Hello, jt1967!
Thank you for your patience while I put this answer together. I
wanted to make sure I covered the most recent research on treatments
for Multiple Sclerosis so that I would avoid duplicating information
you likely already know.
Since MS has so many symptoms that can progress and worsen over time,
many of the references may deal with only one or two symptoms. I have
included some "cutting-edge" therapies that are still in the clinical
stage. Finally, it was hard to restrict the search to just the
"progressive relapsing/remitting" stage of MS, since many of these
treatments are applicable through various stages of the disease.
Although I am sure you are very familiar with resources concerning
MS, a good overview of the stages, current treatments and the recent
research is available in the following recorded interview from
Healthtalk Interactive:
"Symptom Management, Treatment Options and Research Updates." Guest:
Anthony Reder, MD, Kevin McCoyd, MD, Joy Wagner, RN, BSN . (Recorded
May 22, 2003) HealthTalk Interactive.
http://www.healthtalk.com/msen/052203/052203.pdf
==============================================
NEWER DRUG TREATMENTS/INVESTIGATIONS/THERAPIES
==============================================
CAMPATH (ALEMTUZUMAB) TO SLOW DISEASE PROGRESSION AND REDUCE BRAIN
INFLAMMATION
================================================================================
"Participants Sought At Multiple Sites For Clinical Trial Testing
Campath® In Early, Active Relapsing-Remitting MS." National. Multiple
Sclerosis Society Research Bulletins.
(June 11, 2003)
http://www.nationalmssociety.org/Research-2003June11.asp
Summary: "Participants are being enrolled for a new clinical trial
getting under way in the U.S. and Europe, testing the ability of
CAMPATH®, an immune-suppressing monoclonal antibody also called
alemtuzumab, to slow disease progression and reduce brain inflammation
in early, active relapsing-remitting MS."
"The primary objective of the study is to determine efficacy of
CAMPATH compared with Rebif in slowing time to sustained accumulation
of disability, frequency of relapses, and accumulation of brain
lesions seen with MRI. Additional objectives are to determine
comparative safety and tolerability."
"Over the past decade, investigators at Cambridge University in the
U.K. have used CAMPATH to treat MS, using a variety of doses and
delivery schedules, and on different forms of MS. They have reported
positive effects on brain lesions detected by MRI, on controlling
immune function and on reducing disease relapses, and in some cases
actually reversing disability. In spite of short-term worsening of MS
symptoms upon initiation of CAMPATH (which is treated by
pre-medication with steroids), and the development of thyroid disease
in about 25-30% of treated patients (see "Safety Consideration,"
below), these early studies have encouraged the investigators to study
CAMPATH more intensively in individuals with early, active MS to
better determine its safety and efficacy in controlling inflammatory
responses and hopefully slowing progression of disability."
==
"Early Use of Campath in MS May Decrease Disability," by Larry
Schuster. Medscape Medical News.(April 3, 2003)
http://www.medscape.com/viewarticle/451858
"Campath-1H (alemtuzumab) virtually stops episodes and decreases the
disability of early-stage multiple sclerosis (MS), according to a
small open-label study."
"The effect is only seen when the drug, a humanized monoclonal
antibody that depletes T cells, is given in the early
relapsing-remitting stage of the disease, Alastair Compston, PhD,
FRCP, chairman of the department of neurology, Cambridge University,
U.K., told attendees of the American Academy of Neurology 55th annual
meeting, "when clinical disease activity is attributable to
inflammation."
(Read More....)
ENHANCING MEMORY WITH ARICEPT
=============================
"ARICEPT® SHOWS POTENTIAL TO IMPROVE MEMORY IN MS." National. Multiple
Sclerosis Society Research Bulletins. (April 4, 2003)
http://www.nationalmssociety.org/Research-2003Apr4.asp
Excerpt:
Summary:"A new study showed that the oral medication Aricept®
(donepezil hydrochloride, Pfizer, Inc.) modestly improved performance
on a memory test in individuals with multiple sclerosis."
