Circa 2009-10
Multiple sclerosis (MS) is one of more than 80 diseases known as autoimmune disorders. Other notable autoimmune disorders include Systemic Lupus Erythematosis (“lupus” or “SLE”) and Rheumatoid Arthritis (RA). These diseases operate by “confusing” a person’s immune system and attacking healthy cells within the body.
Treatment of autoimmune disorders is tricky, particularly since the human immune system is among the least understood of all systems in the body. Aiding a patient with an autoimmune disorder requires suppressing his immune system to diminish attacks against his body’s cells. Too much suppression of the immune system, however, can allow other diseases to flourish. A wide variety of medications, new and old, are used to treat autoimmune diseases, and are often administered in combination with one another. All of these medications suppress some aspect of a patient’s immunity.
The ideal medication option for treatment of autoimmune disorder would suppress only that part of the patient’s immune system that is attacking the particular cell type in question. Unfortunately, no such treatment is presently available to the population at large. New drugs tend to be either experimental or expensive, making these sorts of treatment options difficult to access.
In cases of MS, the immune system attacks cells that produce myelin, a fatty substance that wraps around nerves in the brain and spinal cord. Myelin functions similarly to insulation on an electrical wire—when it is destroyed, nerves are seriously affected. (Don’t try to investigate this comparison by stripping the insulation on the wires in your house!)
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MS attacks come and go, but in general, the disease is a progressive one. Full recovery from an attack is rare and severity of attacks is variable from instance to instance and from patient to patient, as different areas of the brain and spinal cord are affected during each attack. Medical students learning about MS are taught to look for lesions separated in time and space, the latter being defined as space within the central nervous system (CNS, i.e., the brain and spinal cord) and the former referring to the time between manifestation of lesions. Lesions produced by MS occur in different locations during each episode, resulting in a variety of symptoms.
Fortunately, new medications are available for treatment of MS. Some feature exciting characteristics, like capacity for oral administration and a profound impact on the symptoms of the disease. Copaxone®, or glatiramer acetate, is one such medication. It has even been speculated that these drugs may prove beneficial in treatment of other conditions that affect myelin-producing cells, such as spinal cord injury. Much of the destruction of myelin-producing cells after a spinal cord injury is due to inflammation (an immune system response) commonly associated with traumatic injury.
It is not too surprising, then, that scientists have hypothesized that drugs like Copaxone could be useful for spinal cord injury patients—a theory they have tested by introducing the drug to mice. With a team of colleagues, V. Wee Yong, MD, Professor in the Departments of Clinical Neurosciences and Oncology at The University of Calgary, published results of just such experimentation in The Proceedings of the National Academy of Sciences. In their study, Yong and his team of researchers found that the myelin cells that are attacked in cases of MS grew better in injured mice that were treated with Copaxone than they did in a control group of injured mice that did not receive such treatment.
Young’s research illustrates that Capaxone demonstrates an ability to temper damage to myelin cells caused by inflammation, a medical discovery which could prove beneficial to a wide spread of patients confronted with spinal cord injury and MS. Such discoveries are the tiny “steps for man” (or mouse) that slowly lead to “giant leaps for mankind.” Though most of these tiny steps are rarely reported on by news media, they occur in scientific study all of the time.
Though such developments in science may seem promising, it remains very important to keep these advancements in perspective. Medications such as Capaxone have not placed us on the verge of miracles. For example, it remains unrealistic to assume that Capaxone and similar treatments will allow persons with spinal cord injuries to walk. Nevertheless, this scientific development does indicate some small measure of progress. And we all have to crawl before we can run.
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CURRENT TREATMENT OF MULTIPLE SCLEROSIS
Few drugs have been developed and approved to combat the effects of a malfunctioning immune system on normal or transplanted organs. Use of medications for treatment of autoimmune disorders is a delicate balancing act, since such medications function by suppressing the immune system and make the patient’s body vulnerable to infections.
An old standby for the treatment of MS is the introduction of potent anti-inflammatory steroids into a patient’s system, although this method has a lengthy list of dangerous and unpleasant side effects if the steroids are used for a prolonged period.
Newer medications fall under the categories of immune system suppressors or immune system modulators. Recent experience suggests that combinations of these drugs on various dose and time schedules may provide better results than previous available options. Typically an MS attack is best treated first with an immunopressant agent—such as steroids or another, more recently developed, anti-inflammatory medication.
Once the acute inflammatory phase of the MS attack has subsided, drugs that modify or modulate specific activities of the immune system can come into play. These combinations of drugs for MS are referred to as Disease Modifying Treatments (DMTs). DMT’s are intended to halt the long-term progression of the disease.
A popular combination of drugs that make up one DMT is referred to as “ABC.” In this acronym, the “A” stands for Avonex (Interferon Beta-1a), which is given by injection into a muscle once a week, typically for several weeks. The “B” stands for Betaseron (Inteferon Beta1b). It is given by injection under the skin every other day in escalating doses over a span of six weeks. Finally, the “C” denotes a newer drug called Copaxone, which is glatiramer acetate. It is injected under the skin every day for a duration determined by a doctor on a case-by-case basis.
In addition to DMTs, other medications exist to address specific symptoms of the disease. For example, painful tightness in muscles (resulting from nerve damage associated with MS) can be alleviated by utilization of a type of Botox, though this Botox is not the same as that which is used to smooth wrinkles. Botox treatment for MS can be given in a single maximum dose that is rationed among the affected muscles every few months.
by Thomas Chappell, MD
