Multiple Sclerosis : Treatment and Research

by National Institute of Health

(Page 9 of 9)

As the disease progresses, some patients develop bladder malfunctions. Urinary problems are often the result of infections that can be treated with antibiotics. The physician may recommend that patients take vitamin C supplements or drink cranberry juice, as these measures acidify urine and may reduce the risk of further infections. Several medications are also available. The most common bladder problems encountered by MS patients are urinary frequency, urgency, or incontinence. A small number of patients, however, retain large amounts of urine. In these patients, catheterization may be necessary. In this procedure, a catheter or drainage tube is temporarily inserted (by the patient or a caretaker) into the urethra several times a day to drain urine from the bladder. Surgery may be indicated in severe, intractable cases. Scientists have developed a "bladder pacemaker" that has helped people with urinary incontinence in preliminary trials. The pacemaker, which is surgically implanted, is controlled by a hand-held unit that allows the patient to electrically stimulate the nerves that control bladder function.

MS patients with urinary problems may be reluctant to drink enough fluids, leading to constipation. Drinking more water and adding fiber to the diet usually alleviates this condition. Sexual dysfunction may also occur, especially in patients with urinary problems. Men may experience occasional failure to attain an erection. Penile implants, injection of the drug papaverine, and electrostimulation are techniques used to resolve the problem. Women may experience insufficient lubrication or have difficulty reaching orgasm; in these cases, vaginal gels and vibrating devices may be helpful. Counseling is also beneficial, especially in the absence of urinary problems, since psychological factors can also cause these symptoms. For instance, depression can intensify symptoms of fatigue, pain, and sexual dysfunction. In addition to counseling, the physician may prescribe antidepressant or antianxiety medications. Amitriptyline is used to treat laughing/weeping syndrome.

Tremors are often resistant to therapy, but can sometimes be treated with drugs or, in extreme cases, surgery. Investigators are currently examining a number of experimental treatments for tremor.

What Recent Advances Have Been Made in MS Research?

Many advances, on several fronts, have been made in the war against MS. Each advance interacts with the others, adding greater depth and meaning to each new discovery. Four areas, in particular, stand out.

Over the last decade, our knowledge about how the immune system works has grown at an amazing rate. Major gains have been made in recognizing and defining the role of this system in the development of MS lesions, giving scientists the ability to devise ways to alter the immune response. Such work is expected to yield a variety of new potential therapies that may ameliorate MS without harmful side effects.

New tools such as MRI have redefined the natural history of MS and are proving invaluable in monitoring disease activity. Scientists are now able to visualize and follow the development of MS lesions in the brain and spinal cord using MRI; this ability is a tremendous aid in the assessment of new therapies and can speed the process of evaluating new treatments.

Other tools have been developed that make the painstaking work of teasing out the disease's genetic secrets possible. Such studies have strengthened scientists' conviction that MS is a disease with many genetic components, none of which is dominant. Immune system-related genetic factors that predispose an individual to the development of MS have been identified, and may lead to new ways to treat or prevent the disease.

In fact, a treatment that may actually slow the course of the disease has been found and a growing number of therapies are now available that effectively treat some MS symptoms. In addition, there are a number of treatments under investigation that may curtail attacks or improve function of demyelinated nerve fibers. Over a dozen clinical trials testing potential therapies are under way, and additional new treatments are being devised and tested in animal models.

What Research Remains to be Done?

The role of genetic risk factors, and how they can be modified, must be more clearly defined. Environmental triggers, such as viruses or toxins, need to be investigated further. The specific cellular and subcellular targets of immune attack in the brain and spinal cord, and the subsets of T cells involved in that attack, need to be identified. Knowledge of these aspects of the disease will enable scientists to develop new methods for halting-or reversing and repairing-the destruction of myelin that causes the symptoms of MS.

What is the Outlook for People With MS?

The 1990s-proclaimed the "Decade of the Brain" in 1989 by President Bush and Congress-have seen an unparalleled explosion of knowledge about neurological disorders. New technologies are forcing even complex diseases like MS to yield up their secrets. These burgeoning opportunities in the field of neurological research have prompted the National Advisory Neurological Disorders and Stroke Council to suggest that an effective treatment for and the cause of MS may be found during the Decade of the Brain. The former has already been achieved; scientists continue to diligently search for the latter. Their dedication is the best hope for a cure, or, better yet, a way to prevent MS altogether.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.