Multiple Sclerosis: Treatment Breakthroughs Improving Lives

Just 10 years ago, the daily routine for people with multiple sclerosis (MS) often included painful injections to treat debilitating symptoms, from vision and speech problems to complete paralysis.

While symptoms can still be severe for some patients, most people with MS live better, more active lives today. Early detection, the availability of novel therapeutic interventions and a multi-faceted approach to treatment have changed the way patients manage this life-changing and unpredictable disease.

“I think patients are, in general, living better with a higher quality of life,” said Andrew Lerman, M.D., clinical neurophysiologist with Baptist Health South Florida who treats MS patients, and a member of the Baptist Health Quality Network. “They’re being diagnosed earlier, and receive early intervention to prevent accumulation of effects of the disease. If you do not receive treatment, it is generally felt that you’re at a higher risk for further disability.”

Medications Slow Disease Progression

Major breakthroughs in medication administration and delivery, including oral medications, have occurred just within the past seven years. Three new oral MS medications are designed to slow disease progression and relieve symptoms early on. These breakthroughs were followed up last year with promising research on a new drug which appeared to repair nerve damage caused by MS during clinical trials.

MS affects the central nervous system – the brain and spinal cord — as well as optic nerves, and can impair basic functioning including balance, vision and muscle control. Some people are mildly affected and their symptoms controlled on medication, while others are severely affected, losing their ability to walk and perform basic tasks.

The Four Types of MS

There is no cure for MS, and the cause is still a mystery. However, researchers believe that people with a particular genetic makeup may be at increased risk, and environmental factors could put people at greater risk. Some patients may develop MS, or experience a relapse, after a viral infection like Epstein Barr or herpesvirus 6. Women are more likely to develop MS than men. Here are the four types of MS:

• Relapsing-remitting are attacks followed by periods of remission, in which the disease does not get worse. Most MS cases are relapsing-remitting.
• Progressive-relapsing attacks occur with or without a complete recovery or remission. The disease becomes progressively worse.
• Primary-progressive attacks become progressively worse with no periods of improvement. As many men as women develop primary-progressive MS.
• Secondary-progressive affects the majority of MS patients as the disease advances. Once relapsing-remitting, disease relapses don’t completely go away.

According to the National Multiple Sclerosis Society (NMSS), most people develop MS between the ages of 20 and 40, but children and people in their 70s can also get the disease. Because there is no single test for MS, it can be difficult to diagnose. However, methods of diagnosis have improved, Dr. Lerman said, with a combination of tests including high resolution MRIs, lumbar puncture (spinal tap) and other types of neurophysiological testing.

MS Symptoms

MS occurs when the patient’s immune system attacks protective material called myelin, which encases nerve fibers. Without myelin, the exposed nerve fibers are damaged and become dysfunctional. A mild attack could produce symptoms that improve over time. However, a severe attack causes scar tissue or plaque to form and may lead to permanent disability. The term “sclerosis” refers to this scarring of nerves that prevents the brain from communicating correctly with other parts of the body. This failure to send the right signals can cause symptoms including:

• Fatigue
• Muscle spasms or weakness
• Tingling and numbness
• Slurred speech
• Pain
• Impaired sexual functioning
• Problems with memory and focus
• Depression
• Difficulty walking
• Trouble controlling bladder and bowels

MS Treatment is Multi-Disciplinary

Treatment requires a multi-disciplinary approach, that can include medication, occupational, physical and speech therapies, depending on the mix of symptoms a patient experiences.

“Now that there are so many more available medications, it really has created a new approach unto itself,” Dr. Lerman said. “This provides practitioners ample choice to better match medication profiles to their patients’ preferences and co-morbidities, but also challenges us to be proficient in the use of all. “

The first oral medications designed to treat and prevent symptoms of “relapsing-remitting” MS were Tecfidera, which was approved by the U.S. Food and Drug Administration for use in 2013, Aubagio in 2012, and Gilenya, which gained approval in 2010. Other traditional drugs, including Copaxone and Rebif, are received through subcutaneous injections. Tysabri is administered as a once-monthly IV infusion.

“These medications don’t cure MS, but they definitely modify the disease course,” Dr. Lerman said.

Treatment of MS is not only focused on managing symptoms, but attempting to prevent a potentially devastating episode.

“It’s really about preventing that one critical event, where a plaque forms in a very critical location within the CNS and has detrimental and disabling consequences, like the spinal cord for instance,” Dr. Lerman said. “So the name of game is try and prevent one of those events from happening.”

Also part of effective maintenance are regular exercise (within comfortable limits), a healthy diet and managing stress and depression with rest, talk and group therapy.

“We’ve become better at disease modification,”Dr. Lerman said, “and our therapies have become more sophisticated and focused on treating the symptoms which impact on the patient’s life.”

Tags: Baptist Health Neuroscience Center, Multiple Sclerosis, neuroscience