Multiple Sclerosis

Description

Other Treatments

Experimental Agents

A number of agents are under investigation that may prove to be helpful for multiple sclerosis. Those discussed below are only some of them.

Natalizumab and Other Monoclonal Antibodies. Monoclonal antibodies (MAbs) are specially designed antibodies directed against a specific substance. They are being developed to target immune factors thought to be responsible for MS. The MAb natalizumab (Antegren) is currently the best studied. It blocks the actions of molecules that enable white blood cells involved in MS to pass through the blood-brain barrier. Early studies on natalizumab are reporting fewer relapses and new lesions on MRI scans and improvement in well-being in patients with relapsing-remitting MS. It may prove to be beneficial for secondary-progressive MS as well. Other MAbs under investigation for MS include daclizumab and alemtuzumab.

Aminopyridines. Aminopyridines are potassium-blocking compounds that appear to improve nerve conduction through demyelinated areas. In small, preliminary trials, 4aminopyridine, or AP, has been associated with mild to marked improvement in vision, strength, and coordination and was well tolerated. Beneficial effects, however, lasted only a few hours. A related compound, 3,4diaminopyridine, or DAP, has also produced temporary improvements in nerve conduction without harmful side effects, even when taken for several weeks. One study comparing the two drugs, however, found that AP was superior in improving walking, fatigue, and overall function. Side effects of AP are more apt to include dizziness and confusion. DAP may cause abdominal pain, numbness, or tingling. Overdose can occur at relatively low doses in both drugs and may cause epileptic seizures.

Cannabinoids. Cannabinoids are compounds in marijuana (cannabis), which may have properties that protect nerve cells. Cannabis has been found to improve pain, mobility, tremor, mood, appetite, fatigue, vision, sexual and urinary function, and memory. In a 2003 study, patients reported less pain and improved mobility (although spasticity itself did not improve). Not all patients respond. The agent may also worsen balance and posture in MS patients with spasticity. Synthetic versions are being investigated that allow rapid delivery without the unwanted side effects of natural cannabis.

Estrogen. Although estrogen is commonly associated with heightened immune factors, some autoimmune diseases, including multiple sclerosis, improve during pregnancy when levels of estriol, a form of estrogen, are high. (Estriol levels are low at other times.) In one small study, estriol treatment was associated with significantly fewer lesions and less disease activity in patients with relapsing-remitting MS. Long-term use may have adverse effects, however, and further research is needed.

Plasmapheresis. Plasmapheresis with plasma exchange is a procedure in which blood is removed from the body. Blood cells are separated from plasma (the liquid portion of blood) and mixed with replacement plasma, which is then returned to the body. The replacement plasma is thought to dilute antibodies and other immunologically active substances that may trigger MS. Small investigative studies suggest this procedure may have significant benefits for some patients with severe MS, particularly if they are younger and have an early response to this treatment. Side effects include risk of infection and blood clotting problems.

Oligodendrocyte Implants. A newly developed, minimally invasive method to transplant modified oligodendrocyte cells directly into the brain is under investigation. Such cells stimulate nerve and axon growth. If feasible, this approach might be helpful in patients whose MS is not caused by an autoimmune response (where the new cells would be attacked, just as the patient's own cells were).

Stem Cell Transplantation. Some investigators are studying the benefits of stem-cell transplantation procedures. Stem cells are produced in the bone marrow and are the early forms for all blood cells in the body (including red, white, and immune cells). Early studies indicate that it may slow progression, although at this point it is not a cure.

Statins. Statins (medically referred to as HMG-CoA reductase inhibitors) are currently the most important agents for lowering cholesterol. They are also showing possible benefits, including anti-inflammatory and nerve protecting properties, which may help patients with neurologic conditions, including multiple sclerosis. In one 2002 study, the statin atorvastatin (Lipitor) improved MS symptoms in mice. Other statins include lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and fluvastatin (Lescol).

Nontraditional Treatments

Nearly 60% of MS patients try some form of nontraditional remedies. Research on any benefits is slim and there may be some danger with many remedies commonly used by MS patients. The following are a few alternative remedies sometimes used for MS.

Relaxation and Meditation Techniques. Generally harmless, and possibly helpful, nontraditional therapies for MS are relaxation and meditation techniques and Eastern martial art exercises. Such techniques include biofeedback, music therapy, yoga, tai chi, and massage therapy.

Acupuncture. Some patients report benefit from acupuncture, which does carry a very small risk, usually for infection.

Acupuncture, hypnosis and biofeedback are all alternative ways to control pain. Acupuncture involves the insertion of tiny sterile needles, slightly thicker than a human hair, at specific points on the body.

Electromagnetic Stimulation. A few centers have studied pulses of weak electromagnetic fields applied to the brain. Very small studies have reported improvement in fatigue, tremors, depression, and other symptoms in patients who were severely affected by MS. In one controlled study, this approach alleviated symptoms more effectively than placebo. The effect was small however and more research is needed.

Codi-Loder Regimen. Cari Loder, a woman in England, experienced relief when she simultaneously took a combination of substances. She patented the treatment, which consists of vitamin B12, lofepramine (a tricyclic antidepressant), and L-phenylalanine (an amino acid available in health stores). A 2002 study reported some improvement with the use of these agents, but the effects were very modest.

Linoleic Acid. Linoleic acid, commonly known as evening primrose oil, is a polyunsaturated fatty acid believed by some people to be helpful because myelin is composed of fatty acids. No study has proven that it is beneficial, but supplements sold in health food stores do not appear to be harmful.

Oral Enzymes. Oral agents containing various natural enzymes, including bromelain, trypsin, papain, and rutin, have been used overseas to treat arthritic pain. They appear to reduce inflammation and are also being studied in patients with MS. Such enzymes have been marketed alone and in combinations (Wobenzym, Phlogenzym). In one small study, Phlogenzym was associated with a decline in complications and longer remission. They are not painkillers; any benefits derived from them may take several weeks. As with any natural remedy, there are few clinical studies on these products and no US regulation of quality, safety, or effectiveness.