Multiple Sclerosis Education & Treatment
Multiple Sclerosis is a chronic neurologic disease which causes a variety of neurologic symptoms, including but not limited to weakness, numbness, blindness, or dizziness. While there are no known cures for the disease, the drugs developed over the last 10-15 years have markedly improved the prognosis for patients with this disease. Many patients can now lead a normal life, albeit while having to take medications. The diagnosis of MS can be often relatively complicated and therefore should only be made by experienced neurologists. The following pages will briefly review the diagnostic tests and Treatment for patients with MS.
Multiple sclerosis is a chronic disease of the nervous system, which involves loss of the protective covering of nerves (called myelin). Symptoms are varied but reflect damage to any part of the central nervous system. Therefore patients can experience visual disturbances, weakness, abnormal sensation and balance difficulties. There are several types of the disease: 1) relapsing-remitting: a form in which patients experience discrete attacks interspersed with periods of little to no disease activity. 2)primary-progressive: in which patients experience a slow a constant decline from the time the disease starts, 3)secondary-progressive: in which patients start as a relapsing remitting form and over 10-20 years start to slowly and progressively decline without having discrete attacks anymore.
The disease is diagnosed by a combination of a patient’s clinical history, neurologic exam and laboratory testing. MRI scans of the brain show areas of the brain involved with the inflammation, and these areas are known as white matter lesions. In some cases the changes seen on MRI are so specific that the disease can be diagnosed by this test alone. However, many people have these white matter lesions and do not have MS. Therefore we may need to use other testing. One of the other tests which is very helpful is a lumbar puncture, or spinal tap. This relatively simple test allows us to look at disease activity in the spinal fluid. Electrodiagnosis is sometimes used to help in making the diagnosis of multiple sclerosis. A special electrodiagnostic test known as visual evoked potentials are used to study the quality of the main nerve that controls vision (the optic nerve). Multiple sclerosis often affects the optic nerve and visual evoked potentials are usually helpful in detecting these abnormalities.
There has been much research into the cause of this disease. Various theories including viral and environmental have been proposed without any confirmatory evidence. What is believed is that a person’s immune system, which is supposed to fight bacteria and viruses and preserve one’s health goes awry and starts to attack the myelin coating around the nerves of the brain, optic nerves, and spinal cord.
There are a variety of FDA approved drugs to treat this disease. All of these agents have been shown to slow down the progression of the disease and to reduce the number of attacks. Each of these agents alter the function of the patient’s immune system.
For relapsing remitting MS there are six FDA approved agents. Three of these drugs are interferons which is a chemical our body naturally makes during the course of an infection. These are delivered as injections and include B-seron, Rebif, and Avonex and Extario. Most of the people who takes these drugs have some side effects but they are usually manageable. The other class of drug for relapsing remitting MS is copaxone. Copaxone is a small piece of ther myelin molecule which is injected daily. The last drug is given as an infusion, called Tysabri.
There is a 1 in 100 chance of developing a severe brain infection but otherwise this medication is well tolerated.
For secondary Progressive MS a chemotherapy agent, Mitoxantrone, has been shown to slow down the progression of the disease as well.
Other agents are used in some cases including IVIG (Gammaglobulin), plasmaphresis, or other chemotherapy drugs. However none of these agents have FDA approval.
There are also numerous drugs available to help control the symptoms of MS, even if we cannot reverse the damage. Pain, numbness, dizziness, incontinence, and fatigue are very common symptoms in MS and all of these have effective drugs that can improve these symptoms. Because of this it is important to follow with neurologists who are accustomed to treating MS. We have developed a special multidisciplinary clinic dedicated to helping patients manage the symptoms of MS.
Related publications by our physicians:
- Exploring the Clinical Course of Hair Thinning Associated With Teriflunomide: An Update to the Teriflunomide Real-World Case Series (792k PDF)
- ALLOW – A Phase 3b Trial Characterising Flu-like Symptoms in Patients Transitioning to Pegylated Interferon Beta-1a: Interim Analysis of all Patients
- The Delphi Method on Peginterferon Beta-1 Injection Site Reactions and Management Strategies in the Relapsing-Remitting Multiple Sclerosis ALLOW Study
- Glatiramer acetate in the reduction of relapse frequency in multiple sclerosis
- Clinical, biochemical and imaging parameters that may be predictive of high disease activity, rapid progression or increased disability in multiple sclerosis.
- B-cell depletion with rituximab in relapsing-remitting multiple sclerosis.
- Avonex Combination Trial in relapsing–remitting MS: rationale, design and baseline data.
There’s living with Multiple Sclerosis. And there’s living well with Multiple Sclerosis.
Taking the right medication for you is only part of treating your multiple sclerosis. Diet, fitness, stress relief — these things matter to your overall health, too. When done properly, they may make a big difference in helping you live a fuller life with multiple sclerosis.
Live well. Stay active. That’s MS Active Wellness. Visit the MS Active Source website for more information and videos.