Every day we get lots and lots of questions about the MS (Multiple sclerosis). So we decided to turn to one of the best experts in the field, Dr David Snyder who is the Director of the Multiple Sclerosis Center at the New York Hospital in Queens. I believe most of your questions will be answered. As an added tool in researching MS, you can check out
It seems that we hear more and more about people who suffer with MS. Who is at risk for developing this condition? Should there be a national screening protocol for MS?
You are hearing more about MS because our ability to effectively diagnose it at an early stage has improved. Furthermore, prominent characters (fictional and otherwise) like Montel Williams and the "president" on the TV show "The West Wing" have pheightened awareness of the disease. Other the factors that have made MS more prominent include a young activist patient (and family) population, and the National MS Society, which is one of the best-run disease-specific organizations in the country. Finally, the availability of specific therapy over the past 12+ years has also been a major factor. MS may not be curable, but it is definitely treatable.
The disease most commonly starts from the late teens to the 30’s and 40’s. MS in both the pediatric age group as well those in their 50’s and 60’s and beyond also occurs. Indeed, the MS Society is now focusing on strengthening pediatric MS centers around the country. There is a genetic predisposition to developing MS, e.g. the child of someone with MS has a significantly greater chance of developing MS than someone who has no relatives with MS. However, exposure to an environmental agent at a young age is also important in the sequence of events felt to be necessary before this autoimmune disease develops. It is important to note that MS is seen in greater numbers in women — in New York State, the ratio of women to men is 3:1.
Widespread screening for MS would not seem to make sense at this point given the expense, diagnostic challenges, and the lack of data regarding treatment when the only support for the diagnosis would presumably be a positive test (i.e. the patient never had symptoms but has a suggestive MRI). I do foresee the day when we have diagnostic studies that are easier and less expensive to obtain, and we have medication that will arrest the process. In that situation, screening of the at-risk population would certainly make sense. Right now, increasing awareness of MS is very important so that people are cognizant of the kinds of problems and symptoms it can cause. An early referral to a physician familiar with this disease is very important.
What are the latest diagnostic tests to pick up early MS?
The diagnosis of MS is based first and foremost on the patient’s history and neurological examination. Having said that, MRI studies of the brain and spinal cord have added critical corroborative information. There is increasing emphasis on the MRI data, and this has allowed us to start treating patients at an earlier point in their disease. Researchers are actively looking for biomarkers of the disease, but at this point there are no specific blood or urine tests. Spinal fluid studies may yield important adjunctive information in some patients.
What are the latest treatment modalities and how are other countries dealing with the treatment of MS?
The current treatment modalities include three drugs that are forms of Interferon, which is a naturally occurring protein that serves an important role in the human immune system. In particular, forms of Beta Interferon have been shown to slow the disease course of MS. Another drug, glatiramer acetate, has a chemical make-up that appears to mimic a fragment of myelin, the insulation around the nerve axon. This medication may, among other actions, ‘deflect’ the immune system of someone with MS and thus spare the myelin present in the brain and spinal cord of those people. These four drugs are approved for treatment of relapsing-remitting MS, which is the most common presentation of this disease. They are all injectable medications usually administered by the patients themselves.
Natalizumab (Tysabri®) has just been approved for re-release by the FDA for treatment of relapsing-remitting MS. This is an antibody that interferes with the ability of inflammatory white cells to get into the brain of someone with MS. By blocking the passage of white cells, it is hoped that there will be less damage and less neurological disability. Natalizumab was taken off the market for about one year after 3 patients (out of about 2000) developed a serious, usually fatal, neurological complication. This was investigated and the drug has been re-released with certain safeguards and restrictions. It is given intravenously every 4 weeks. It represents a class of drugs (monoclonal antibodies) that offers great promise for MS and other auto-immune diseases.
A fifth FDA-approved drug for MS is mitoxantrone that is given intravenously every 3 months for two years. It serves to suppress the immune system and is used for those with later, progressive disease.
Except perhaps for Natalizumab, these medications are generally available around the world. They are, however, very expensive (more than a $1000 per month) and coverage for them by insurance companies and state-run healthcare systems around the world is variable.
What does the future look like? Will regenerative medicine play a role in the treatment of MS?
The treatment era of MS is just 12-13 years old. A tremendous amount of research is underway, and I would be very optimistic about our ability to significantly slow or even arrest this disease over the next decade. Reversing the damage caused by MS is another matter, but that too is receiving a great deal of attention. Stem cell therapy may play an important role in this, as well as therapy aimed at stimulating the bodies own ability to regenerate axons and myelin.
Are the children of patients with MS are at risk of getting the disease?
The primary relatives of somebody who has MS have a 20-fold increase of getting MS. But that doesn't mean they will get it. What that means is that they are genetically predisposed to potentially get it. The absolute chance of getting it is 2 or 3 in 100. There has to be something in the environment one is exposed to in order to develop MS later in life. The sequence starts in childhood.
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Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. Click here for more information on Dr. Manny's work with Hackensack University Medical Center. Visit AskDrManny.com for more.