Multiple sclerosis sounds like a scary disease, and may prompt images of stricken wheelchair-bound patients. MS has come a long way since that stereotype.
Now more than ever MS is a chronic disease that can be managed with most patients living a normal life expectancy. The quality of life for patients has improved tremendously in recent years, and new drugs are already on the horizon.
"It is, in many instances, quite manageable," said Dr. Staley Brod, professor of neurology at The University of Texas Health Science Center at Houston (UTHealth) Medical School and a member of the medical staff at Memorial Hermann-Texas Medical Center.
When it comes to diagnosing MS, there is not one particular symptom that helps doctors immediately pinpoint what is wrong. More often it is an accumulation of maladies that help paint a picture.
"It's getting a story that makes sense. Many symptoms, and any neurological symptoms, could be a symptom of MS," said Dr. Brod, who noted that neurological symptoms could come and go.
He noted that some of the more common MS symptoms include painful or painless loss of vision one eye, experiencing double vision, numbness or weakness on one side of the body or bladder problems. Doctors also may be tipped off by a patient's age, race and gender. MS is more commonly found in Caucasian women between the ages of 20 and 50, though it can occur across any race, age or gender.
Some patients experience milder symptoms such as limb numbness, while others may be affected by more serious disabling effects such as paralysis, though most do not become severely disabled.
"The problems may come on over days or weeks. Then when they reoccur they may be different the second time," Dr. Brod said.
In some cases a physical exam may be enough for a diagnosis. Otherwise, MRI scans of the brain or spinal cord can check for white matter changes near the center or edge of the brain, or in the brain stem.
Because medications are now offered to slow progression, identifying MS early is critical. Dr. Brod noted that statistics show that patients who have many attacks during the first two years after being diagnosed tend to fare worse, making early diagnosis and treatment especially critical.
Improvements with medication
MS naturally progresses about five to eight years into the disease, though medication can slow the progression of the disease and reduce the number of episodes.
Such medication to slow the progress wasn't always available. Though there were treatments, the disease was not as easy to manage.
"About 18 years ago we had just started getting medications and didn't have much to offer," said Dr. Brod. "It's become a much more manageable disease."
The first disease changing drug for MS wasn't introduced until 1993, he said. Prior to that MS patients were usually treated with steroids to lessen the severity of attacks or chemotherapy, which could successfully slow the disease in some patients but could come with numerous side effects. Both treatments are still used in some patients, though often in conjunction with other therapies.
Medication slowing the disease can be life-changing. About 16 years after being diagnosed, Dr. Brod estimates that about half of patients would require at least a cane for walking if they did not receive medication.
"Medications really changed that natural history. It's really extended the quality of life," Dr. Brod said.
Injectable interferons are key to treating MS patients for their ability to slow the disease. In some MS patients with worsening acute symptoms that have lasted less than six months, drugs may be able to reverse worsening of the symptoms.
Some medications also are now available in a pill form such as recent drug addition fingolimod (Gilenya), though the oral medications tend to have more side effects including macular swelling and restrictive lung disease. Patients must be monitored for six hours following their first dose of such oral medications since some individuals may experience blood pressure or pulse drops.
Other drugs such as psoriasis medication BG12 are on the horizon and already in phase three clinical trials. Dr. Brod expects the drug could be available to patients by the end of this year or early 2013. Though the medication could offer additional benefits to MS patients, BG12 also will come with drawbacks. It could cause gastrointestinal side effects and the drug must be taken orally twice a day.
"The compliance rate in (patients) taking two pills a day is very low, only about 50 percent," said Dr. Brod, noting that the treatment could not aid patients with difficulty remembering to take their pills twice a day.
In comparison interferons are injected by patients at home, usually between one and three times a week. Some such as glatiramer acetate (Copaxone) must be injected daily.
Living better physically
With new treatments, most MS patients are now able to take the manageable disease in stride with an improved quality of life.
Though physical activity can benefit MS patients, years ago it was mostly discouraged because when MS patients get extremely hot it can affect their neurological function. This change in neurological function once becoming overheated is usually not permanent, but can be frightening for patients. Not all MS patients experience problems with heat sensitivity however.
Dr. Brod said there's no need for hesitation. Rather it's simply about choosing the right activity for patients with heat sensitivity. He said activities such as gardening and swimming can be enjoyed by most patients, though he wouldn't discourage more physical activities in MS patients not bothered by heat sensitivity and are able to cope with it.
In addition to the positive health benefits of exercise, MS patients often find that physical activity helps them improve their mental state and outlook.
"Physical activity can really be helpful to the psyche," Dr. Brod said.