Multiple sclerosis has mystified many, but recent advances show promise.
It wasn't until the late 1890s that physicians recognized multiple sclerosis (MS) as a specific disease with a unique set of signs and symptoms, including slurred speech, abnormal eye movements, imbalance and plaques on the brain found at autopsy. While progress in understanding what triggers MS and what can be done to treat it effectively has been slow, recent research is unearthing information that has the potential to answer questions that have confounded the health care community for generations. Below Roumen D. Balabanov, MD, a neurologist at Rush who both studies and treats MS, shares some insights about this puzzling and often debilitating disease.
It's an autoimmune disease. "When it comes to MS, doctors know what happens to cause symptoms but not why," Balabanov says. The "what" is when molecules and cells from the body's immune system find their way to nerves of the brain and spine. There, they attack the nerve's outer layer of insulation (myelin) and prohibit the speedy transmission of impulses, or signals, along the nerves. This transmission is slowed down significantly and causes the symptoms associated with MS. Because the body's immune system attacks the central nervous system in the absence of an identifiable infection, doctors consider MS an autoimmune disease.
Diagnosis is difficult. "Because symptoms of MS are often similar to other conditions and can really vary from patient to patient, MS can be challenging to diagnose, which is why it's important to see a specialist," Balabanov says. Diagnosis is often a process of elimination along with a series of tests. While symptoms may vary in terms of severity, frequency or progression, there are some common early symptoms that may indicate MS. These include the following: Unexplained fatigue, which is more likely to occur midafternoon and may be accompanied by increased muscle weakness, memory problems, sleepiness or drowsiness; sensitivity to heat; and uncharacteristic clumsiness, such as dropping things, knocking things over or tripping. If doctors suspect MS, patients can expect a neurological evaluation to assess nerve reflexes, mobility and body sensations; an eye examination; and tests, such as a lumbar puncture (also called a spinal tap) and brain and spinal MRI.
Research has yielded new treatments. Currently, there is no cure for MS, but there are eight FDA-approved medications designed to suppress MS attacks and slow disease progression. In addition, physical, occupational and speech therapy can be extremely helpful. Neurologists at Rush — Floyd Davis, MD, and Dusan Stefoski, MD, currently director of the Rush Multiple Sclerosis Center — pioneered dalfampridine, a drug heralded as the first oral medication for MS and the first to help improve walking when it was approved by the FDA in 2010. Unlike other MS medications, dalfampridine doesn't decrease inflammation of damaged nerves; rather, it promotes transmission of signals despite damaged myelin. Work began on the drug back in the 1960s when Davis (who is now retired) observed that MS patients did better when their body temperatures were lowered. After identifying and developing a compound that lowered body temperatures, doctors evaluated it extensively prior to FDA approval. According to Balabanov, the science behind the drug's development was especially illuminating to researchers. "It showed that the damaged nerve fibers were not totally lost, as previously believed," Balabanov says. Rush, which continuously conducts clinical trials related to MS, also participated in clinical trials for the monoclonal antibody, natalizumab. The antibody is designed to prevent immune cells from migrating to the bloodstream and therefore stops them from damaging myelin.
Gene research shows promise. In 2011, researchers identified 29 new genetic variants associated with MS, confirmed 23 previously known genetic links, and suggested five more genes that may contribute to the disease. This enlightening data came about thanks to the largest-ever gene study of MS, which was published in Nature. Many of the genes noted play vital roles related to the immune system and immune responses, information that provides valuable insights about the series of events leading to the development of multiple sclerosis and will help direct researchers in designing future treatments. In the study, researchers identified two genes also involved in the metabolism of vitamin D. "This finding is particularly intriguing because prior research has shown that intake of high doses of vitamin D can reduce the risk of developing MS," says Babalanov. "The information in the Nature study offers further insights into the connection between genetic and environmental risk factors for MS."
Cinnamon may be beneficial. Since medieval times, physicians have used cinnamon to treat a variety of disorders including arthritis, coughing and sore throats. Now the National Institutes of Health is funding Kalipada Pahan, PhD, a researcher at Rush, to evaluate cinnamon's effectiveness in stopping the destructive process of MS in experimental laboratory models. The basis of his research: Cinnamon has an anti-inflammatory property to counteract and inhibit processes that can cause brain cell death and possibly lead to MS. While this research is preliminary, it offers hope of finding a more natural and less toxic approach to combating the disease. For more about this study, read an article from the Discover Rush print newsletter.
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Please Note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
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