investigating the use of stem cells to repair nerve damage, he says. They also are reviewing whether low-level inflammation can be used to tap into the body's natural healing processes.
But with the therapies currently available, the most important thing for physicians is to diagnose MS quickly. The sooner it is diagnosed, the sooner it can be treated until a cure is found.
"We have eight and 10 years' worth of data showing people responding well to the current treatments," Dr. Thrower says. "We have to find people quickly and get them on treatment because the sooner we do, the better they will do long-term."
Always consult your physician for more information.
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Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is an unpredictable condition that can be relatively benign, disabling, or devastating.
Some individuals with MS may be mildly affected while others may lose their ability to write, speak, or walk - when communication between the brain and other parts of the body becomes disrupted.
There are many possible causes of MS, including the following:
viruses
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autoimmune disorders
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environmental factors
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genetic factors
The symptoms of MS are erratic. They may be mild or severe, of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected.
The following are often initial symptoms of MS:
blurred or double vision
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red-green color distortion
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pain and loss of vision due to optic neuritis, an inflammation of the optic nerve
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difficulty walking
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paresthesia - abnormal sensation, or pain, such as numbness, prickling, or "pins and needles."
Throughout the course of the illness, an individual may experience any/all of the following symptoms, to a varying degree:
muscle weakness in the extremities
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difficulty with coordination (impaired walking or standing may result; partial or complete paralysis is possible)
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spasticity - the involuntary increased tone of muscles leading to stiffness and spasms
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fatigue (this may be triggered by physical activity, but may subside with rest; constant, persistent fatigue is possible)
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loss of sensation
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speech impediments
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tremor
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dizziness
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hearing loss
Approximately 50 percent of all people with MS experience cognitive impairments related to their disease. The effects of these impairments may be mild, often detectable only after comprehensive testing, and may include difficulty with any/all of the following:
concentration
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attention
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memory
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poor judgment
Always consult your physician for more information.
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