Scientists' understanding of MS is beginning to change as research on MS progression intensifies.
Whether you’re newly diagnosed with multiple sclerosis (MS) or have had it for decades, you probably have some questions about the disease, how it might affect you in the future, and how to stay as healthy as possible for as long as possible.
Robert Fox, MD, a neurologist at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic in Ohio, shares what he tells his patients with MS about what doctors know — and don’t know — about MS, and what doctors and patients can do to treat symptoms and prevent disability.
1. This Is a “Good” Time to Be Diagnosed With Multiple Sclerosis
Being diagnosed with MS is never a good thing, but, Dr. Fox says, “We’re at a point in MS where once we find the right treatment, in the majority of cases, we can get the disease completely managed so that patients can continue doing all the things they want to do in life, whatever that is.”
“We don’t always do it with the first treatment,” he cautions. “Sometimes, it takes the second or the third, but usually — at least in the early stages of MS — we can get the disease fully managed and fully controlled.”
2. Multiple Sclerosis Has Two Components: Inflammation and Neurodegeneration
Scientists are beginning to think differently about the different types, or stages, of MS.
“We used to think of MS as two separate stages or two different types — either relapsing-remitting MS, or secondary-progressive MS — and primary-progressive MS is sort of lumped in with the secondary-progressive MS,” Fox says.
“What we’ve come to realize,” he says, “is that it’s probably not two separate, distinct forms or stages of MS, but rather two different components that overlap one another.”
One of those components is the active inflammation, which causes injury to the brain and spinal cord. “And the other is what I call the degeneration of progressive MS,” says Fox, in which old injuries gradually get worse.
This explains why a person’s symptoms may get worse even when an MRI shows no new lesions.
“Patients will have predominance of one aspect of the disease at one point, and then predominance of another aspect at another point.”
While the inflammation associated with MS can often be controlled, so far, doctors’ ability to change the course of degeneration in MS is limited.
3. Doctors Take a Three-Pronged Approach to Treating MS
According to Fox, there are three parallel arms to MS treatment.
“One is treating the active inflammation that might be going on,” he says, “and we typically do that with corticosteroids.”
The second parallel arm is prescribing a disease-modifying medication to stop future bouts of inflammation. Over a dozen drug therapies are currently FDA-approved for relapsing forms of MS, and more are likely coming in the next couple of years. But, Fox cautions, these medications are preventive, not restorative.
“They’re like taking an aspirin to prevent a heart attack,” Fox says. “You don’t feel better when you’re taking your aspirin, but hopefully it’ll prevent a heart attack. Disease-modifying therapies prevent the episodes and the relapses, and they also prevent new lesions” in the brain and spinal cord.
“The third parallel pathway,” says Fox, “is treating the symptoms that are left following the injury to the nervous system. Even early on, it’s not uncommon for patients to have residual symptoms after a relapse.”
Relatively common MS symptoms include numbness or tingling, weakness or stiffness in an arm or leg, bladder or bowel problems, walking and coordination problems, and sexual dysfunction. Treatments for these symptoms can include medicines, physical therapy, and even counseling for the depression and anxiety that’s common among people with MS.
4. Other Health Conditions Can Make MS Worse, but a Healthy Lifestyle Can Help
“Other diseases like heart disease, hypertension, high cholesterol, and diabetes are associated with an accelerated progression of disability in people with MS,” Fox says.
Managing your weight with moderate exercise can help. “The activity can be whatever a person is able to do to get the heart rate up into an aerobic range for 30 to 45 minutes,” Fox says. And if you smoke, quit. “People who smoke not only have a higher risk of MS, but they also appear to have an accelerated course of their MS,” Fox says.
5. There’s Still a Lot We Don’t Know About MS
“One patient’s experience may be vastly different from another patient’s,” Fox says, and there’s no way to predict what symptoms MS will cause, nor how disruptive MS will be in a person’s daily life.
For newly diagnosed patients, disease-modifying medications can control the disease and prevent relapses.
For older people with MS who have lived with the condition for many years, however, it’s not known how safe and effective the newer disease-modifying therapies are, in large part because the trials for those drugs enrolled only patients ages 55 or younger.
“Older people are at a little higher risk of one of the complications of oral drugs — which include Gilenya (fingolimod) and Tecfidera (dimethyl fumarate) — called progressive multifocal leukoencephalopathy, or PML,” a brain disease caused by a viral infection, Fox says.
Another unknown, says Fox, is what drives progression in MS, although “there’s been a lot of work focused on this.” In particular, the Progressive MS Alliance, an international consortium of MS societies, formed in 2012 to raise both awareness of progressive MS as well as funds for research into its causes and potential treatments. While the Alliance is still young, it awarded more than 20 research grants in 2015, with more planned for 2016.
