January 6, 2004
Dr Allen Douma
Q. I'm a 49-year-old woman, and about three years ago, I was diagnosed with multiple sclerosis. Already, I have numbness of my legs, which comes and goes. I've tried the immune shots, but the only thing they did was cause some liver damage. What else can I do? -L.R., Canton, Ohio
A. Nerve fibers in the brain and spinal cord are wrapped in an insulating sheath made of myelin. When the myelin sheath is damaged, nerves don't function correctly.
Damage can result in many symptoms, including muscle weakness, dizziness, fatigue, numbness and tingling, and a variety of visual problems. Any of these symptoms can show up, then disappear.
For years, it has been suspected that the Epstein-Barr virus is responsible. This is the virus that causes mononucleosis. But another recent study found that pertussis, the virus that causes whooping cough, causes an MS- like disease in mice.
MS symptoms usually start at the age of 20 to 40 years. They occur more commonly in women and more often in people who spend the first 10 years of their lives in temperate climates. The disease is more often diagnosed in people in their 30s rather than 40s. But diagnosis is often delayed by many years because the early symptoms can be mild and go away quickly.
There seems to be a relationship between the pace at which symptoms increase and how bad they finally become.
An MRI is the most sensitive diagnostic technique. PET scans are also good at detecting abnormalities in demyelinating diseases such as MS and in the future may provide better data than MRIs do.
Corticosteroids like prednisone have been used for decades to relieve acute symptoms, but they do have negative side effects and don't seem to have much impact on long-term outcomes.
There are two types of drugs used primarily to treat MS. I presume that interferon is the immune drug you are referring to. You might want to try the other drug, glatiramer. Even though these drugs decrease brain lesions, they have not been successful in slowing the development of disability.
Mitoxantrone, a drug used in treating cancer, has recently been shown to help when used to treat patients with the more aggressive form, called progressive MS. But it has major side effects, which the benefits may not outweigh.
One of the most recent drugs tested, natalizumab, showed a dramatic drop in new brain lesions. But it's not been tested long enough to determine the effect on symptoms and disability.
Experts have recently suggested MS is four or more different diseases,
which would explain why most people are not helped by a single drug. Trying
a second type of drug when one fails would be a reasonable option. And
using two types of drugs at the same time may work for some.
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