A revolution in MS treatment

Advances in the past 20 years have improved prospects for many with MS

jamie lynn sigler

Actress Jamie Lynn Sigler recently revealed she’s been dealing with multiple sclerosis (MS) for 15 years, since she was 20 years old and starring in “The Sopranos.”

People across the country were wondering, ‘How did this successful and busy actress keep her MS diagnosis a secret from the press?’ Sigler said in interviews she was symptom-free for a long time, and now takes medication to keep her symptoms stable.

Such a scenario is becoming more and more common, as patients are diagnosed earlier in the disease course and being treated with drugs that decrease the rate of MS attacks, or “relapses,” by as much as 30 percent to 70 percent. I myself have many patients who are high-functioning, successful contributors to society, from CEOs and professors to doctors and lawyers. Many of these individuals have no signs of MS that are apparent to co-workers or acquaintances.

The last 20 years have witnessed remarkable progress in the introduction of so-called “disease modifying agents” or DMA, drugs that actually lower the risk of potentially debilitating symptoms from MS. Neurologists now aspire to find no evidence of active disease in our patients, in terms of new symptoms, new signs on a neurological exam or changes in surveillance MRI scans of the brain and spinal cord. This represents a significant departure from our goals in the pre-DMA era, when we struggled to stabilize our patients’ neurological status.

What is MS?

Multiple sclerosis, or MS, is the most common non-traumatic cause of neurologic disability among young adults in the western hemisphere. It can present at any age, but most commonly initially appears in young adults in their 20s and 30s, consistent with Jamie Lynn Sigler’s diagnosis at age 20.

MS has different effects on different people, because the disease can strike anywhere in the central nervous system, from the optic nerves to the brain to the spinal cord. That means one patient could have decreased or double vision, while another has vertigo and numbness or tingling in the arms or legs, yet another has weakness in both legs.  Furthermore, one person’s symptoms can shift from one relapse to the next. Every case is unique.

Current research indicates MS is triggered by a combination of genetic and environmental factors. It’s believed to be an autoimmune disease, in which the immune system begins attacking nervous system tissue. It’s a very serious disease that can cause significant disability.  Therefore, it’s fortunate that we now have drugs that decrease relapse risk in many patients.

Current treatments

The toolbox of drugs to combat this disease has grown immensely, with 13 drugs currently approved by the Food and Drug Administration. There are more on the way.

This plethora of drugs now allows neurologists to personalize treatment according to each patient’s responsiveness to a particular drug and ability to tolerate any potential side effects.  Matching the correct drug to an individual patient is as much an art as it is a science.  There are no tests that help us to predict which drug an individual patient will benefit the most from, with any degree of certainty.

None of the FDA-approved drugs is a cure, and none are effective in all patients.  Some patients do not respond to any of the currently available drugs.  Nevertheless, there’s evidence that all of these treatments – whether injections, infusions or pills – can help reduce the frequency of MS symptoms in a substantial percentage of patients. The growing list of potential treatments provides an increasing number of alternatives.

The most common type of MS is called relapsing-remitting MS (RRMS, about 85 percent of patients have this type).  RRMS is characterized by discrete attacks separated by periods of clinical stability. Some studies suggest that the more potent drugs might delay or prevent people with RRMS from evolving into progressive MS, which gets gradually worse as the patient ages.  However, more data need to be collected for us to be certain that this is indeed the case.  Unfortunately, DMA have not been found to be beneficial in progressive MS the way they are in relapsing-remitting MS.

Looking forward

We are gratified that the U-M MS Center is recognized as leader in MS research and in educating the next generation of scientists and doctors, with the ultimate goal of finding a cure.   Our clinic has grown more than fivefold over the past 8 years, currently providing care for over 3,300 individuals.  We were designated a “Center of Excellence for Comprehensive MS Care” by the National Multiple Sclerosis Society in 2012.   There are now six fellowship-trained MS specialists actively seeing patients and participating in research at UM.  And we are continuing to grow.

The good news is that the implications of being diagnosed with MS today are very different than 20 years ago. With today’s treatments, we can significantly improve our patients’ chances of maintaining their function and lifestyle.

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Dr. Benjamin SegalBenjamin Segal, M.D., is the Holtom-Garrett Professor of Neurology and director of the U-M Multiple Sclerosis Center. He is co-chair of the Program Committee of the Americas Committee for Research and Treatment in Multiple Sclerosis, and Chair of the Research Advisory Board for the VA MS Centers of Excellence-East. Segal received his baccalaureate degree, magna cum laude, and medical degree from the integrated Seven Year Program at Brown University, followed by a residency at Cornell University Medical School (the New York Hospital and Memorial Sloan Kettering Cancer Center). He then completed a fellowship in Neuroimmunology and Cellular Immunology at the National Institutes of Health. Dr. Segal focuses exclusively on multiple sclerosis research and treatment.