Aging Begins at 30

Multiple Sclerosis Treatment

Creation Date: July 2000
Last Revision Date: July 2000
Peer Review Status: Internally Peer Reviewed

In multiple sclerosis (MS) early treatment is essential to prevent relapses that cause progressive worsening. Spontaneous recovery of specific symptoms is rare when they are over 6 months old.

MS is scattered damage to the nervous system, affecting two million young adults worldwide, mostly women. Sclerosis means hardening or scarring. It damages the nervous system progressively with a fluctuating course, causing general decline over 40 years. Symptoms vary from blurred vision to paralysis. Fatigue is almost universal. MS appears to be an autoimnune disease with scattered attacks on the nervous system as a foreign invader. There is a genetic element with increases in identical twins and MS patients' children. Also an environmental effect, perhaps a virus, but not any specific one. Bad signs are, progressive MS from the beginning, trouble with muscle weakness, balance or coordination, a short interval between the first of two relapses, slow recovery from a relapse and many separate MRI areas of brain abnormality at onset.

Six new developments help. 1. A similar disease is produced in mice by injecting myelin (nerve wrapping insulation) protein. (Experimental Autoimmune Encephalitis or EAE) that can be transferred to others by activated immune cells. It is used to screen possible treatments. 2. A standard nomenclature adopted for the four main MS subdivisions. (relapsing-remitting, the most common; secondary progressive -50% over time; primary progressive (10%) mostly late onset age 40 to 60 and progressive relapsing, the least common. 3. A disability status score for severity. 4. New understanding of T cell activation, chemical messengers and neurological tissue changes so treatment can be targeted. 5. Therapeutic trials by the Canadian and U.S. MS Societies. 6. Serial MRI (nervous system imaging) with gadolinium enhancement.

The FDA has approved interferon beta la (Avonex or Rebifin Europe), interferon Ib (Betaseron) and glatiramer acetate (Copaxone) for patients with relapsing remitting MS.

Methylprednisolone (a cortisone derivative) IV 3-5 days followed by oral treatment tapered over l2 days is useful in treating optic neuritis (a common precursor of MS) reducing the later onset of MS by 50%. It is the mainstay for acute MS relapses.

Interferon beta Ib is the choice for relapsing-remitting MS, given subcutaneously every other day (up to 5 years) reducing relapses by 31%. Those that occurred were half as severe. MRI lesions in treated patients increased 6% in contrast to 17% with placebo. Interferon Beta la given weekly by IM injection slowed the progression to disability and its severity. MRI lesions decreased by 32%. Higher doses may be more effective. These interferons have flu-like side effects for 2 days.

Glatiramer acetate a mixture of polypeptides mimicking myelin, delays the onset of EAE in mice. It lowered the annual relapse rate by 29% and lessened disability but the MRI scores changed little (but useful for the relapsing-remitting patient resistant to interferon beta). Azothioprine, a general immunity suppressant, reduces relapses but does not slow disability. IV immune globulin may decrease disability.

In progressive MS, treatment is by general immune suppression with methotrexate, cyclophosphamide or cyclosporine. Cyclophosphamide has many side effects. Kidney toxicity and hypertension are common with cyclosporine. European trials suggest that interferon beta 1b is effective in treating progressive MS.

We need to know the cause of the disease to correctly direct our treatment.

Skeptical physicians and patients are however beginning to be optimistic.

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See related Patient Topics Bones, Joints and Muscles, Brain and Nervous System or Multiple Sclerosis.

See related Provider Topics Bones, Joints and Muscles, Brain and Nervous System or Multiple Sclerosis.

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