As of Friday, December 27, 2013
DEAR DOCTOR K: I was recently diagnosed with relapsing remitting multiple sclerosis. Can you tell me about my treatment options?
DEAR READER: Multiple sclerosis (MS) is a disabling illness that affects the brain and spinal cord and worsens over time. MS damages nerve cells and a substance that is wrapped around the nerve cells, called myelin. A nerve cell functions like a copper wire — it transmits electrical signals. Myelin is like the insulation surrounding a wire. It helps the electrical signal get transmitted down the nerve cell. When myelin is damaged, that transmission is interrupted.
MS is an autoimmune disease: The damage comes from an activated immune system. Immune system cells and possibly immune system chemicals called antibodies attack the myelin. The immune system’s function is to attack foreign invaders, such as various germs. For reasons no one understands, the immune system attacks part of the body instead.
The areas in the brain and spinal cord where the immune system attacks develop what are called plaques — areas of inflammation and lost myelin. The plaques can be seen on imaging studies, particularly magnetic resonance imaging (MRI) scans.
The disruption of nerve signals can cause a variety of symptoms. For example, MS may cause (usually temporary) loss of vision or double vision, loss of coordination, hand trembling, extreme fatigue, inability to move parts of the body, and inability to feel pain or touch.
There are several types of MS, and they vary by how they progress. The most common is relapsing remitting MS, the type you have. In relapsing remitting MS, symptoms come and go. Periods when symptoms suddenly get worse are called relapses. They alternate with periods when symptoms improve, called remissions.
There is no cure for MS, but treatments do exist. One type of treatment works to suppress the disease; the other type improves specific symptoms of MS.
Treatments that suppress the disease include:
— Corticosteroid drugs are most often used for MS relapses. They shorten the length of relapses and may speed up recovery from an attack.
— Interferons are a type of protein. They reduce the frequency of relapses, and they may slow the worsening of symptoms.
— Glatiramer acetate blocks cells that damage myelin. The drug may also reduce the frequency of relapses.
— Monoclonal antibodies block immune cells from entering the brain and spinal cord. This may prevent damage. Rarely, these drugs can provoke a potentially fatal brain disease.
Your doctor may also prescribe medications to treat specific symptoms of MS. For example, treatments can improve fatigue, muscle tightness and spasms, bladder dysfunction, and neurological symptoms such as seizures.
When I went to medical school, there was little understanding of what caused MS, and there also was no way of seeing inside the brain and spinal cord to diagnose it. There were few effective treatments. A lot of progress has been made, but much more is needed.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)