Multiple sclerosis occurs when immune cells target and destroy the myelin sheath that covers nerve cells in the brain and spinal cord, causing scarring that interferes with normal nerve-signal transmission. Depending on the location of the scarring, patients may suffer muscle spasms, vision loss, slurred speech, bladder, bowel or sexual dysfunction, dizziness, depression, numbness or tingling, cognitive problems and/or extreme fatigue.
Until recently, multiple sclerosis (MS) has been viewed as a debilitating disease that can condemn sufferers to wheelchairs and nursing homes.
Now: New studies at the renowned Mayo Clinic in Rochester, Minnesota, offer reason for optimism.
Background: Each year more than 10,000 Americans are diagnosed with MS, an inflammatory disorder of the central nervous system. About 90% of MS patients have the "relapsing-remitting" form, suffering intermittent attacks of symptoms such as difficulty walking, visual disturbances, numbness, tingling and memory loss. Flare-ups are sometimes separated by years, followed by full or partial recovery.
The remaining 10% of patients have "primary progressive" MS, which causes more continuous symptoms and a steady deterioration over a period of 10 to 20 years.
Researchers at Mayo Clinic have studied MS in Olmsted County Minnesota (population 100,000), for 100 years. We've literally gone door to door to identify every person in the county with MS—and for the past 25 years we have tracked the progression of the disease in more than 170 confirmed patients. This method allows us to study patients with absent or mild MS symptoms, who are often missing from clinic-based studies that use only patients whose disease is active.
Our findings for the 90% of patients with the relapsing-remitting form of MS…
- MS is benign in up to one-third of these patients, causing minimal or no disability even after decades. For reasons that are still under investigation, these patients seem to have an intrinsic ability to repair themselves following acute MS flare-ups.
Although there is no way to predict at the onset whether MS will prove benign or progressive, we do know that people who do not suffer disability, including deficits in fine motor skills and coordination and bowel and bladder problems during the first five years, have a less than 70% chance of seeing their condition worsen over the next 10 to 30 years.
- Another 50% of patients develop mild to moderate disabilities, such as arm and/or leg weakness, tingling and/or numbness and mild incoordination, but are still able to walk unassisted after 10 or more years with MS.
- Less than one-quarter of the patients with relapsing-remitting MS ultimately suffer significant declines in their ability to function. Even for these patients, medications can alleviate symptoms.
IS MEDICATION NECESSARY?
In 2005, a new medication that had shown significant promise in early clinical trials—reducing the incidence of MS flare-ups by as much as 67%—was linked to two deaths. As a result, the drug natalizumab (Tysabri) was abruptly recalled just three months after receiving FDA approval.
National Multiple Sclerosis Society (NMSS) guidelines call for all patients with relapsing-remitting MS to begin treatment with older drugs to slow the disease's progression when a diagnosis is made. Patients are diagnosed after suffering two isolated attacks at least one month apart that damage more than one area of the central nervous system myelin—the sheath that surrounds and protects nerve fibers.
Recall, however, that our studies show that for one-third of MS patients who have the relapsing- remitting form, there will be minimal or no disease progression, even without treatment. This is no small consideration. The disease-modifying drugs prescribed for MS, including glatiramer (Copaxone), can reduce the frequency of MS attacks by 30% but can cost more than $20,000 annually and may not be covered by insurance. They must be injected as often as every other day and can produce serious side effects, including nausea, vomiting, fatigue, muscle aches and liver damage.
DR. RODRIGUEZ'S VIEW
The NMSS and many experts in the MS field believe that MS demands early intervention with these powerful drugs because the disease is so unpredictable. Based on our new research, however, I recommend that newly diagnosed patients take a wait-and-see approach when considering medication. If the patient experiences more than two attacks a year or shows signs of neurological deterioration, such as deficits in coordination and fine motor skills, we will initiate drug therapy.
For patients who go years between flare-ups, recover fully from attacks and experience minimal or no disability, the cost and side effects of drug treatment may be more damaging than the disease itself. For patients with this type of benign or mild MS, self-care measures can help keep the disease in check. Key strategies...
- Reduce stress. Studies have shown that stress can compromise healthy immune functioning, increasing your risk for MS flare-ups. Get plenty of rest and adequate sleep, and practice daily relaxation exercises, such as deep breathing or meditation.
- Keep cool. Many MS patients are heat-sensitive. Increases in body temperature brought on by warm weather or physical activity exacerbate their symptoms. Studies suggest that lowering body temperature by a degree or two can help bolster nerve-signal transmission. This may help relieve fatigue and improve mental functioning and muscle strength in MS patients. Cooling can be achieved with special garments (vests, hats, scarfs, etc.) designed for people who work in high-heat conditions. For more information, contact the Multiple Sclerosis Cooling Foundation, www.mscooling.org.
- Take aspirin. In a Mayo Clinic trial, we showed that taking high-dose aspirin twice daily significantly improves MS symptoms.
Researchers are unsure of aspirin's mechanism but believe it may work by reducing body temperature.
- Exercise. While heat-sensitive patients may need to limit vigorous aerobic activity, research confirms that moderate exercise greatly improves mobility and mood in people with MS. Swimming is an ideal choice, because the water prevents overheating.
- Take vitamin D. Studies suggest that not getting enough vitamin D through sun exposure or diet—in foods such as milk or sardines—is a significant risk factor for MS. Aim to get 15 or 20 minutes of sun exposure daily, before applying sunblock. Or take a daily supplement that provides 400 international units (IU) of vitamin D.
Ample evidence supports the use of these lifestyle changes, combined with a healthy diet (and avoiding smoking and alcohol), to help slow or halt the progression of mild to moderate MS.
Others with more serious symptoms or emerging disabilities should practice these measures and take a disease-modifying drug, such as glatiramer, interferon beta-1a (Avonex, Rebif) or interferon beta-1b (Betaseron).
The immune-suppressing drug mitoxantrone (Novantrone) also has recently been approved for treating steadily worsening relapsing-remitting MS. But this drug should be used with caution, due to serious potential side effects, including aggressive leukemia or lymphoma. There is still no approved treatment for primary progressive MS.
ON THE HORIZON
New research suggests that estrogen and cholesterol-lowering drugs may prove useful in treating MS. In one small but promising study, the Alzheimer's drug donepezil (Aricept) improved memory in MS patients.