October 28th, 2011
12:25 PM ET
Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.
Asked by Kayla in North Carolina:
Hi, I got multiple sclerosis about a year ago, and I'm very young. I was curious if there has been any further information about a possible cure or not. I know that people have been searching for a cure, but I'm curious as to how close they really are.
Multiple sclerosis is a neurologic disease that affects women more often than men. Onset is most commonly in the 20s or 30s.
MS is an autoimmune disease in which there is initially focal inflammation and then permanent damage to nerves of the central nervous system. The damage is really removal of the insulating material surrounding nerves. The tissue that insulates nerves is called myelin, and the damage is referred to as demyelination.
As a nerve that controls sensation or movement of a part of the body loses some of its myelin covering, the nerve may become dysfunctional. This can manifest itself as loss of that nerves function which can be sensation, vision, movement or coordination of movement. Affected sensory nerves can also cause pain.
There have been tremendous advances in our ability to diagnose and assess MS with the development of magnetic resonance imaging. Unfortunately, our understanding of the cause of this disease remains limited, as does our ability to treat it. There is some limited success in stopping or decreasing the severity of an MS attack. We would also like to stimulate a regrowth of the damaged myelin over the nerve. Unfortunately, this is not possible at this time.
There are several types of MS. Some patients have disease that will have an acute exacerbation followed by a prolonged quiet period, which can last years or decades. This form of disease is referred to as relapsed remitting MS, or RRMS. Others have a disease that gets progressively worse over time. There are two types of progressive disease. In primary progressive MS, or PPMS, symptoms steadily worsen over time from the very beginning. Secondary progressive MS, known as SPMS, begins as relapsed remitting disease and becomes progressive over time.
For an acute exacerbation of multiple sclerosis that can result in neurologic symptoms and increased disability or impairments in vision, strength or coordination, the preferred initial treatment is usually a type of steroid called a glucocorticoid. Patients who do not have a good response to steroidal therapy are often treated with plasma exchange. Plasma exchange is an extreme therapy that removes antibodies to myelin from the blood.
Patients with RRMS are often treated with immune-modulating drugs such as interferon or glatiramer acetate. Glatiramer is an exciting drug. It is a series of small proteins that are similar to myelin protein. It is thought to prompt the immune system to avoid attacking myelin.
Available treatments of primary and secondary progressive MS are of limited efficacy and have significant side effects. An additional fact to consider is that most trials have not lasted longer than two or three years and give only hints about long-term results of treatment.
In brief, no clinical trial has shown convincing evidence of benefit in the treatment of primary progressive MS. All suggested treatments for PPMS are empiric. Several drugs that are more commonly used in the treatment of malignancy, cladribine and mitozantrone, appear to have some activity.
In contrast, there is definite modest benefit in some treatments for secondary progressive MS. These treatments include various regimens of steroid therapy and the use of some drugs that modulate the immune system. Many of these drugs are more commonly used in treatment of cancer and rheumatoid arthritis such as cyclophosphamide, methotrexate and interferon.
MS should be treated by a neurologist with experience in managing it. The American Academy of Neurology has published treatment guidelines for MS.
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