Multiple Sclerosis

An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted.  Many investigators believe MS to be an autoimmune disease -- one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus.Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye.  Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance.  These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis.  Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations.  Some may also experience pain.  Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked.  Depression is another common feature of MS.

Treatment

There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks.  However, three forms of beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting MS. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe.  The FDA also has approved a synthetic form of myelin basic protein, called copolymer I (Copaxone), for the treatment of relapsing-remitting MS. Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third.  Other FDA approved drugs to treat relapsing forms of MS in adults include teriflunomide and dimethyl fumarate.  An immunosuppressant treatment, Novantrone (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic MS.  The FDA has also approved dalfampridine (Ampyra) to improve walking in individuals with MS.One monoclonal antibody, natalizumab (Tysabri), was shown in clinical trials to significantly reduce the frequency of attacks in people with relapsing forms of MS and was approved for marketing by the U.S. Food and Drug Administration (FDA) in 2004.  However, in 2005 the drug’s manufacturer voluntarily suspended marketing of the drug after several reports of significant adverse events.  In 2006, the FDA again approved sale of the drug for MS but under strict treatment guidelines involving infusion centers where patients can be monitored by specially trained physicians. While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients.  Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers such as baclofen, tizanidine, diazepam, clonazepam, and dantrolene. Physical therapy and exercise can help preserve remaining function, and patients may find that various aids -- such as foot braces, canes, and walkers -- can help them remain independent and mobile.  Avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue.  If psychological symptoms of fatigue such as depression or apathy are evident, antidepressant medications may help.  Other drugs that may reduce fatigue in some, but not all, patients include amantadine (Symmetrel), pemoline (Cylert), and the still-experimental drug aminopyridine. Although improvement of optic symptoms usually occurs even without treatment, a short course of treatment with intravenous methylprednisolone (Solu-Medrol) followed by treatment with oral steroids is sometimes used.

Prognosis

A physician may diagnose MS in some patients soon after the onset of the illness. In others, however, doctors may not be able to readily identify the cause of the symptoms, leading to years of uncertainty and multiple diagnoses punctuated by baffling symptoms that mysteriously wax and wane.  The vast majority of patients are mildly affected, but in the worst cases, MS can render a person unable to write, speak, or walk.  MS is a disease with a natural tendency to remit spontaneously, for which there is no universally effective treatment.

Research

The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) conduct research in laboratories at the NIH and also support additional research through grants to major medical institutions across the country.  Scientists continue their extensive efforts to create new and better therapies for MS.  One of the most promising MS research areas involves naturally occurring antiviral proteins known as interferons. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe.  In addition, there are a number of treatments under investigation that may curtail attacks or improve function.  Over a dozen clinical trials testing potential therapies are underway, and additional new treatments are being devised and tested in animal models.In 2001, the National Academies/Institute of Medicine, a Federal technical and scientific advisory agency, prepared a strategic review of MS research. To read or download the National Academies/Institute of Medicine report, go to: "Multiple Sclerosis: Current Status and Strategies for the Future."

Organizations

Multiple Sclerosis Association of America
National, non-profit organization dedicated to enhancing the quality of life for those affected by multiple sclerosis. MSAA provides ongoing support and direct services to individuals with MS and their families and works to promote a greater understanding of the needs and challenges of those who face physical obstacles.

706 Haddonfield Road
Cherry Hill, NJ 08002
webmaster@msassociation.org
http://www.mymsaa.org
Tel: Cherry Hill
Fax: 856-661-9797

Multiple Sclerosis Foundation
Dedicated to helping people with MS, the Multiple Sclerosis Foundation offers a wide array of free services including: national toll-free support, educational programs, homecare services, support groups, assistive technology programs, publications, a comprehensive website, and more programs to improve the quality of life for those affected by MS.

6520 North Andrews Avenue
Ft. Lauderdale, FL 33309-2130
support@msfocus.org
http://www.msfocus.org
Tel: Ft. Lauderdale
Fax: 954-351-0630

Accelerated Cure Project for Multiple Sclerosis
National nonprofit organization dedicated to accelerating efforts toward a cure for MS. Researchers have access to online resources and the ACP Repository of highly characterized biosamples.

460 Totten Pond Rd. Suite 420
Waltham, MA 02451
info@acceleratedcure.org
http://www.acceleratedcure.org
Tel: Waltham
Fax: 781-487-0009

National Multiple Sclerosis Society
Funds research, helps families stay together, provides accurate and up-to-date information, helps with employment issues, offers free counseling, runs self-help groups, advocates for people with disabilities, and provides referrals to medical professionals.

733 Third Avenue
3rd Floor
New York, NY 10017-3288
ContactUsNMSS@nmss.org
http://www.nationalmssociety.org
Tel: New York
Fax: 212-986-7981

Content Provided By

NINDS Disorders is an index of neurological conditions provided by the National Institute of Neurological Disorders and Stroke. This valuable tool offers detailed descriptions, facts on treatment and prognosis, and patient organization contact information for over 500 identified neurological disorders.

Neurological Disorders and Stroke »