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Monday, March 26, 2018
Multiple sclerosis (MS) is not your average neurological disorder.
For one thing, it tends to strike patients at a much younger age than most cases of Alzheimer’s disease or Parkinson’s disease. In fact, it is the leading non-traumatic cause of disability in young adults in the United States.
For another, each patient’s experience with MS tends to be different—from the types of symptoms experienced to the severity of those symptoms to the progression of disease over time.
But unlike other neurological diseases, which have proven to be stubbornly difficult to understand and treat, MS is advancing rapidly when it comes to research and treatments, says Farrah Mateen, MD, PhD, a clinician investigator in the Multiple Sclerosis Clinic at Massachusetts General Hospital.
MS is a disease of the central nervous system in which the body’s own immune cells begin to attack the brain, spinal cord, or optic nerves. These attacks disrupt the flow of information between the brain and the body, leading to symptoms that include difficulty seeing, dizziness, numbness and difficulty walking. MS can also cause depression, other mood changes, fatigue, and cognitive decline.
Most MS patients initially have relapsing-remitting MS, in which they experience attacks of new symptoms, followed by periods of time when those symptoms go away partially or completely. Others experience a gradual and ongoing loss of function without distinct periods of attack, which is known as progressive MS.
MS has been described since the 1800s, if not earlier. But for over a century, there were no treatments for the disease.
That changed in the mid-1990s with the approval of the first injectable medication. Since 2011, three new pill-based treatments for MS were approved. Infusion-based treatments are available as well. There are now 15 FDA-approved medications for multiple sclerosis (per the National MS Society), and at least 10 other MS drugs in the development pipeline.
While the growing number of treatments is encouraging, some of the drugs are quite powerful and come with side effects, such as an increased risk of developing cancer or a serious infection. “Even though there are a lot of medicines out there, people sometimes don’t want to take them,” Mateen says. “The medicines aren’t perfect.”
In addition to drug-based treatments, researchers are also investigating new strategies to help relieve the symptoms suffered by MS patients. This includes food and diet plans, exercise routines and stress management programs. At Mass General, Dr. Mateen is conducting a clinical trial to test the effectiveness of a light-based therapy on MS patients who are experiencing disease-related fatigue.
One key challenge in diagnosing and treating MS is that there are still no good blood-based biomarkers (measurable biological indicators) for the disease. Patients still need to see a neurological specialist for diagnosis, which typically includes an MRI scan.
Mateen says that a blood-based test would not only make diagnosis easier, but could also help to confirm exacerbations of the disease in patients with relapsing remitting MS. “Sometimes they have a symptom and it is not always clear if it is a relapse, the beginning of a relapse or if it is unrelated,” Mateen explains. “There is a lot of uncertainty in the fluctuations of the disease.”
Mateen believes a better scientific understanding of MS progression and recurrence, combined with a wider array of therapeutic options,will give MS patients more control over how they manage their disease. Because each patient experience is different, there is no one-size-fits-all approach when it comes to treatment.
“I think there are going to be a lot more options coming. The question is going to be who gets what, and when? The more we understand about each person’s disease activity, the better medication choices we can make.”
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