From another perspective: multiple sclerosis
I had wanted to talk about traumatic brain injuries today, but I’ve had so many email questions about our discussions about multiple sclerosis that I wanted to add some additional information about the subject. Again, MS is an unpredictable disease of the central nervous system, which can range from relatively benign, to somewhat disabling, to devastating, as communication between the brain and other parts of the body is disrupted.
As noted before, many investigators believe MS to be an autoimmune disease — one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus, as many researchers now believe.
Most people with MS begin to experience their first symptoms between the ages of 20 and 40, with the initial symptom of MS often being blurred or double vision, red-green color distortion, or even blindness in one eye. Most MS patients also experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can also produce partial or complete paralysis.
Most people with MS will also exhibit paresthesias, with transitory abnormal sensory feelings such as numbness, prickling, or “pins and needles” sensations. Some may also experience pain. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked.Depression is another common feature of MS.
As I write this, there is as yet no cure for MS, while many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. However, three forms of beta interferon (such as Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting MS. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability.
When MS attacks do occur with many of these various medications, they can tend to be shorter and less severe. The FDA has also approved a synthetic form of myelin basic protein, called copolymer I (Copaxone), for the treatment of relapsing-remitting MS. Copolymer I has few side effects, and recent studies have indicated that the agent can reduce the relapse rate by almost one third. An immunosuppressant treatment, Novantrone (mitoxantrone), has also beenapproved by the FDA for the treatment of advanced or chronic MS.
One monoclonal antibody, natalizumab (Tysabri), was shown in clinical trials to significantly reduce the frequency of attacks in people with relapsing forms of MS and was approved for marketing by the FDA in 2004. However, in 2005 the drug’s manufacturer voluntarily suspended marketing of the drug after several reports of significant adverse events. In 2006, the FDA again approved sale of the drug for MS patients, but only under strict treatment guidelines involving infusion centers where patients can be monitored by specially trained physicians.
While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers such as baclofen, tizanidine, diazepam, clonazepam, and dantrolene.
As always, if you are an MS patient, please be sure to check with your physician about any of these drugs to ascertain which one(s) might be best for your condition. Next week, we’ll try to discuss some of the current gains which can be realized with physical therapy for MS patients, along with noting some other drugs that can be used, while reviewing what the current prognosis may be for MS patients.Stay tuned.
Paul Rendine is Chair of the Disability Advocates of Delmarva, Inc. group.He can be contacted at his email address at quoteman3@aol.com with any comments or questions.