"Researchers are investigating whether Aricept - a drug shown to
improve memory in Alzheimer’s disease - can improve memory in MS. 35
subjects taking Aricept showed significantly greater improvements on a
memory test, and according to clinician and patient reports, than 34
subjects taking placebo. Larger studies are needed to confirm the
safety and benefits of this medication for improving memory in MS."
Conclusions: "This study, although small, suggests that Aricept may
have the potential to modestly improve memory function in individuals
with MS who have mild to moderate cognitive impairment. However, it
is not clear to what extent this improvement would have an impact on
daily activities. Larger studies are needed to confirm the safety and
benefits of this medication for improving memory in MS."
ZOCOR MAY REDUCE NEW MRI-DETECTED BRAIN LESIONS
===============================================
"EARLY STUDY FINDS ORAL CHOLESTEROL DRUG ZOCOR® SAFE FOR MS; LARGER
STUDIES NEEDED." National Multiple Sclerosis Society Research
Bulletins. (April 1, 2003)
http://www.nationalmssociety.org/Research-2003Apr1.asp
"Summary: A small clinical trial was done of the oral
cholesterol-lowering drug Zocor® in 30 individuals with
relapsing-remitting MS:
"Zocor appeared to reduce the number of new MRI-detected brain lesions
over the six-month treatment period, and demonstrated other signs of
possible benefit;
Previous studies have suggested that this and other statin drugs can
alter immune responses in a way that may be beneficial for treating
MS;
Larger, controlled trials will be required to determine the drug’s
safety and effectiveness against MS; such trials are in planning
stages."
Results:"Preliminary analysis of the results indicates a significant
(43%) decrease in the mean number of new lesions, and in the volume of
new lesions. No serious adverse events related to treatment occurred.
Analysis of immune responses suggested a positive shift away from
inflammation, but there were no differences observed in neurological
status or disability in this short study."
Conclusions: "This small study, indicating possible benefit on lesion
development and immune activity, shows promising results for Zocor in
treating people with relapsing-remitting MS."
BETASERON FOR REDUCING RELAPSE RATE AND POTENTIAL REDUCTION OF BRAIN
LESIONS
============================================================================
"FDA Extends Approval Of Betaseron® To "Relapsing Forms Of MS,"
Including Secondary-Progressive MS With Relapses." National Multiple
Sclerosis Society Research Bulletins.
(March 19, 2003)
http://www.nationalmssociety.org/Research-2003Mar19.asp
"..significant benefit with treatment was seen in several secondary
outcomes, including reduced relapse rate and reduced steroid use for
relapses. There was also reduced accumulation of new brain lesions and
of persistent lesions detected by MRI."
Conclusions: "The FDA’s approval of extending labeling of Betaseron to
treat relapsing forms of MS means that individuals with
secondary-progressive MS who experience relapses now have a new
treatment option."
==
Also read "MS Study Explores Effects of Increasing Dose and Frequency
of Beta Interferon Therapy." (March 17, 2003)
http://www.betaseron.com/betas/rel2003/20030315.jsp
AVONEX CAN DELAY THE ONSET OF A SECOND ATTACK
=============================================
"FDA Extends Avonex® Labeling To Include Those Experiencing First
Attack and Having MRI Suggestive of MS." National Multiple Sclerosis
Society Research Bulletins. (February 7, 2003)
http://www.nationalmssociety.org/Research-2003Feb7.asp
Conclusions: "Research suggests that damage to brain and spinal cord
tissues can occur early in the disease course of multiple sclerosis.
These data show that use of Avonex after a single demyelinating attack
in people with multiple brain lesions can delay onset of a second
attack and thus of clinically definite MS. Thus, the FDA’s approval of
expanded labeling of Avonex supports earliest treatment which many
believe may forestall the development of permanent clinical
disabilities. This is also a signal to physicians and third-party
insurers that this is an appropriate treatment for individuals with
this condition."
POSSIBLE VIRAL CAUSE OF MS AND ANTIBIOTIC THERAPY
==================================================
"Antibiotic treatment trial directed against C. pneumoniae in MS".
