The puzzling picture of multiple sclerosis

FDA Consumer, July-August, 1989 by Margie Patlak

Radiation treatment designed to "knock off" T cells, McFarlin says, has also stabilized--for up to four years so far--disease progression in 18 of 27 patients treated with severe forms of multiple sclerosis. The patients, studied by Stuart Cook, M.D., of the New Jersey Medical School of Newark, were given total lymphoid irradiation intermittently over a five-week period. Radiation was directed to the spleen and to lymph nodes in the neck, armpit, chest, abdomen, and groin--tissues that produce T cells. The patients suffered no serious side effects from the treatment.

Research that clearly demonstrates the safety and effectiveness of these and other experimental therapies involving immune-suppressing drugs is needed, however, before the Food and Drug Administration can approve them for treatment of multiple sclerosis. Often a treatment that seems worthy in preliminary studies doesn't pan out in controlled trials with larger numbers of patients.

In the meantime, several drugs can be used to counter some of the symptoms of multiple sclerosis. Short-term administration of ACTH (adrenocorticotropic hormone) and steroids such as prednisone can shorten the duration of attacks. These immune suppressants don't impede the long-term progression of the disorder, however, and can cause mood changes, fluid retention with consequent weight gain, high blood pressure, and ulcers. Patients given ACTH often must be hospitalized for continual monitoring for side effects.

Aspirin, acetaminophen, and other painkillers may relieve the occasional pain some multiple sclerosis patients experience. If the pain stems from muscle spasms, an anticonvulsive such as carbamazepine or muscle relaxants such as diazepam and dantrolene sodium may also help. The constant pain that afflicts some people with severe multiple sclerosis is more difficult to relieve. Tricyclic antidepressants such as amitriptyline may be helpful. Drugs that relax the bladder, such as amitriptyline, can help alleviate urinary frequency and urgency in patients with these problems.

Preventive measures are also beneficial. Overexhaustion, emotional stress, viral infections, and a rise in body temperature (from a hot bath or hot and humid weather, for example) are thought to trigger or worsen symptoms and should therefore be avoided. Patients should also follow a well-balanced and nutritionally sound diet and maintain a desirable weight.

Patients with muscle stiffness may be aided by physical therapy, and moderate exercise can help keep limbs supple and maintain muscle function. Certain exercises can also alleviate spasms.

Occupational therapy can provide multiple sclerosis patients with techniques or devices that help them perform their normal daily tasks. For example, "reachers" that help open cabinet doors, devices that aid with opening plastic bags and boxes, and a swiveling wall mirror that enables a person to see into a pan while it is bubbling on the stove can allow a wheelchair-bound patient to continue to cook meals.