Multiple
Sclerosis TreatmentTreatment for multiple sclerosis in the past has been
frustrating for many years. Corticosteroid therapy can be used for a period of
2 to 3 weeks and has been the main therapy for flare-ups for many years. It tends
to shorten the length and severity of an acute attack, but it does not change
the overall outlook. Corticosteroids are powerful hormones that the body's adrenal
glands are also producing. Treatment with this cannot be extended beyond 2 or
3 weeks. To
do so would cause osteoporosis with the risk of fractures as a side effect and
it would also weaken the immune system. Otherwise the body's own production of
this hormone would shut down and other serious side-effects would occur including
hip fractures and serious infections.
| Immunomodulation with
interferon-beta has been introduced several years ago and seems to reduce the
frequency of flare-ups of multiple sclerosis by interfering with the autoimmune
process that causes MS. It might actually improve the overall outlook by preventing
the real severe disability that could have occurred and with the newer immune
modulators MRI scans and PET scans have shown disappearance of MS lesions. In
Ref.1 the authors have attempted to explain some of the possible mechanisms of
interferon-beta on a cellular level. Glatiramer(= brand name:Copaxone) is another
immune modulator, which is effective in early multiple sclerosis ( Ref. 2). Natalizumab
(= brand name: Antegren) is a humanized monoclonal antibody that works as an immunomodulator
and has produced amazing results of 68% lesion reduction in 1 year (Ref.6). With
these newer successes the neurologist will likely not use immunosuppressive drugs
that also work somewhat as often and reserve these for the more severe forms of
multiple sclerosis, but there are significant risks with toxicity. |
The spastic muscles are best treated with physiotherapy treatments
and pool therapy. Antispastic medication such as baclofen (brand names:
Lioresal, Liotec) can be used as well to reduce the spasticity in the muscles. Clinical
depression is treated with counseling and antidepressant medication. Generally
speaking the patient should stay as involved and active as possible. Severe end
stage cases likely need more care than can be given at home and need constant
supervised nursing. Many patients at this stage will need to be admitted to a
nursing home (Ref. 3, p.1476). Future treatment possibilities
There
is a lot of research going on that was reviewed at a recent review by Dr. John
Hooge (Ref.6) in November 2004. Neurocrine, an altered peptide ligand of myelin,
is being tested in clinical trials for effectiveness. Minocycline and Copaxone
combined are being tested as well. Estriol, the estrogen compound
of pregnancy, is showing a large positive effect on MRI scans warranting larger
well controlled studies. In the meantime a person with MS should consider bio-identical
hormone replacement as the anti-aging literature persistently reports
great clinical results with this treatment. Statins, particularly Simvastatin
(the cholesterol lowering agent), have shown a moderate effect on MRI testing
of treated MS patients, but this does not make sense in view of the bio-identical
hormone link (cholesterol is the substrate out of which the sex hormones are formed
by the body, so why would you want to suppress it with a cholesterol lowering
agent?). Another monoclonal antibody (daclizumab, brand name: Zenapax), which
is an anti-IL-2 receptor antibody, shows promise as well. In the last few years
there has been an explosion of research with new knowledge benefitting MS patients.
One such field is research in animal models with neural stem cells. Some
success has been shown with regenerating some of the supportive connective tissue
cells of the central nervous system (called oligondendrocyte cells). When stem
cells are transplated into the spinal cord or into the brain near lesions from
MS that are "burnt out", new nerve cells can sprout out with the support
of these nurturing cells. This type of research will take years to lead to reproducible
results, but it is very encouraging. Reports about some of this research hit the
news media from time to time. It would be prudent to be cautious about getting
too excited regarding this until larger prospective trials show it is effective,
safe and leads to significant benefits to the MS patient. See your neurologist
and discuss your present realistic options. This web site about a surgical
approach for multiple sclerosis by Dr Zamboni and others shows that a
lot is still unknown about the causes of this illness. Although some successes
have been registered by unplugging veins in the neck region to allow blood from
the brain to flow freely, this technique is by no means generally accepted as
this interview
with Dr. Zamboni shows. |
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