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It is currently unknown what causes MS. At present, research studies suggest that MS results from a combination of genetic factors and environmental factors, however, few specific genetic or environmental factors have been identified. Therefore an individual who may be at risk for MS (for example – by family history) could not know what environmental triggers to avoid. Persons with a Caucasian ancestry are at higher risk of acquiring MS than non-Caucasians. Residence, particularly during adolescence, in places further from the equator, as opposed to places close to the equator, hold a higher risk for acquiring MS. The reason for this is unclear. We do know that MS itself is not a communicable disease, and thus far, no infectious agent has been definitively shown to cause MS.

This is a common misconception. An autoimmune disorder is very different than an immune deficiency disorder. MS just affects the central nervous system, and is never the cause of a low blood cell count. However, some treatments for M.S. may cause a low blood count. The immune-suppressive chemotherapies (cyclophosphamide, Cytoxan; mitoxantrone, Novantrone) are particularly likely to have this effect, so a doctor prescribing such treatment may request periodic tests to check your blood counts. Interferon-beta can also cause low white blood cell counts, but this side effect is uncommon and rarely life threatening.

There is no evidence that people with MS are infected with anything other than viruses that are also common in the general population. A person with MS should not fear they will spread some “M.S. virus” to their family or friends. MS is not contagious. The risk of an MS exacerbation is slightly increased in the weeks following a viral upper respiratory tract infection (head cold or flu). It is supposed that an unusual immune response to common viruses can trigger an autoimmune reaction. This linkage of infection and autoimmune disease remains a leading theory to explain the cause of MS. A related concern is whether vaccination in general poses any special risk for a person with MS This has been carefully studied, and vaccination does not appear to increase the short-term risk of relapse in MS, at least for tetanus, hepatitis B, or influenza vaccination.

There is conflicting data regarding whether interferon-beta (e.g., Avonex, Betaseron, Rebif) is an effective treatment in cases of secondary progressive M.S. European and American trials of Rebif in secondary progressive M.S. (the PRISMS and SPECTRIMS studies) gave different answers on the question of whether interferon-beta can significantly affect disability progression. It seems likely that interferon-beta can be effective, particularly if the individual continues to have acute relapses superimposed on the progressive deterioration. Obviously, if a person already using interferon-beta deteriorates and advances to a secondary progressive stage, it must be questioned whether the interferon treatment has been effective in that case. Mitoxantrone (Novantrone) is approved by the U.S. Food and Drug Administration (FDA) for the treatment of secondary progressive M.S. It can have severe side effects. Other therapies may be effective, but also have substantial potential toxicity and have not received FDA-approval specifically for treatment of M.S. Cyclophosphamide (Cytoxan) and mycophenolic acid (Cellcept) are prescribed by some neurologists for secondary progressive M.S., but these treatments are not universally accepted.

Treatment referred to as immunomodulating therapy includes Avonex, Betaseron, Copaxone, and Rebif. These medications decrease the progression of multiple sclerosis through decreasing relapse rate, MRI lesions, and disability. The immunomodulators will not give relief to current symptoms. Intravenous steroids called methylprednisolone (Solumedrol) are used to treat acute attacks and may relieve a number of symptoms. Residual symptoms after an untreated or treated attack, such as pain, tingling, and fatigue, may remain. These chronic symptoms are treated with medications directed at the symptoms but will not treat the disease. Interferons, which include Avonex, Betaseron, and Rebif, have the known side effect of flu-like symptoms. Typically, if a patient experiences flu-like symptoms, there will be an improvement after a few months.

Exercise may make previous symptoms reappear due the warming of your body. Areas of demyelination cause a slowing of conduction across an axon (part of a nerve cell), heat will contribute to this slowing. The slowed conduction across the axon causes neurological symptoms experienced in multiple sclerosis. The symptoms should improve with cooling of your body. Exercise, especially with a focus on muscle stretching has been found to improve muscle stiffness and spasms in patients with multiple sclerosis. Therefore, we recommend moderate exercise in a cool environment.

Maintenance of a healthy live style with an attempt to continue your normal routine is our recommendation. Activities should be limited to the tolerance level of the patient due to difficulties with fatigue.