Current Funded Research/Tennessee. National Multiple Sclerosis
Society.
http://www.nationalmssociety.org/Research-Sriram2.asp
(Research funded through 2004)
"In previous Society-funded research, Subramaniam Sriram, MD, has
observed a possible association between Chlamydia pneumoniae (a
bacterium that causes a mild form of pneumonia) and the development of
MS. It has not been proven, however, whether this or any other
bacterium or virus actually triggers the disease."
"If therapies used for C. pneumoniae infection are effective in
treating MS, this may help determine the role of this bacterium. Dr.
Sriram is administering antibiotics used to treat C. pneumoniae to 20
people with relapsing-remitting MS. Two centers are involved in
conducting the trial. A third center will analyze the results using
magnetic resonance imaging (MRI), to determine if antibiotic therapy
alters the development of lesions (areas of damage). The results will
be compared with 20 people who are taking inactive placebo."
"If Dr. Sriram finds antibiotics to have an influence on MS in this
small study, his findings may lead to a larger and more definitive
study of this treatment alternative. Further study may also clarify
the role of C. pneumoniae in the development of MS."
ANTEGREN MAY REDUCE RELAPSES
=============================
"Promising Results Published From Clinical Trial Of Antegren In MS."
National Multiple Sclerosis Society Research Bulletins. (January 2,
2003)
http://www.nationalmssociety.org/Research-2003Jan2.asp
Summary: 'Promising results from an early-phase clinical trial of the
monoclonal antibody natalizumab (Antegren®; Biogen Inc., Cambridge MA
and Elan Corporation, PLC, Dublin) in relapsing forms of MS were
recently published:
"Those treated with Antegren by monthly intravenous infusions for 6
months had fewer new 'enhancing' MRI lesions than those treated with
placebo, and treated patients had fewer relapses. No benefit on
progression of disability was detected in this short study.
Antegren functions by blocking the adhesion of immune cells to blood
vessels and can inhibit movement of immune cells from the bloodstream
into the brain.'
"Conclusion: This short-term clinical trial showed promising results
for an agent that appears to have a highly specific - and different -
mode of action than currently available treatments. This study
demonstrates that targeting movement of immune cells into the central
nervous system is a reasonable approach to treatment of MS."
==
From "Symptom Management, Treatment Options and Research Updates."
Multiple Sclerosis Education Network. (May 22, 2003)
http://www.healthtalk.com/msen/052203/07.html
"The ongoing studies right now that I think are interesting [are on] a
drug called Antegren. It's an antibody that binds to a special type of
T cell which is a white blood cell that gets up into the brain and
causes trouble in MS. These are the activated memory cells that have
this protein on their surfaces. The antibody, which is the drug, binds
to that protein and doesn't allow the cells to get up into the brain.
[Medical editor’s note: Antegren, also called natalizumab, is a
monoclonal antibody that binds with a specialized T cell in such a way
as to prevent the migration of the T cell across what is called the
blood-brain barrier. It is necessary for the T cells to migrate into
the brain to produce the damage in MS.]
CANNABIS MAY EASE SYMPTOMS AND SLOW DEGENERATIVE PROCESS
========================================================
Abstract - "Cannabinoids inhibit neurodegeneration in models of
multiple sclerosis." Pryce G, Ahmed Z, Hankey DJ, Jackson SJ, Croxford
JL, Pocock JM, Ledent C, Petzold A, Thompson AJ, Giovannoni G, Cuzner
ML, Baker D. Brain (July 2003)
http://brain.oupjournals.org/cgi/content/abstract/awg224v1
(full text article may be bought at
http://brain.oupjournals.org/cgi/reprint/awg224v1
As shown in an animal model of MS:
"Therefore, in addition to symptom management, cannabis may also slow
the neurodegenerative processes that ultimately lead to chronic
disability in multiple sclerosis and probably other diseases.
