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Dr. William Stuart on recent advances in treating Multiple Sclerosis

(CNN) -- A recent study showed that early treatment with an available interferon drug can dramatically slow the onset of multiple sclerosis, and may even halt the progression of the disease in some cases. Dr. William Stuart is medical director of the Multiple Sclerosis Center at the Atlanta-based Shepherd Center, the country's largest hospital specializing in spinal cord and brain injuries and other neuromuscular diseases.

Chat Moderator: Thank you for joining us today Dr. William Stuart and welcome.

William Stuart: I look forward to talking with you and answering questions about MS. This is something I do a lot of and I hope you have a lot of good questions ready.

Question from Fresnobug: Dr. Stuart, I have MS and my question is what advances do you see in the forseeable future that will have a significant impact on treating this disease?

William Stuart: The most significant impact that we can have on the disease is to consistently use the drugs currently available. The drugs do have some mild problems in using them, but at present, they are vastly under utilized, and only 30- to 40 percent of patients that should be on one of the medicines is currently taking one of them. A recent study using Avonex in early onset multiple sclerosis demonstrated dramatic ability to control disease progression, both clinically and on the MRI scan. And this study recently released, gave us the support we needed for encouraging the early use of Interferon, in this case Avonex, in newly diagnosed MS patients.

Question from MS: How early should someone with MS go on medication? After the first symptoms?

William Stuart: The multiple sclerosis society, NMSS, has a position statement on that, and it generally recommends that any patient with definite diagnosis of MS should go on treatment. There are obviously some exceptions to that -- in very mild disease states -- but by and large, it's a good and strong recommendation. Beyond that, the Champs data is showing us we may be able to be certain of the diagnosis at an earlier time, and begin treatment at an earlier time. The advantage of that is that medications, the Avonex, for example, work best during this early phase of the disease. In doing this, we anticipate that a major change will occur in progression rates to higher levels of disability.

Question from karen: I have been diagnosed for four years with no significant progression at all. Why should I consider taking injections now when an oral form (of medication) is just around the corner?

William Stuart: The oral form is not just around the corner. It's in study. The drug is oral Copaxone. The study will most likely go on another one to two years, following which there will be the FDA approval process. This generally takes another year. The other reason is that MS patients in a sense are at their greatest risk when they feel well. The reason is that at least 80 percent of disease activity occurs within the brain, and remains clinically silent for as long as five to 10 years in some patients. The result of this is that accumulated fixed injury occurs during this period of seemingly good health, producing a substrate of brain injury, upon which additional injury ultimately leads to fixed clinical findings. The end result is that the untreated patient, five to 10 years down the road, has a situation that could have been modified during that period of time but now is not modifiable.

Question from guest: I've been having clinical symptoms for the last 15 years but no plaques shown in the MRI, therefore, no concrete diagnosis. Could Avonex be helpful? Since my main symptom is dizziness, my life has been really impaired.

William Stuart: MRI-negative MS patients do exist, but they are rare. If her MRI has been negative for this long of a period, it is probable that she does not have MS, unless there are specific abnormalities in the spinal fluid or in the evoked response studies. I would suggest re-questionning the diagnosis, assuming that her MRI scans are current.

Question from MS: About a year ago, a neurologist has told me, "You probably have MS," but has not yet told me "You definitely have MS." Is this a normal statement? What should I do? I have very mild symptoms -- some numbness and the occasional problem walking.

William Stuart: This statement is unfortunately a common statement, and it is a normal statement that is an outgrowth of the guidelines for diagnostic specificity in MS. In previous years, purely clinical criteria were used under what was called the Schumaker criteria. As testing evolved, these were modified to include the new testing procedures, and that would be MRI, spinal fluid, and evoked response studies. This new set of criteria called the Poser criteria now defined MS in terms of possible, probable and definite MS using a combination of clinical and laboratory findings. These criteria were defined primarily to categorize patients for new clinical drug trials. Unfortunately, they became standard criteria used in the clinical setting as well. This has led to significant anxiety and confusion on the part of patients with MS or with potential MS.

The Champ study, in addition to demonstrating the significant benefit of early treatment, also demonstrated that many of the specific single clinical events that occur before diagnosis, result in a very high likelihood of clinically definite MS being present. It is expected that in the future, we will use the possible, probable, and definite categories, with increasingly fewer patients. The ability to know with a high probability that a patient has MS, based on an MRI and a clinical event, will be significant enough to lead to earlier definite diagnoses of MS.

Question from merry: Is there any progress in the severest kind of MS? I am wheelchair-bound and my doctor kinds of throws up her hands to say there is nothing more that can be done.

William Stuart: Progress in this area is more complicated. While patients at this level of disease -- usually having occurred after many years of experience with the disease -- may get a lesser response from the newer drugs, it is apparent that they do get some response. The decision to use these drugs, and indications to use them in these patients, are being defined at the present time. Many of these patients may benefit from multiple drug regimens that are being studied and designed at the present time. Additionally, these are the patients who would ideally benefit from a variety of symptom management techniques, reconditioning, weight loss, and rehabilitation. These treatments, while not directed at the disease progress, often can result in substantial improvement in level of function.

Chat Moderator: Do you have any final thoughts to share with us today?

William Stuart: As a summary, this is a time for extreme hopefulness, where none existed. MS patients should be encouraged to explore their treatment options with their physicians, whether these treatments are intervention in disease activity, symptom management or rehabilitation. All of these elements of care contribute to improved quality of life. The years ahead are promising for continued improvement in disease intervention therapies, as well as hope for medications that would affect regeneration.

Chat Moderator: Thank you for joining us today

William Stuart: Appreciate the opportunity of talking with you. Your questions were good. I hope you will take the information from today and share it, and use it for your common good. Thank you.

Dr. William Stuart joined the chat from Atlanta, Georgia. CNN provided a typist for him. The above is an edited transcript of the chat, which took place on Friday, October 6.



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RELATED STORIES:
Drug may limit development of multiple sclerosis
September 25, 2000


RELATED SITES:
National Multiple Sclerosis Society
Multiple Sclerosis Center at the Shepherd Center

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