MS researchers share findings in Baltimore. (National MS Society).

More than 2,000 scientists involved in MS research in North America, Europe, and beyond, spent four days in Baltimore sharing recent findings. The researchers ranged from investigators who see patients regularly to laboratory scientists seemingly removed from daily life with MS. The meeting was sponsored by ACTRIMS (Americas Committee for Treatment and Research in Multiple Sclerosis) and ECTRIMS (its European counterpart) in collaboration with the National MS Society, which orchestrated the conference. The researchers offered one another different perspectives on very basic questions--creating the kind of ferment that produces new insights.

What happens in an MS attack?

Investigators reported on work to map the path from initial inflammation to loss of myelin (the fatty coveting of nerve fibers in the brain and spinal cord)--and then to damage or destruction of nerve fibers and nerve cells. Can the fibers, called axons, be protected from the initial inroads of inflammation? Can the myelin-attacking immune cells be more effectively blocked from entering the brain? How much myelin repair would be needed to restore lost function to a person with MS? Initiatives are in progress in all these areas.

Who will respond to a disease-modifying drug?

As experience with the four disease-modifying drugs accrues, it is clear that the people who benefit continue to benefit. Some are relapse-free for two or more years at a time. But a smaller group continues to have frequent relapses and to accumulate MS damage, as seen on MRI. Researchers are Straggling to identify factors that will predict individual success or failure.

Dr. John Noseworthy of the Mayo Clinic made a stirring request to pharmaceutical companies for release of any data they may have relating to people who don't respond to treatment. He also urged his fellow neurologists to follow all their MS patients for vital clues.

What leads to permanent disability?

The absence of active inflammation in the brain, as revealed by MRI scans enhanced by the contrast agent called gadolinium, appears to be a good benchmark of treatment success. However, in an eight-year follow-up of people taking Avonex, even the "complete responders" who had no further signs of MS inflammation after starting the drug had some modest declines in their physical abilities and some brain tissue shrinkage.

Distinguished researchers differ about the impact of relapses on disability. One group confirmed that 45% of people recovering from relapses have small but permanent losses afterward. This supports the concept that preventing relapses will slow down the accumulation of disability. But observations of what happens to people with relapsing-remitting MS (and frequent relapses) with those who have secondary-progressive MS (with few or no relapses) as well as the results of experimental inflammation-suppressing drugs tell a somewhat different story. Despite dramatic reductions in the frequency of relapses, slow accumulation of disability goes on, some research suggests.

A long-term patient database kept in Lyon, France, shows a statistical trend to similar levels of disability after 30 years with the disease for all people with MS. This covers a time period before disease-modifying therapy was available but supports the concept that inflammation alone may not tell the whole story of permanent disability.

New directions

Many of the findings that excited researchers in Baltimore are described in the feature story, "In the Pipeline" (page 50). New knowledge about immunity and about the roles of different types of brain cells in permanent MS damage is giving rise to ideas for new MS therapies that may go beyond limiting inflammation.

While the major focus of this meeting was the drive for a cure, researchers also shared insights on symptoms, such as sleep problems (affecting 25-35% of people with MS) and fatigue. Depression is increasingly seen as an organic aspect of MS. A group reported that people with MS are not only more prone to depression than people with other chronic disabling conditions, but may also have, different depressive symptoms. They tend to feel irritable, wary, and discouraged rather than guilty or worthless. They also tend to have excellent recoveries from depression when it is treated.