PULSED ELECTROMAGNETIC THERAPY MAY HELP EASE SYMPTOMS
=====================================================
"Effects of a pulsed electromagnetic therapy on multiple sclerosis
fatigue and quality of life: a double-blind, placebo controlled
trial," by Lappin MS, Lawrie FW, Richards TL, Kramer ED. Altern Ther
Health Med. 2003 Jul-Aug;9(4):38-48.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12868251&dopt=Abstract
Excerpt from Abstract:
"This study is a follow-up to a placebo controlled pilot study in
which multiple sclerosis (MS) patients exposed to weak, extremely low
frequency pulsed electromagnetic fields showed significant
improvements on a composite symptom measure."
CONCLUSIONS: "Evidence from this randomized, double-bind, placebo
controlled trial is consistent with results from smaller studies
suggesting that exposure to pulsing, weak electromagnetic fields can
alleviate symptoms of MS. The clinical effects were small, however,
and need to be replicated. Additional research is also needed to
examine the possibility that ambulatory patients and patients taking
interferons for their MS may be most responsive to this kind of
treatment.
AN OVERVIEW OF SOME CURRENT TREATMENTS FOR VARIOUS STAGES OF MS
===============================================================
From "Perfect Pitch: Fine-tuning the Management of Multiple Sclerosis"
By Patricia K. Coyle, MD (March 31, 2003)
http://www.medscape.com/viewarticle/447692_3
The following section of the article may be found at
http://www.medscape.com/viewprogram/2201
Treatment of Secondary Progressive MS Without Relapse
=====================================================
"Data to support treatment of patients with secondary progressive MS
without relapses are mixed. The European study of IFN beta-1b found
treatment to be quite effective in patients with secondary progressive
MS, with or without relapses.[27] No other study has been as
convincingly positive. The International MS Secondary Progressive
Avonex Controlled Trial (IMPACT), using double-dose IM IFN beta-1a,
documented a treatment effect on progression as measured by the MS
functional composite (MSFC) (25-foot timed walk, 9-hole peg test,
Paced Auditory Serial Addition Test [PASAT]), but not on the EDSS.[28]
However, the only significant effect on the MSFC was in the 9-hole peg
test component. Neither the North American IFN beta-1b study nor the
SC IFN beta-1a Secondary Progressive Efficacy Clinical Trial of
Recombinant IFN beta-1a in MS (SPECTRIMS) trial showed an effect on
progression based on EDSS.[29,30]
"Despite the discrepancies in the effect of treatment on EDSS
progression, all the trials of treatments for secondary progressive MS
have shown benefits in suppressing superimposed relapses, and on MRI
(T2 lesion burden, Gd+ lesions) parameters. The only DMT approved for
secondary progressive MS in the United States is the immunosuppressor
mitoxantrone. Because of concerns about cardiotoxicity, this drug can
only be used up to a lifetime maximum of 140 mg/m2 (about 11 doses).
The pivotal mitoxantrone in MS (MIMS) trial entered 194 patients who
had relapsing and secondary progressive MS with or without relapses,
but participants were randomized to 1 of 3 treatment arms,[31] and
thus, no statement about statistical significance of treatment is
possible with regard to the group of patients with secondary
progressive MS without relapses."
Treatment of Primary Progressive MS
===================================
"There is no proven treatment for primary progressive MS. The recent
phase 3 trial of glatiramer acetate (GA), the PROMISE trial, did not
find a treatment benefit on progression. Although the drug was well
tolerated, neither placebo- nor GA-treated patients deteriorated at
the rate predicted from natural history studies. Two phase 2 trials of
IFN beta in primary progressive MS have proved disappointing; 1
suggested modest benefits on secondary outcomes, the other was almost
uniformly negative.[32,33] An ongoing phase 2 trial of mitoxantrone
has not yet reported any results."
"Thus, based on available evidence, use of DMT cannot be endorsed for
patients with either secondary progressive MS without relapses or
those with primary progressive MS, who together may account for 25% of
all patients with MS. At the same time, a case can be made for
treatment benefit in patients who have secondary progressive MS with
Gd+ activity on MRI, who have worsened by greater than 1 EDSS point in
the previous 2 years, or who are temporally close to their relapsing
phase. In addition, a benefit of DMT, especially over the long term,
has not been disproven for primary progressive MS."