All of the immunomodulators available, Avonex, Betaseron, Copaxone, and Rebif, decrease the progression of the disease through relapse rate, MRI lesions, and disability. In general, all of the immunomodulators decrease relapse rate by approximately 30%.

The currently available disease-modifying treatments for relapsing-remitting MS are all in the form of in-jectable therapies (IFN-B1a, IFN-B1b and glatiramer acetate). These treatments are all designed to prevent further relapses. Currently there are no oral or non-injectable treatments that have been shown to prevent relapses. The oral form of Copaxone (glatiramer acetate) was not found to be effective in MS treatment. Oral methotrexate may help to reduce relapses when used in combination with the injectable IFN-B1a (Avonex). Acute relapses may be treated with intravenous steroids, however, this is generally used as short-term therapy only, and does not prevent future attacks. Natalizumab (Tysabri) may be used for patients who have a relapsing form of MS and who have not responded to the Beta-interferon therapies or Copaxone. Severe relapsing-remitting MS or early secondary progressive MS that does not respond to the injectable treatments may be treated with intravenous infusions of Mitoxantrone (Novantrone) or cyclophosphamide (Cytoxan). Oral forms of disease-modifying treatments are currently being tested for efficacy in reducing relapses, and results are expected to be available within the next 2 years.

We have multiple research trials available at the Partners Multiple Sclerosis Center. Eligibility for a patient to participate is determined after an evaluation by a physician at the center.

Many MS patients continue to work after being diagnosed. Your ability to continue to work may depend on the type of work you do, the amount of time that you spend at your job, and the severity of your disease. You may want to discuss these factors with your doctor, and possibly with your employer. If you do have significant physical disability, you should not work at a job that requires heavy physical labor, or that requires skills such as balance or driving ability. You should consider stopping or modifying your work schedule if a physical or mental disability prevents you from performing your job, or if you are excessively fatigued. You may have the ability to modify your work-load, or to work part-time. Resources are available at the BWH MS Center and through the MS Society to help you with this decision.

The natural history of patients who are untreated for MS suggests that 15-25% of patients may eventually need to use a wheelchair because of difficulty walking. This data was taken from patients who were not treated with disease modifying agents (IFN-B1a, IFN-B1b and glatiramer acetate). We expect that in patients who have been treated with these medicines will have a more benign course of MS, and that an even lower percentage of patients will have severe disability requiring wheelchair use in the long-term.

There is great interest among scientists and pharmaceutical companies in developing new and more effective treatments for MS. There is real hope that some of the drugs currently under development will represent a breakthrough in treating MS. Your doctor cannot prescribe any “experimental drugs” (that is, drugs not yet approved by the FDA) outside of a clinical drug treatment trial. If a research center or clinic near you is involved in MS clinical trials, you may be eligible to receive an experimental treatment as a research subject. Every clinical trial will have eligibility rules, and not every MS patient will qualify as a research subject for a particular study. You should keep in mind that an experimental drug has not yet been proven safe and effective. Participation as a research subject may provide you an early opportunity to receive a novel therapy, but there can be no guarantee that the treatment will help you, and it may have harmful side effects. Also, in some clinical trials many research subjects receive a placebo rather than the actual experimental drug.

MS generally affects more women than men, at a ratio of 2:1. The reasons for this are unclear, however, the female hormones estrogen and progesterone may contribute to susceptibility to disease. There is some experimental evidence that the male hormone testosterone reduces susceptibility to the animal model of MS. In addition, it is known that during the third trimester of pregnancy, MS patients have fewer relapses. Experimental data has shown that a hormone called estriol, which is increased during pregnancy, is protective in the animal model of MS. The role of hormones and possible therapeutic implications are currently being studied.

It is currently unknown what causes MS. At present, research studies suggest that MS results from a combination of genetic factors and environmental factors, however, few specific genetic or environmental factors have been identified. Therefore an individual who may be at risk for MS (for example – by family history) could not know what environmental triggers to avoid. Persons with a Caucasian ancestry are at higher risk of acquiring MS than non-Caucasians. Residence, particularly during adolescence, in places further from the equator, as opposed to places close to the equator, hold a higher risk for acquiring MS. The reason for this is unclear. We do know that MS itself is not a communicable disease, and thus far, no infectious agent has been definitively shown to cause MS.

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