TZPSS Articles | Health | Multiple Sclerosis

Health

TZPSS
science

Topics Front Page

Knowledge has power.

Health Science

Multiple Sclerosis

An estimated 400,000 Americans have MS. Every week,
about 200 people in the United States are diagnosed with the
disease. But many are managing their symptoms and staving
off debilitation with medications.

Today, five FDA-approved treatments to lessen the likelihood
of MS attacks are on the market. Three of them also slow the
progression of disability in this often- incapacitating disease.

Signs and Symptoms of Multiple Sclerosis
Multiple Sclerosis is a non-contagious, lifelong chronic disease
that causes symptoms such as weakness, muscle stiffness,
poor coordination and balance, tingling, numbness, tremors,
blurred vision, and slurred speech. About half of all people
with MS also experience memory and concentration problems.

The first symptom can be loss of vision in one eye, because
of inflammation of the optic nerve (optic neuritis). And
treatment with steroids usually is able to restore the sight.
Then a few years later, the second symptom appears such
asnumbness and tingling in one leg.

Forms of Multiple Sclerosis
Experts recognize three main forms of Multiple Sclerosis. In
its most common form--relapsing-remitting--an attack, or
relapse, is followed by a period of decreased or no symptoms
(remission) until the next flare-up.

A second form of Multiple
Sclerosis--primary-progressive--brings on a gradual decline
and disability without specific attacks. In the third
form--secondary-progressive--multiple sclerosis starts out
as relapsing-remitting but eventually takes on a course of
gradual progressive disability with few or no relapses.

Research indicates that despite disability, most people with
multiple sclerosis have a life expectancy only a few years
shorter than normal.

Causes of Multiple Sclerosis
The exact cause of multiple sclerosis is unknown. Genetic
predisposition and Gender seem to play a role. Women are
more commonly affected than men.

In a healthy individual, nerve fibers act like electrical cables,
transmitting electrical impulses, or messages, at high speeds
between the brain, the spinal cord, and the rest of the body.
The fibers are insulated by a fatty coating called myelin.

In a person with multiple sclerosis, the immune system
appears to attack the brain and spinal cord. This attack
inflames random patches of plaques, causing lesions that
destroy the nerve-protecting myelin. Scar tissue replaces the
myelin, a process known as demyelination. When electrical
impulses zip through the nerve fibers and reach the scarred
areas, they "short circuit," slowing or preventing
communication.

The loss of myelin disrupts the way we receive signals, the
way we give commands to our muscles to allow us to move,
and the integrating activity that the brain and spinal cord
needs to process sensory and motor movement information
to allow us to function normally.

Diagnosing Multiple Sclerosis
It is difficult to diagnose this disease.

Until recently, to meet the diagnostic criteria for multiple
sclerosis, a person must have had two separate attacks at
least a month apart and in different parts of the body. But
early on in the disease process, some people have infrequent
relapses or symptoms so mild that they might not recognize
a second attack.

Recent advances in technology, particularly magnetic
resonance imaging (MRI), a non-invasive form of taking
pictures of the brain to detect multiple sclerosis lesions, have
aided physicians in diagnosing people with multiple sclerosis.

One of the frustrations for newly diagnosed patients is the
uncertainty of living with a potentially debilitating disease.
The variability of the disease from person to person makes
giving an individual prognosis for multiple sclerosis very, very
uncertain.

Relapses also are variable. When they strike, how long they
last, and what organs or functions they affect differ from
person to person.

Temperature changes may trigger a worsening of symptoms
in some individuals. This effect is usually reversible when the
temperature returns to normal, but it can sometimes be
confused for a clinical relapse. Some people are sensitive to
heat, but others are more sensitive to cold.

Treatment
The FDA has approved six drugs to treat MS, all injections.
They cannot reverse the damage already caused by the
disease, but they can help prevent relapses and further
damage. In addition, a number of oral drugs can help alleviate
some of the symptoms, such as fatigue, bladder infections,
constipation, pain, depression, and involuntary jerking
movements (spasticity).

The most recently approved MS drug, Tysabri
(natalizumab), was licensed by the FDA in November 2004
to reduce the frequency of multiple sclerosis (MS) attacks in
people with relapsing forms of MS. In February 2005, the
drug manufacturer, Biogen Idec Inc., voluntarily suspended
marketing of Tysabri because of two serious adverse events,
including one death, reported with its use. A rare brain
disease, progressive multifocal leukoencephalopathy (PML),
was confirmed in two people with MS who had been taking
Tysabri for more than two years.

PML can occur in people whose immune systems are
suppressed. It often results in irreversible neurologic
deterioration and death. Although the relationship, if any,
between Tysabri and PML is not clear, the FDA concurred with
the manufacturer that it voluntarily withdraw the drug from
the market because of the serious nature of PML. The FDA
has also prohibited new clinical trials with Tysabri until more
information is available.

No previous cases of PML had been reported in the roughly
3,000 people who took Tysabri in clinical trials. The two
people who developed PML were taking the drug in
post-marketing studies required by the FDA.

People who were being treated with Tysabri should contact
their physicians to discuss other treatments that may be
appropriate. The FDA is working with the manufacturer to
determine the best methods for assessing those who have
received Tysabri in order to assure their safety and
understand the connection, if any, between Tysabri and PML.

Four other treatments for people with relapsing MS are
approved for lifelong use by the FDA: Avonex, Betaseron,
and Rebif (beta interferons), and Copaxone (glatiramer
acetate), a synthetic drug. All of these drugs reduce the
frequency of MS attacks by influencing the activity of the
immune system. In addition, Avonex and Rebif may slow
down the rate of physical disability.

Each of the four drugs can be injected by the patient at
home and each is used at regular intervals, ranging from
once a day to once a week. Common side effects of the three
interferon drugs are flu-like symptoms and reactions at the
area of injection. Copaxone may trigger a short-term reaction
that includes flushing, chest pain, heart palpitations, anxiety,
and shortness of breath.

Another drug, Novantrone (mitoxantrone), is approved
for people with secondary-progressive MS or those with
rapidly worsening relapsing-remitting MS. This IV cancer
chemotherapy drug is given in a medical facility. By
suppressing the immune system, the drug may reduce new
lesions, decrease relapses, and slow down the rate of
disability. Because of the serious side effect of heart damage,
Novantrone is restricted to use in an individual no more than
four times a year for up to three years.

Each of these drugs is different and they cost different
amounts. Some patients may be responsive to only one or
two drug(s).

Patients with progressive multiple sclerosis can often benefit
from rehabilitation therapies such as exercise, nutritional
guidance, and psychological support to increase coping and
adapting skills plus deal better with depression. Most people
learn to recognize that quality of life is more related to having
good relationships and feeling productive than running a
100-yard dash."

Doctors advise people with all forms of multiple sclerosis to
get enough rest, eat healthily, not smoke, and to exercise
regularly.

Importance of Early Treatment
Earlier treatment may have changed the course of the
disease. Exercise with cautions is important.

Content Credit FDA Consumer Magazine. March-April 2005 Issue

MEDICAL NOTES