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M
ind Over Matter
 

MS: An Early Treatment Strategy Worth Considering

© Barry Bittman MD

The following is one in an ongoing series of columns entitled Mind Over Matter by Barry Bittman MD. View all columns in series
Just when it didn’t seem like there was much on the research horizon for individuals with Multiple Sclerosis (MS), some promising news echoes a major breakthrough.

A recent study published in the September 2000 issue of the New England Journal of Medicine focuses on a novel treatment strategy that has great promise for thousands of people in our society. An international team of medical scientists at the State University of New York School of Medicine at Buffalo along with investigators at about 50 other U.S. and Canadian sites reported fascinating findings concerning a drug already in use that could make a substantial difference for individuals especially at a very early stage.

Prior to exploring the details that underscore this breakthrough, let's take a few moments to review some preliminary information about the disorder. MS is a central nervous system disease, affecting nerves (actually their insulation called myelin) in the white matter of the brain and spinal cord. The disorder surfaces when a person's immune system mounts an attack against its own myelin. Often affecting people in their twenties, the disease can actually manifest itself at any adult age. MS is unpredictable - it can flare up at any time. The diagnosis is often challenging as symptoms vary considerably from individual to individual.

Although a wide spectrum of initial presentations occur, common MS symptoms include, weakness, numbness, blurred or double vision, incoordination and loss of bladder control. Typically lasting weeks to months, individual flare-ups and symptoms vary considerably not only from person to person, but also within an individual who suffers multiple attacks over time.

Patterns of MS include a number of variations, the most common of which are the "exacerbating-remitting type" which results in flare-ups with returns to baseline, and the chronic-progressive type characterized by a flare-up or series of flare-ups that eventually lead to an ongoing progressive functional decline.

Treatment typically includes a short course of steroids for an acute attack, and immune modulating drugs which can sometimes aid in the prevention of flare-ups or slow the progression. The latter are typically not used early on as the diagnosis of MS requires the fulfillment of 2 specific criteria - both of which are based on the word "multiple." A clear-cut diagnosis requires multiple (more than one) flare-ups over time involving multiple anatomical locations. Now for the exciting part...

Getting back to the research, the research team tested 383 people utilizing interferon beta-1a, (Avonex), one of the standard immune agents in use by MS patients worldwide. Of particular note is the fact that for the first time, individuals were treated almost immediately after the first attack. To backtrack for a moment, the diagnosis of MS cannot be established with certainty until a second attack has occurred. Therefore, therapy was, in fact, started before the actual diagnosis could be clearly established.

In order to carefully control the experiment, volunteer subjects were randomized (divided into 2 groups) to receive either the real drug or a placebo. Subjects were included only after MRI (magnetic resonance) scans revealed 2 or more white matter lesions in their brains.

Of those who gave themselves weekly injections of Avonex, only one third developed MS symptoms within three years compared to half of those who injected the placebo during the same period. Beginning treatment within weeks of the first attack reduced the chances of developing MS symptoms by 44 percent within three years.

According to Dr. Lawrence Jacobs, professor of neurology at SUNY-Buffalo and head of neurology at Buffalo General Hospital, "Along with delaying the onset of MS, Avonex cut the number of new or actively inflamed lesions detected by MRIs by more than half, compared with patients in the comparison group. It also cut the total volume of such lesions in the nervous system by 91 percent over the comparison patients."

The study's investigators are highly recommending the early use of Avonex. They also believe individuals with "silent lesions" (not associated with symptoms yet appearing on MRI scans) representing approximately one fifth of the 350,000 MS patients in the US could benefit as well. It is also suggested that MRI scans be ordered early for any individual with symptoms that could be consistent with the disease.

While cost is always an issue, and MRI scans as well as Avonex injections are expensive, this neurologist strongly agrees with these recommendations. No doubt $10,000/year for Avonex is costly. However, from my perspective, the potential for disability and loss of quality of life for any person with MS clearly outweighs such cost-saving considerations.

In conclusion, these research findings represent a major advance that will enhance our ability to prevent the onset, or slow the progression of a potentially devastating disease process that impacts a great number of people in our society. It is a long-overdue breakthrough that holds great promise for enabling many people to continue to enjoy the gift of a healthy life. It is my hope that this is only the first of many giant steps in the field of MS research - Mind Over Matter!

© 2000 Barry Bittman, MD all rights reserved

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About The Author
Barry Bittman, MD is a neurologist, author, international speaker, award-winning producer/director and inventor. As CEO and Medical Director of the Mind-Body Wellness Center, a comprehensive, interdisciplinary outpatient medical facility in Meadville, PA., Dr. Bittman has pioneered a new paradigm for treating the “whole person.” Based upon extensive......more
 
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