Multiple Sclerosis : Importance of Early Treatment

by Food and Drug Administration (FDA)

(Page 4 of 4)

People who have frequent relapses or whose functioning is severely affected may willingly take one of the injectable drugs approved to treat MS. When symptoms are mild, however, some people are reluctant to go on medication, says Bourdette. But even if a person has just one attack and an abnormal MRI brain scan, "they are at high risk for developing MS," he says, adding that 80 percent to 90 percent of such people will develop MS within five years. "The goal is to make a definite diagnosis as early as possible and go on therapy."

Even without symptoms, "the disease marches on," adds McDermott, noting that studies involving MRIs of the brain of MS patients have shown new lesions forming even when relapses are not occurring. "I've seen patients who say, 'I had a mild attack five years ago and I don't need to be on medication — I'm feeling great.' But the MRI shows a couple new spots, indicating areas of demyelination." It's like hypertension, says McDermott. "You can't feel high blood pressure, but the damage goes on every day."

The patients taking a placebo in clinical trials in MS "never caught up to the functioning of the patients treated with immune therapies from the beginning," says Burks. "What is lost is gone forever."

Harriet Fridkin, 62, knows this all too well. Fridkin knew that something was wrong in 1971, at age 29, when she couldn't hold a drinking glass and her knees buckled under her. She was diagnosed with an orthopedic problem and the symptoms went away after her doctor prescribed several anti-inflammatory drugs. Six years later, Fridkin developed optic neuritis, which cleared up with steroid treatment. It wasn't until 1980, when she was taken by ambulance to a hospital with vomiting, vision problems, and loss of balance, that Fridkin was diagnosed with MS. Treatments at that time were limited and Fridkin was told to "forget about it — you might never get another attack."

When the first interferon drug for MS was approved in 1993, Fridkin's doctor didn't recommend it for her. Looking back, Fridkin believes that earlier treatment may have changed the course of her disease, now in a progressive state. "On a good day, I can move my left arm," says Fridkin, who is confined to a wheelchair.

"Make sure you get help early and are proactive," Fridkin advises people with symptoms, even mild ones. "If a doctor tells you there's nothing you can do, don't be afraid to get a second opinion. Read about the disease, educate yourself, and ask questions."

Fridkin also stresses the importance of exercise but cautions not to overexert. "Don't exercise until you overheat and are tired," she says, "because with MS, you don't recover as fast." Exercising for short periods, more frequently, is less fatiguing, she says.

Drawing on the experiences of people who have had the disease for a long time can also be helpful, says Fridkin. "Join a support group and listen to what others say." Local support groups and other assistance are available through the NMSS and the MSAA.

Ferko says she is pleased with her quality of life right now. "I haven't been that significantly affected in comparison to many other patients," she says, adding that planning is important. Knowing that early in the day is better for her than afternoons and evenings, Ferko does her physical activities, like grocery shopping, in the mornings and does activities that she can sit down for in the afternoon. "Once you understand your symptoms and how it works in you, you have to modify things a little.

"And one of the most important things you can do is to find a doctor who specializes in MS," Ferko advises. "It made the difference for me."

Future of MS Treatment

Researchers continue to work toward a better understanding of MS and to find safe and effective treatments for all forms of the disease. Current drugs can curtail relapses, but they don't stop the body's attack on its immune system or the degenerative aspect of MS in the more advanced stages. "A major research focus on neuroprotection to stop the degeneration is underway," says Burks.

Another area of research centers on finding agents that not only stop the damage but also repair it, says Reingold. "We need to learn how to reverse the damage that has been done, and hopefully, to improve functioning on a day-to-day basis for people with MS." Researchers are studying the repair and regeneration of the myelin coating on nerve fibers that is destroyed by MS. "Myelin does repair itself," says Reingold, but myelin repair is then subject to myelin damage in a person with MS whose immune system is launching an attack.

Repairing damage from MS remains a hope for the future, but in the short term, Reingold says, "The general consensus is that no single therapy is going to prove completely efficacious for MS. We need to focus on safety and efficacy of combination therapies and try to capitalize on multiple modes of action." Reingold expects to see more studies that combine drugs with different modes of action, and is encouraged by the explosion of clinical trials. "There are more clinical trials for more new drugs to be used on MS going on right now than ever before in history."

About the Author

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