Multiple sclerosis (MS) is a mysterious disease… and all too often, the first mystery is figuring out whether you have it, since early symptoms are vague and sometimes almost nonexistent. Researchers are working feverishly to find ways to prevent and cure MS. In the meantime the goal is to find ways to slow disease progression so sufferers can live as symptom-free as possible. The best advice to that end is to pay attention to possible early symptoms, such as tingling, numbness or fatigue… get an accurate diagnosis… and start treatment as fast as possible, says Thomas Stewart, JD, PA-C, MS, a founding partner of the Aspen Neuroprevention Clinic in Denver, a clinic focused on preventing neurological diseases, such as MS and Alzheimer’s Disease. Stewart also is coauthor of Dietary Supplements and Multiple Sclerosis.
About 400,000 people in the US have MS, most of them women. It is an inflammatory disease of the brain and spinal cord (the central nervous system) that damages the fatty substance (myelin) surrounding and protecting nerve cells (neurons), fibers, and ultimately, the neurons themselves. In the early stages, the damage may cause no notable symptoms, although in some people there is an almost immediate severe loss of physical functioning. Also, says Stewart, amorphous early symptoms often get wrongly attributed to other diseases, including viral infections, or even simply to stress. Therefore, he urges anyone with even the slightest worrisome symptoms to quickly schedule a visit with a doctor who specializes in MS — treatment works best when started as early as possible. Specific diagnostic criteria include having at least two flare-ups (episodes) occurring a month or more apart, plus MRI evidence of characteristic areas of damage (lesions) on the spinal cord or brain.
You would think it would be a blessing to have mild initial symptoms that don’t interfere with your life. That’s not necessarily the case, because people often ignore them. This allows the disease to progress silently, causing significant damage that will eventually take its toll. The good news is that when caught early, before significant damage to the brain has occurred, MS usually can be well-controlled with medication.
Four drugs — three forms of interferon (Avonex, Betaseron and Rebif) and glatiramer acetate (Copaxone) — have been used to treat MS for a number of years. All are self-injected and work by controlling inflammation. They’re generally considered safe and at least somewhat effective. Patients typically start with one and then, when it stops working (as they often do), move on to what’s next on the list. There was great excitement when a more powerful treatment, natalizumab (Tysabri), became available a few years ago, but it was pulled from the market when it turned out to cause a rare but debilitating, sometimes even lethal, brain infection known as progressive multifocal leukoencephalopathy (PML).
There’s plenty of clinical research underway on MS treatments, and hope is on the horizon for new and better medications, with five new drugs that have either completed clinical trials or are in late stages. One big improvement: All are oral, which is vastly better than having to give medications by injection or infusion. Look for oral cladribine (Mylinax), which works by suppressing the immune system, and FTY720 (Fingolimod), which works by sequestering immune cells in lymph organs, both expected to be available soon. The other three oral agents include laquinimod, BG12 and teraflunimide. (Note: Some of these drugs do have side effects, which Stewart calls “of concern.”)
Meanwhile, Stewart shared some other suggestions on how to live more fully and comfortably with MS — and possibly even slow the disease…
Exercise. Physical activity is a must for MS patients, helping preserve not only physical function but also cognition. Studies demonstrate that aerobic exercise, in particular, is brain protective, possibly because it increases a substance called brain-derived neurotrophic factor (BDNF), a protein that supports existing neurons and encourages growth of new ones. Evidence suggests that exercise also is helpful in ameliorating depression, which is common among MS patients.
However, it is important that workout sessions be tailored to match each patient’s abilities, including fatigue level, specific impairments and heat sensitivity, which can be problematic for people with MS. More important than intensity is consistency, says Stewart. Start slowly, he advises, and work your way toward doing more. He adds that generally speaking, the more exercise the better.
Vitamin D. Research has shown that the further you live from the equator, the greater your risk for MS. There seems to be a link between the disease, sunlight and vitamin D, and research continues to explore this connection. In the meantime, we know that the so-called “sunshine vitamin” is crucial for people with MS. Stewart says supplementation with 2,000 international units (IU) of vitamin D daily is often advised, though some patients need much more than that. Consult your doctor to learn what is right for you.
Other supplements — and a good diet. Some research suggests that the anti-inflammatory properties of supplemental omega-3s (EPA/DHA) are helpful and, of course, a healthy diet is always important. Stewart suggests avoiding saturated fats and choosing mono- and polyunsaturated fats instead. Brightly colored fresh fruits and vegetables are key, because they contain important antioxidants and compounds that help modulate inflammation. Other supplements that may be of benefit include calcium with magnesium, because osteoporosis is common with MS. And, for those who don’t always eat a healthy diet, a basic multivitamin may be a good idea as well.
Fatigue. Among the most common complaints of MS patients is chronic exhaustion. Try acupuncture, suggests Stewart, who notes that several of his own research studies have suggested that it may help with the anxiety and pain that are also often troublesome, too. A cup of coffee can be an easy and effective way to boost energy… and Stewart says that many patients find the drug modafinil (Provigil) works to fight fatigue, too — though it is expensive and sometimes not covered by insurance.
Some research suggests that some of the above strategies may decrease MS risk. This may be especially true and important if there is a family history, which was found to elevate risk by about 2% to 3%. Though at present there is no magical fix for MS, doing all you can do to enhance your health can make a difference — often a big one. Says Stewart, “an ounce of prevention is surely worth more than a pound of cure when it comes to your brain.”
