Multiple Sclerosis Treatment

Treatment 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. Statins, particularly Simvastatin (the cholesterol lowering agent), has shown a moderate effect on MRI testing of treated MS patients. 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.

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Neurological Disease

Multiple Sclerosis

Disclaimer

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References

1. Z Liu et al. J Neuroimmunol 2001 Jan 1;112(1-2): 153-162.

2. C Liu et al J Neurol Sci 2000 Dec. 1; 181(1-2): 33-37.

3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 180.

6. Dr. John Hooge: "New therapis in MS" at the 50th Annual St. Paul's Hospital Continuing Medical Education Conference for Primary Physicians, Nov. 16 - 19, 2004

Last Modified: Dec. 15, 2004