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The ups and downs of multiple sclerosis.

The ups and downs of multiple sclerosis

Contrary to the longstanding notion that patients diagnosed with chronic, progressive multiple sclerosis (MS) face a relentless downhill course, new research shows that 30 percent of such cases stabilize after a two-year period.

For patients diagnosed with progressive MS, the news is a relief from the grim prognosis of the past. "It gives them something to hope for," says lead researcher Donald E. Goodkin, now at the Cleveland Clinic Foundation. Many MS patients experience day-to-day waxing and waning of symptoms, but those who show steady decline during a six-month period are classified as chronic, progressive patients and until now were not expected to stabilize. Goodkin and Richard A. Rudick, also at the Cleveland Clinic, presented their work in Chicago this week at the annual meeting of the American Academy of Neurology.

For MS researchers, the report raises questions about the way some clinical triisl are conducted and their results interpreted. Many researchers assume that patients with progressive MS will continue their steady decline, getting weaker and losing vision as time goes on. They often conduct uncontrolled trials in which all patients are given experimental therapy, attributing any improvement in the progressive MS patients to the new treatment. That assumption is false, according to the new study, which shows some progressive MS patients stabilize spontaneously. "We have to be more careful to perform studies that are properly blinded and controlled before drawing any conclusions," Goodkin says.

Multiple sclerosis is a neurological disorder of unknown origin caused when immune system cells destroy the myelin sheath that normally protects nerve fibers in the brain and spinal cord. The resulting scar-like areas can disrupt nerve transmission, causing a wide variety of symptoms including weakness, tremors and loss of vision.

Goodkin conducted the study while at the Fargo (N.D.) Clinic. He and his co-workers categorized 254 MS patients as progressive or stable based on medical history and their scores on a neurological test measuring vision, coordination and other MS markers. Two years after the initial assessment, the researchers found that 30 percent of the chronic, progressive patients showed no decline in test results. Moreover, 32 percent of the patients initially classified as stable had shifted to the chronic, progressive category.

"The results indicate that patients change categories of disease frequently," Rudick says. "These categories are artificial and not terribly meaningful." The new study shows that a bad year doesn't necessarily signal the beginning of a steady decline, he says. Longer follow-up studies must be done to find out what happens to such patients over a lifetime, he adds.

Many doctors give chronic, progressive patients experimental treatments in a last-ditch attempt to stave off disease progression. Patients with the worst prognosis often receive methotrexate or cyclophosphamide, which suppress the immune system and cause severe side effects such as vomiting. But Rudick's report suggests MS patients may want to wait and see if their symptoms subside before jumping into such therapy, comments Robert P. Lisak at Wayne State University School of Medicine in Detroit. In the meantime, physical therapy can help reduce disability, he says.

Scientists must find better ways of identifying MS patients who will go on to suffer severe and progressive disability, adds George W. Ellison of the University of California, Los Angeles. At this week's meeting, Ellison presented a study showing that individual MS cases can follow a highly variable course ranging from marked improvement to considerable deterioration. But as a group, he found, MS patients show an average course of gradual decline.
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Author:Fackelmann, K.A.
Publication:Science News
Date:Apr 22, 1989
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