References Cited:
http://www.medscape.com/viewarticle/447692_9
OVERVIEW OF SOME "NOVEL TREATMENTS" FOR MS
===========================================
The following information is from "Perfect Pitch: Fine-tuning the
Management of Multiple Sclerosis" By Patricia K. Coyle, MD (March 31,
2003)
http://www.medscape.com/viewprogram/2201
The following excerpts may be found at
http://www.medscape.com/viewarticle/447692_7
NATALIZUMAB:
"Natalizumab, a humanized monoclonal antibody directed against alpha 4
integrins, blocks lymphocyte binding to endothelium and cell migration
into the CNS. There are 2 ongoing phase 3 trials in relapsing MS."
BONE MARROW TRANSPLANTATION:
"At least 3 different groups are evaluating bone marrow
transplantation to treat severe MS. Radiation and chemotherapy are
used to ablate the host immune system, and then stem cells are infused
to reconstitute a new healthy immune system. To minimize morbidity and
mortality rates, autologous stem cells from the MS patient are
harvested before treatment and later infused back. Although in theory
allogenic healthy control stem cells are preferable, they involve the
risk of graft vs host disease, with greater morbidity and mortality.
Even autologous bone marrow transplantation carries a risk of death.
To be considered successful, transplantation will have to stabilize
patients for very prolonged periods and provide much better results
than intensive drug immunosuppression."
STATIN DRUGS
MINOCYCLINE:
"Another attractive, well-tolerated oral agent is minocycline. This
oxytetracycline also has a number of immune effects that would be
expected to benefit MS, including inhibition of matrix
metalloproteinases, inducible nitric oxide synthase, caspases, tumor
necrosis factor, and microglial activation, as well as induction of T
helper 1 to T helper 2 immune deviation. Minocycline treatment lessens
clinical and pathologic severity of EAE, with less CNS inflammation,
demyelination, and microglial activation.[44] Preliminary studies are
ongoing in relapsing MS."
SEX HORMONES
"Sex hormones are another novel treatment strategy. The most studied
in connection with MS are the estrogens. In a single-center safety
trial, oral estriol at 8 mg daily was well tolerated (menstrual cycle
disruption was the only notable side effect) and appeared to benefit 6
women with relapsing MS. While on treatment, they showed reduced
numbers and volume of contrast brain MRI lesions and stable T2 lesion
volume. When taken off treatment, MRI activity increased, only to
decrease again when estriol was reinstituted.[45] A phase 2
multicenter trial is planned."
PPAR LIGANDS:
Peroxisome proliferation-activated receptors (PPARs) are nuclear
hormone receptors that regulate adipocyte differentiation and gene
transcription. There are alpha, delta, and gamma isotypes. Oral PPAR
ligands are being evaluated for treatment of diabetes. These drugs
have multiple actions, including anti-inflammatory microglial effects,
inhibition of T-cell activation and proliferation, and enhancement of
myelin gene expression.[46] The PPAR ligand pioglitazone, as well as
other PPAR ligands, have been shown to prevent or reduce severity of
EAE.
GLUTAMATE RECEPTOR ANTAGONISTS:
"A number of studies suggest that glutamate excitotoxicity is a damage
mechanism in MS.[47] In a recent report, riluzole treatment decreased
development of cervical spinal cord atrophy and brain T1 hypointense
lesions in patients with primary progressive MS.[48] Riluzole and
other glutamate receptor antagonists may have a role in treating MS,
but further studies are needed to confirm this role."
CNS REPAIR:
"CNS repair strategies are growing as a therapeutic focus, because
they can theoretically restore function and improve fixed damage. As
noted, many approaches are under development. One approach is to use
neurotrophic factors to boost remyelination, preserve or restore
neurons and oligodendrocytes, and protect or regenerate axons. Both
ciliary neurotrophic factor and leukemia inhibitory factor can
alleviate EAE. They may be helpful to promote oligodendrocyte survival
in patients with MS."
