MS Relapses: How to Deal with Them

Transcript:

ANNOUNCER: Multiple sclerosis occurs in about 2.5 million around the world. It's a disease that causes a wide variety of symptoms that can worsen over time.

FREDERICK MUNSCHAUER, MD: Multiple sclerosis is a disease characterized by inflammation of the brain or spinal cord. We actually don't know what causes multiple sclerosis, but it's important to recognize that the disease is an inflammatory disease. We do feel that it is probably autoimmune. Now what do we mean by that? An autoimmune disease is a disease where the body senses that a protein that is within the body is actually a protein that came from out of the body and the immune system tries to attack it and destroy it.

ANNOUNCER: In MS, the immune system attacks the coating around the nerves, called myelin.

VINCENT MACALUSO, MD: The myelin sheath is critical for the nerve conduction impulse to make it through the length of the nerve to the next nerve. When the body's immune system attacks this nerve and strips away the myelin, the impulse can no longer be conducted to the next nerve.

ANNOUNCER: Symptoms experienced by individuals with MS vary and are dependent on the location of inflammation in the nervous system.

VINCENT MACALUSO, MD: If it happens in your optic nerve, you get an optic neuritis and you get visual loss. If it happens low down in your spinal cord and it interrupts the reflex arc that controls your bladder, then you have bladder dysfunction.

FREDERICK MUNSCHAUER, MD: The majority of people with MS will experience bouts of symptoms either related to vision, coordination, strength, sensation, or bladder and bowel. And over time, those symptoms can accumulate. You may not completely heal from each one. And later on in MS, usually about five to ten years into the disease, some people may even have trouble just remembering things as quickly as they used to or being able to solve multiple problems simultaneously. MS rarely is a disease that causes frank dementia, but it can slow you down. You'll get the right answer, but it'll take you a little bit longer.

ANNOUNCER: Symptoms don't always lead right to a diagnosis of MS and can often be mistaken for other conditions. This is why a careful patient evaluation is necessary.

VINCENT MACALUSO, MD: When a patient comes to see me and they have some symptoms that they don't know what's going on, I try to elicit a history from them, and if I'm suspecting MS, I find out if they have intolerance to heat, if their symptoms come on and stay for a while and then go away, if they have trouble with their coordination in one limb, trouble with strength in another limb. Once I started hearing a history that could possibly go along with MS, then I do my neurological exam when the possibility of MS comes up, the number-one test that we use nowadays is MRI and we have the patient gets some gadolinium, which is an enhancer to show us inflammation in the central nervous system.

The nice thing about our technology is we've come to a point where sometimes, if the MRI shows a certain number of lesions that enhance, we have certain criteria called the McDonald criteria, that allow us to diagnose MS based on the history, the physical findings and the MRI.

Unfortunately, the MRI is not always conclusive and we have to use other tests to try to support the diagnosis. These other tests include lumbar puncture and other tests we call evoked responses.

ANNOUNCER: Once a diagnosis is made, action should be taken immediately.

VINCENT MACALUSO, MD: If you have come to a diagnosis of MS, the first thing that you want to do is get a person on therapy to help start slowing down the disease right away.

FREDERICK MUNSCHAUER, MD: We know now, from ten years of experience, that the earlier you diagnose and start treatment of multiple sclerosis, the better the long-term prognosis.

ANNOUNCER: There is no cure for MS but the treatments available can decrease the number of flare-ups by at least a third and slow the progression of the disease.

FREDERICK MUNSCHAUER, MD: We now have three classes of treatment options available for treating people with multiple sclerosis. We have the interferons, of which there are three commercial products -- Avonex, Betaseron and Rebif -- available, and we have Copaxone or glatiramer acetate, a separate classification. And, for those people who have severe, rapidly-progressive multiple sclerosis, we have a chemotherapeutic agent called Novantrone or mitoxantrone.

We know that the disease-modifying therapies, particularly interferons and Copaxone, decrease inflammation. And, in fact, early on in relapsing multiple sclerosis, there may be more inflammation more responsive to our current drugs than later on when the disease has progressed to secondarily progressive MS.

The early forms of the disease tend to respond better to all of our therapies and, therefore, therapy should be begun very early in the diagnosis of MS.

ANNOUNCER: And with the help of the MRI, doctors can keep careful watch of disease progression and make appropriate treatment decisions with their patients.

VINCENT MACALUSO, MD: If their disease seems to be progressing more rapidly, you can get a quantifiable reading of what their brain looks like by getting an MRI and how much activity there is going on and whether more immunosuppression is needed to help slow down the disease even more.

ANNOUNCER: Although the fight against MS is not over, technology and treatments have come a long way and continue to provide great strength in the battle.

VINCENT MACALUSO, MD: The important thing for somebody to keep in mind, if they've just been diagnosed with MS, is that we have made tremendous strides in the past ten years to come to slowing down the disease by at least a third

We've come so far so quickly, that a whole new world is opening up, and that you can never, ever lose hope that we're going to have a cure very soon.