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Waging the Battle Against Multiple Sclerosis

Consider just 15 years ago the picture of Multiple Sclerosis. We didn't know what caused the disease, we didn't have specific treatments for the disease, there was no cure, and the symptoms were unpredictable. When the first treatment, Interferon Beta-1B was approved under accelerated review by the FDA, it could not be manufactured fast enough, so persons with MS were put into a lottery system. If their number was chosen, they were able to start treatment. If they were not so lucky, it would be another two to three years before the makers would catch up to the demand and four years before another MS drug, Glatiramer Acetate, would be available. Patients, however, didn't give up hope, and neither did researchers.

Currently there are over 400,000 persons with MS in the United States and about 30 new patients are diagnosed every day. There are about 2.5 million people with MS worldwide. One of the best outcomes to the ongoing study of MS was the knowledge dissemination to healthcare providers.
Diagnosis was hard to come by as the symptoms are so varied, but with increased education, it is now considered at least a possibility if not fully recognized at onset, and referrals to MS Centers are expedited. Ongoing monitoring of the patient, even after the first attack is vitally important as there can be "silent" disease progression in which the person is having new lesions develop without symptoms. It is for this reason that the primary care physician collaborate with a neurologist specializing in MS treatment for optimal patient outcomes.

Symptoms which should prompt the primary care physician to consider MS includes unexplained fatigue with heat sensitivity, a sudden tingling sensation occurring in an extremity and progressing or intensifying for several days before calming down, weakness in one or more limbs, either self-limited or ongoing, problems with balance and incoordination, and visual blurriness. Vision changes in MS are unique in that symptoms can include some intermittent blurriness to visual loss. Optic Neuritis, in which the optic nerve becomes inflamed, is a risk factor for MS, and as many as 25 percent go on to develop MS despite no brain lesions. Many local ophthalmologists are now advising MRI when finding ON in their patients, to promote early diagnosis.

Diagnosis occurs in three parts; the features of the clinical symptoms; diagnostic testing including MRI's of the brain and cervical spine, and laboratory testing to rule out any other possible causes of the symptoms (such as SLE, Sjogren, Lyme disease, etc.). MRI remains the gold standard to identify active lesions and to trend disease progression. There are certainly other causes of lesions appearing in the brain (including B12 deficiency, migraine history and hypertension) which is why MRI results are considered in conjunction with symptoms, and laboratory testing. Lumbar puncture for spinal fluid analysis also helps to confirm those cases that do not meet criteria for diagnosing MS but remain suspicious, as well as those whose symptoms require further investigation.

There are now five therapies approved for Relapsing-Remitting disease. Four of the first line disease modifying agents (Interferon Beta 1B, Interferon Beta 1A, Glatiramer Acetate, and
Interferon Beta 1A high dose) slow progression by reducing relapse rates by about 30 percent. These medications are all subcutaneous or intramuscular injections given anywhere from three to seven days per week. The fifth medication, Natulizamab also modifies the immune system. It is a monoclonal antibody which reduces relapse rates even further. There is the potential for severe adverse reactions so that it is reserved for those with Relapsing-Remitting disease who fail the other therapies. For those patients with worsening MS, Mitoxantrone can be given, but there are limitations to this therapy due to its cardiotoxicity as well as lifetime limit.

Through ongoing research we are finding more ways to slow the progression of the disease. There are four oral agents currently in clinical trials. This will be the first time an approved treatment for MS is not an injection. Canadian researchers are also evaluating a vaccine for its effectiveness in reducing relapse and disability in patients with Multiple Sclerosis.

One recent study showed the importance of early treatment. Research shows that the earlier treatment is begun, the less disease progression and disability for the patient. It is extremely important to have patients with an initial diagnosis be seen by a neurologist with an expertise in MS.

Affiliated with Orlando Health, all staff at MS Comprehensive Care Center have expertise in MS and utilize state of the art facilities to treat acute exacerbations.

Stephen Rosenberg, MD received his medical degree and did his internship and neurology residency in the University of Pennsylvania system. After 10 years as the Co-Director of the Brain Injury Rehabilitation Center in Orlando he combined his rehabilitation skills with his career long subspecialty interest in multiple sclerosis by joining Victor Robert, MD in the creation of the Multiple Sclerosis Comprehensive Care Center. Dr. Rosenberg is on the teaching faculty of Orlando Regional Medical Center and the University of Florida Medical School. He is board certified in neurology and neuro-rehabilitation and is a Fellow of the American Academy of Neurology.

Debbie Chandler has been a registered nurse for over 25 years and a nurse practitioner for the last 15 years. She received her Master's of Science in nursing at the University of Florida and is currently a Doctoral student at the University of Central Florida. Debbie has worked in Neurology since January 2000. She is a member of the Florida Nurses Association and Sigma Theta Tau Nursing Honor Society.

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