Treatments for MS
For a growing portion of the estimated 431,000 people living with Multiple Sclerosis or “MS” in the U.S., no approved medications exist to manage the progression of their disease.
Dr. Ted Brown of EvergreenHealth's Multiple Sclerosis Center says advances are on the way.
We often hear about MS and a lot of us have known someone diagnosed with MS, but it is often confused with other conditions. What is MS in a nutshell?
Dr. Ted Brown: MS is a disease of the brain and spinal cord that is caused by an interaction between the immune system and the cells of the central nervous system.
Myelin, the lining of the nerve fibers, is the primary target of a misdirected immune attack.
MS causes weakness, visual problems and cognitive problems.
It is one of the most common neurological causes of disability in young people.
The prevalence of MS is higher in the U.S. than many places and Washington is among the states that are hardest hit by this disease.
What are the different types of MS and how do they vary in severity and prognosis?
Dr. Brown: For decades, we’ve recognized that people with MS may follow different courses over time. Some are relatively stable, some gradually worsen.
There are at least 4 different types of MS, but they follow 2 basic patterns:
Relapsing Remitting is the most common type of MS with attacks of symptoms like vertigo, numbness, difficulty walking and vision loss that develop over hours to days, peak and then subside over weeks to months.
In this form of MS, people are stable between attacks.
With Progressive MS, people slowly get worse becoming more physically and cognitively disabled over time without a clear link to attacks. These individuals may still experience an attack, but the disease progresses with or without attacks.
- Ten percent have progressive MS from the onset.
- About 2/3 of people who start with relapsing MS will transition to progressive disease in 15 years.
What’s new on the horizon for treating MS?
Dr. Brown: There are now 12 drugs approved to treat relapsing remitting MS now.
We still don’t have a drug that has been demonstrated to work in progressive forms of MS.
However, recent clinical trials and others that are ongoing have shown promising treatment advances for progressive MS. This includes:
- Drugs that affect the immune system but may directly or indirectly also treat progressive disease. This is being studied with approved drugs and a host of drugs in development.
- Drugs used for other indications, such as epilepsy, hypertension and high cholesterol are being studied for potential unrelated benefits in progressive MS.
- Antioxidant supplements that target free radicals are being studied for neuroprotective effects, including high-dose antioxidant trials in the USA and in France.
- Monoclonal antibodies are in clinical trials to target specific sites in the nervous system that may stimulate myelin producing cells or promote the repair of myelin damage.
- Stem cell studies are underway that involve infusions of precursor cells that may develop into myelin producing cells directly or improve the cellular environment to help cells in restoring myelin, a process called “remyelination.”
All of these treatments are still works in progress, but we should be seeing effective progressive MS treatments come into practice within the next 10 years.
What can people with Progressive MS do right now?
Dr. Brown: Some people with Progressive MS also need to take established MS drugs.
For this reason and for symptom management, it is important to follow up with health providers who treat MS.
As a rehabilitation doctor, I personally see exercise making a huge difference my patients.
- Being sedentary will cause deconditioning and worsen a variety of symptoms.
- Anyone with progressive MS needs to have a regular exercise program incorporating the strength that they have. They If they don’t have a program, then they should discuss it with their doctor.
- Don’t forget to exercise the brain too! – Read something every day, do puzzles, brain games or other thinking activities.
A healthy diet and exercise go hand in hand. We are still learning about the role of nutrition in MS, but, as a dietary rule of thumb, if it’s good for your heart, it’s probably good for your brain.
Smoking can worsen the course of MS, so I always encourage patients to quit smoking.