STEROIDS:
"Recent studies suggest that glucocorticoids may have an impact on the
MS disease process. In a single-center phase 2 trial, patients with
relapsing MS were randomized to either receive regular pulses of
intravenous steroids or only be treated at the time of relapse. At 5
years, the pulse steroid-treated patients showed less disability,
brain atrophy, and T1 brain lesion load compared with those in the
control group, who received steroids only for acute relapses.[49]
Another small study evaluated brain lesions detected on monthly MRI
scans of 4 patients with relapsing MS. Lesions showed the least
permanent tissue damage (as measured by magnetic transfer ratio) when
patients were treated with steroids.[50] The greatest tissue damage
was noted in untreated lesions, while moderate damage was noted in
lesions that occurred in IFN beta-treated patients. However, because
complications involved with long-term steroid use may be significant,
the role of steroids in management of MS needs further study, in terms
of both safety and efficacy."
http://www.medscape.com/viewarticle/447692_8
References Cited:
http://www.medscape.com/viewarticle/447692_9
==
Also Read:
"In Search of Better Therapies for MS." by Rohit Bakshi, MD (April
2003)
http://www.medscape.com/viewarticle/453292
"Corticosteroids or ACTH for acute exacerbations in multiple
sclerosis," by Filippini G, Brusaferri F, Sibley WA, Citterio A,
Ciucci G, Midgard R, Candelise L. From Cochrane Review Abstracts
(Posted 04/01/2003)
http://www.medscape.com/viewarticle/454353
"Natalizumab Useful in Autoimmune Disease," by Laurie Barclay, MD.
Medscape Medical News. (Jan. 2, 2003)
http://www.medscape.com/viewarticle/447304 )
"Statin Appears Promising for MS," by Larry Schuster. Medscape Medical
News.
(April 2, 2003)
http://www.medscape.com/viewarticle/451781
STEM CELLS
==========
Several MEDLINE Abstracts are available under the following reference:
Stem Cell Transplants for Multiple Sclerosis. From Medscape Neurology
& Neurosurgery (Posted 10/29/2002)
http://www.medscape.com/viewarticle/441708
"Hematopoietic Stem Cell Transplantation for Multiple Sclerosis: A
Retrospective Multicenter Study", by Fassas AS, Passweg JR,
Anagnostopoulos A, et al. J Neurol. 2002;249:1088-1097
http://www.medscape.com/viewarticle/441708
Patients: "Eighty-five patients with progressive MS were treated with
autologous HSCT in 20 centers and reported to the autoimmune disease
working party of the European Group for Blood and Marrow
Transplantation (EBMT)."
Results: "The stem cell source was bone marrow in 6 and peripheral
blood in 79, and stem cells were mobilized into peripheral blood using
either cyclophosphamide combined with growth factors or growth factors
alone. Three patients experienced transient neurological complications
during the mobilization phase. The high dose regimen included
combination chemotherapy, with or without anti-lymphocyte antibodies
or, with or without, total body irradiation. The stem cell transplants
were purged of lymphocytes in 52 patients. Median follow-up was 16
[3-59] months. There were 7 deaths, 5 due to toxicity and infectious
complications, 2 with neurological deterioration. The risk of death of
any cause at 3 years was 10 (+/-7)% (95 % confidence interval).
Neurological deterioration during transplant was observed in 22
patients; this was transient in most but was associated with MS
progression in 6 patients. Neurological improvement by >/= 1 point in
the EDSS score was seen in 18 (21 %) patients. Confirmed
progression-free survival was 74 (+/-12)% at 3 years being 66 (+/-23)%
in patients with primary progressive MS but higher in patients with
secondary progressive or relapsing-remitting MS, 78 (+/-13)%; p =
0.59. The probability of confirmed disease progression was 20
(+/-11)%. MRI data were available in 78 patients before transplant
showing disease activity (gadolinium enhancing, new or enlarging
lesions) in 33 %. Posttransplant MRI showed activity at any time in
5/61 (8 %) evaluable cases."
