Coastal Neurological
Medical Group, Inc.

“The Savvy Patient”
Column # 59
Word Count – 500 (Word Limit is 500
Today’s Date: May 6, 2012
REVISED VERSION

“The Savvy Patient” – Scripps Experts Offer Insights to Help Guide Consumers

Early Diagnosis & Treatment May Reduce MS Relapses

By Dee Silver, M.D.

Multiple sclerosis (MS) is a chronic autoimmune disease that attacks the central nervous system. It affects approximately 400,000 people in the U.S., with another 200 diagnosed weekly.

MS attacks myelin, the protective coverings around nerve fibers, and sometimes the fibers themselves, disrupting nerve impulses along the central nervous system. MS may cause symptoms such as numbness, weakness, gait disturbances, cognitive and memory problems, speech disorders, vision problems and more.

Because MS is an episodic disease with relapses and remissions, symptoms can range in frequency and severity from one episode to the next. Because they symptoms are so diverse and may be caused by other factors, MS is not often immediately suspected. Generally, a neurologist diagnoses the disease though a physical examination and a brain MRI, which will show abnormal areas on the brain. Once MS is diagnosed, patients generally have a brain MRI every year to track the progress of the disease.

The cause of MS is still unknown. Treatment focuses on relieving symptoms and reducing the frequency of relapses. Historically, MS patients who receive no treatment have had an annual relapse rate of about 1.7, meaning they will have an average of 1.7 relapses or episodes per year. During the past two decades, dramatic improvements in treatment show promise in significantly reducing the relapse rate. Patients treated early do much better.

The standard foundation drugs, immunomodulators, were first given in the 1990s. They include interferons, such as Betaseron, Avonex and Rebif, and another immunomodulator, Copaxone. These drugs work by stopping the body from damaging its own nerve cells. In earlier clinical trials with these foundation drugs, the annual relapse rate dropped from 1.7 to about 0.7. While this alone is impressive, the patient population treated in these trials had been diagnosed five or six years earlier and had already shown a significant amount of myelin and nerve damage and brain abnormalities. Once researchers began treating very aggressively—for example, after a single episode with minimal changes on the brain MRI—the annual relapse rate was reduced to just 0.3. Immunomodulators may cause side effects, including flu-like symptoms and skin reactions for several days after treatment, and not all patients respond to or can tolerate them.

Tysabri, a newer immunosuppressant, prevents potentially damaging immune cells from reaching the brain and spinal cord, resulting in an annual relapse rate of 0.2 to 0.3. However, Tysabri may increase the risk of progressive multifocal leukoencephalopathy (PML), a rare and sometimes fatal viral disease. Patients must have a blood test to determine whether they have the antibodies that increase the risk of PML before being approved for Tysabri.

Gilenya, a newer immunomodulator, reduces the annual relapse rate to about 0.16. However, concerns have been raised that it may cause macular edema, cardiac abnormalities and deaths. Patients must have a history of varicella (chicken pox) or varicella immunization before using it.

With all of these medications, early diagnosis and treatment are vital to reducing the relapse rate, MRIs, and the progression of the disease.

Dee Silver, M.D., specializes in neurology with Scripps Health.

Refer a Friend

Coastal Neurological Medical Group
9850 Genesee Avenue
Suite 860
La Jolla, CA 92037
Tel: 858.453.3842
Fax: 858.535.9390

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