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HOUSE CALL: Raising hope: The future of Multiple Sclerosis

 


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Multiple Sclerosis (MS) is an immune-mediated disease that affects the brain, nerves that connect the eyes to the brain, and spinal cord. Approximately 400,000 people in the U.S. have MS, which typically begins between the ages of 20 and 40 and is the leading cause of non-traumatic disability in young adults. 2011 was a remarkable year in MS. Here's a glimpse at some of the latest discoveries:

• Twenty-nine new genes that influence the risk of developing MS were identified.

• New criteria were established that allow for an earlier MS diagnosis.

• Researchers found that higher vitamin D levels in people with MS are associated with fewer new brain MRI lesions. * • Another study concluded vitamin D supplementation in combination with interferon (an MS medication) may be more effective than interferon alone. Studies are ongoing to conclusively determine if vitamin D supplementation is beneficial in MS.

• Research suggests individuals with MS who smoke may be more likely to develop disability. People with MS who smoke should definitely try to stop.

In 2008, a vascular surgeon, Dr. Paolo Zamboni, coined the phrase chronic cerebrospinal venous insufficiency (CCSVI) to describe a state of impaired drainage of blood from the brain and spinal cord due to narrow veins in people with MS.

He has speculated CCSVI might contribute to the cause of MS and surgery to improve blood flow might be a treatment for MS. Numerous studies in the past year have yielded conflicting results regarding the frequency of CCSVI in MS.


Some revealed no evidence of CCSVI while others reported CCSVI in healthy individuals. Research is ongoing to determine if CCSVI is related to MS. If an association is confirmed, a study to determine if surgical treatment of blocked veins is safe and effective should begin later this year.

Many people with MS experience symptoms on a daily basis. Proper identification and treatment of these symptoms often maximizes function and improves quality of life. Optimal management usually requires a combination of medication with other interventions, such as rehabilitation and exercise. The recent availability of several medications that improve some MS symptoms is a welcome advance.

Tremor can be disabling and one of the most difficult MS symptoms to treat. However, treatment with Botox was recently shown to be beneficial. Transient mild-moderate weakness was a common side effect.

There are currently eight FDA-approved MS disease-modifying therapies. Tysabri seems to be one of the most effective treatments. It has been used mainly as a second or third-line agent because it is associated with progressive multifocal leukoencephalopathy (PML), an untreatable and sometimes fatal viral illness of the brain. The recent availability of a blood test is helpful in identifying people treated with Tysabri who are at risk for developing PML and may aid treatment decisions.

Results for numerous new medications are promising. It's conceivable by 2013 there will be 11 FDA-approved disease-modifying therapies.

As promising as 2011 was in MS, we anticipate even greater advances in 2012.

 

Dr. Mark Tullman, is a neurologist at the MS Center for Innovations in Care on the campus of Missouri Baptist Medical Center. He also is a member of BJC Medical Group of Missouri. For referrals call 314-996-LIFE.

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