Conclusion: "Autologous HSCT suggest positive early results in the
management of progressive MS and is feasible. These multicentre data
suggest an association with significant mortality risks especially in
some patient groups and are being utilised in the planning of future
trials to reduce transplant related mortality."
===
A QUESTION AND ANSWER
=====================
From "Suggested Management of a Patient With Secondary Progressive
Multiple Sclerosis." From Medscape Neurology & Neurosurgery. (Posted
05/13/2003)
http://www.medscape.com/viewarticle/453702
Question (from Dr. Sharfuddin, United Kingdom)
"What management strategy would you suggest for a patient with
secondary progressive multiple sclerosis (SPMS) with clinical relapses
and gadolinium-enhanced brainstem and cerebellar lesions on MRI? The
clinical deficits are mild -- with Kurtzke Expanded Disability Status
Scale (EDSS) of 2 and cardiomyopathy with good left ventricular
function. She is on interferon beta-1a, 44 micrograms 3 times a week.
Response from Mark S. Freedman, MD, 05/13/2003:
"The diagnosis of SPMS in this patient might be a bit of a problem, as
patients with this form of multiple sclerosis (MS) usually do not
present with "mild" deficits. Most SPMS patients would, by definition,
have progressed, usually in motor/cerebellar functions, to an EDSS of
3.5 or greater -- the minimum inclusion criterion for all SPMS
studies."
"More likely, this patient has relapsing remitting multiple sclerosis
but is not experiencing complete recovery from relapses. Hence it
appears that she is "progressing." It is not easy at times to discern
"progression" from the accumulated deficits of relapses, especially
early on."
"Patients do not respond to interferons for many reasons. If the
patient has been treated with an interferon for at least 6 months and
continues to suffer relapses and multiple enhancing lesions, then it
would appear that she is not responding well. She could be a poor
responder or a poor healer. She also might have developed neutralizing
antibodies to interferon (these can be measured). Finally, she might
have a poor prognosis with accumulated disease that presents a larger
burden than the routine disease-modifying drugs can handle."
"So, in escalating beyond the disease-modifying drugs, one would
consider mitoxantrone for this patient. Because of the patient's
cardiac condition and the cardiac toxicities possible with this agent,
however, its use would likely be contraindicated, but a cardiologist's
opinion should be sought before therapy with mitoxantrone is ruled
out."
"The alternative would be to use another immunosuppressive regimen.
Before the availability of mitoxantrone, we used the Harvard regimen
with great success. The regimen consists of 1 g of intravenous
methylprednisolone daily for 5 days; on day 4 the first dose of
cyclophosphamide is added, at 800 mg/m2. For the first year, the
regimen of 1 g methylprednisolone together with cyclophosphamide is
given every 4 weeks, with the cyclophosphamide dose adjusted to
produce a white blood cell count nadir of ~1.5 x 109/L. It is rare to
increase the cyclophosphamide dose above 1400 mg/m2. In the second
year this regimen is administered every 6 weeks, and then every 8
weeks the third year. By the end of the third year, maximal doses of
cyclophosphamide will have been reached. This regimen is detailed in
published reports.[1]"
ALTERNATIVE THERAPIES TO HELP "EASE THE SYMPTOMS" OF MS
=======================================================
The following natural therapies are not new but may help to ease the
symptoms of multiple sclerosis for certain individuals.
From "Multiple sclerosis and alternative therapies." Disability
Online. Last reviewed: 30/06/2002
http://www.disability.vic.gov.au/dsonline/dsarticles.nsf/pages/Multiple_sclerosis_and_alternative_therapies?OpenDocument
Excerpts:
Acupuncture:
"Acupuncture can help ease MS-related pain and reduce the severity of
muscle spasms."
Massage
"Regular massages can help a person with MS to better manage muscle
pain."
Yoga:
"Yoga can help relieve stress, because concentrating on the postures
and breathing acts as a powerful form of meditation. The gentle
sustained stretches also help to improve flexibility and reduce muscle
stiffness."
Chiropractic:
"Back pain is a common problem for people with MS, exacerbated by
weakened leg muscles. Chiropractic practice is recognised as one of
the most effective treatments for back pain and injury."
Meditation:
"Meditation is a powerful stress management therapy."
Evening primrose oil and fish oil supplements:
"Some studies suggest that evening primrose oil and fish oil
supplements can measurably reduce the severity and length of an MS
attack. However, these supplements don't seem to influence the
frequency of attacks."
Dubious therapies:
"The following alternative therapies, which are alleged to help people
with MS, have been shown through clinical testing to be ineffective:
Replacing mercury dental fillings -
"Mercury in dental fillings has been incorrectly blamed for causing
MS. This claim was made because mercury poisoning affects the brain
and can cause symptoms similar to MS, such as muscle tremors."
Hyperbaric oxygen therapy -
"This means inhaling oxygen under pressure. Studies around the world
have found that hyperbaric oxygen therapy has no effect on either MS
symptoms or disease progression."
Vitamin supplements -
"High doses of vitamin or mineral supplements have no demonstrable
influence on MS."
Special diets -
"There is no evidence that dietary factors contribute to the
development of MS. Like anyone else, a person with MS should eat a
well-balanced high fibre, low fat diet that includes fresh fruits,
vegetables, cereals, lean meats and dairy products."
===
The Rocky Mountain MS Center at
http://www.ms-cam.org/CAMbanner.htm
has an entire site devoted to alternative therapies that may help with
MS. You can subscribe for free and look through all the alternatives
listed on the left column.
A SCIENTIFIC REVIEW OF SELECT ALTERNATIVE THERAPIES
===================================================
"Complementary and alternative therapies for treating multiple
sclerosis symptoms: a systematic review," by Huntley A, Ernst E.
Department of Complementary Medicine, School of Postgraduate Medicine
and Health Sciences, University of Exeter, Exeter, UK. Complement Ther
Med. 2000 Jun;8(2):97-105.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=10859602
Abstract:
"Multiple sclerosis (MS) is a chronic disease of the central nervous
system without a known cure. Thus the role of complementary and
alternative therapies (CATs) for the management of symptoms lies in
palliative care and this is borne out by the popularity of these
treatments amongst MS sufferers.This review is aimed at determining
whether this use is supported by evidence of effectiveness from
rigorous clinical trials. Database literature searches were performed
and papers were extracted in a pre-defined manner.Twelve randomized
controlled trials were located that investigated a CAT for MS:
nutritional therapy (4), massage (1), Feldenkrais bodywork (1),
reflexology (1), magnetic field therapy (2), neural therapy (1) and
psychological counselling (2).The evidence is not compelling for any
of these therapies, with many trials suffering from significant
methodological flaws. There is evidence to suggest some benefit of
nutritional therapy for the physical symptoms of MS. Magnetic field
therapy and neural therapy appear to have a short-term beneficial
effect on the physical symptoms of MS. Massage/bodywork and
psychological counselling seem to improve depression, anxiety and
self-esteem. The effectiveness for other CATs is unproven at this
time. In all the CATs examined further investigations are needed in
the form of rigorous large-scale trials."
===
A website recommendation:
One very comprehensive website that may be of interest to you, which
seems to have everything all in "one place" is the Noah Website at
http://www.noah-health.org/english/illness/neuro/muscler.html
==
A book recommendation:
"Alternative Medicine and Multiple Sclerosis," by Allen C. Bowling,
M.D.,Ph.D.
Read a review on the Demos Medical Publishing website:
http://www.demosmedpub.com/book88.html
==
I hope the information I have provided is helpful and provides some
interesting resources. If you need further clarification, please do
not hesitate to ask and I will be happy to help if I can!
umiat-ga
Google Search Strategy
progressive relapsing remitting multiple sclerosis AND innovative
treatments
+alternative +therapies for "multiple sclerosis"
PubMed Search http://www.ncbi.nih.gov/entrez/query.fcgi
Multiple Sclerosis
Multiple Sclerosis therapy
Medscape Search http://www.medscape.com/medscapetodayhome
Multiple Sclerosis |
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