Articles

InPharm Tours

Prepared by Geoff Barnett

Multiple sclerosis (MS) is a slowly progressive disease of the central nervous system characterised by inflammation and demyelination of white matter in the brain and spinal cord. The disease derives its name from the numerous sclerotic patches that form over the nerve fibres at the sites of demyelination. Nerve impulses are blocked or delayed by the lesions and, in consequence, cause a variety of frustrating and debilitating signs and symptoms that vary unpredictably and may relapse, progress or undergo spontaneous remission.

Although our knowledge of MS has expanded substantially over recent years, many fundamental and tantalising questions remain to be resolved. Why, for instance, do symptoms rarely begin before the age of 15 or after 60; why are whites more than twice as likely as other races to develop it; why are women affected at almost twice the rate of men; why is MS five times more prevalent in temperate climates than in the tropics? To explore these and other perplexing issues go to the very readable Multiple Sclerosis: Hope Through Research. The section Who Gets MS? provides epidemiological findings that hint strongly of an environmental factor. Many investigators believe it to be an autoimmune disease and this is eloquently argued under What Causes MS? Read on to learn how genetics may also play a part in determining a person's susceptibility to MS. These and other aspects are also expounded at MS Update: Clinical Trials and Research - an audio/slideshow given by Dr David Squillacote, senior medical adviser for the Multiple Sclerosis Foundation. There is something mesmeric about listening to an articulate presenter and responding to his cue to click for the next slide, so be aware that his presentation lasts for two hours!

MS is frequently difficult to diagnose in the early stages because the first signs, such as blurred or double vision, fatigue or muscle weakness, are often subtle and inconclusive. The distressing problems that may arise are reflected in The Multiple Sclerosis Problem List - a summary of health issues that the author, a physician, tries to cover with her MS patients on an annual or more frequent basis. A diagnosis of MS is usually based on a full medical history and neurological examination. Although not foolproof magnetic resonance imaging (MRI) of the brain and spinal cord remains the most sensitive and specific test in MS. Among other significant MS events, Scientific Milestones tells us that the first MRI pictures of the brain of an MS patient were obtained in 1981, and by clicking on Tour1 you can see a quick MRI video sequence of MS brain lesions.

Five types of MS are now recognised - the majority of patients (about eighty per cent) presenting initially with relapsing-remitting (RR) MS in which episodes of attacks are followed by complete or partial remissions as symptoms mysteriously lessen, only to return later after a period of stability. This and the other four types are explained at Multiple Sclerosis under Diagnosis and disease progression.

There is no cure for MS and until the last decade there has been no specific treatment. Therapy has revolved around symptomatic control and the management of acute exacerbations with steroids. Medications Commonly Used in Multiple Sclerosis is a ten (A4) page list of most of the drugs currently used, and the wide variety of therapeutic agents again demonstrates the broad spread of body systems that may be affected. In the last few years the introduction of interferon beta and glatiramer acetate (formerly known as copolymer-1) has offered the first real hope for some MS sufferers in altering the course of the disease. Click on Imaginis.Net for a list of trade names, manufacturers and details of administration of these newer drugs. It is difficult to understand why, when there are only five different brand names, the URL for Avonex is the only one given. For the sake of completeness and for those of you who wish to explore details of the drugs more fully I'll give all the links here:

• Avonex (interferon beta-1a)
• Betaferon (interferon beta-1b)
• Betaseron (interferon beta-1b)
• Rebif (interferon beta-1a)
• Copaxone (glatiramer acetate)

Note that Copaxone, launched in the US in 1997, awaits licensing approval in the UK.

No discussion of the drug treatment of MS is complete without reference to cannabis. The drug has been used for centuries as an intoxicant and, in recent years, by an estimated one per cent of MS patients in the UK for the symptomatic relief of spasticity and pain. Its claimed benefits arise more from anecdotal evidence than from the few published trials, but the main controversy centres around it being an illegal substance in Britain. For decriminalisation to occur there must be incontrovertible evidence that cannabis is a safe and effective medicine, and this can only be achieved following the completion of controlled clinical trials using a standardised formulation - not the crude drug. However, with the recent discovery of a cannabinoid receptor and the mapping of brain areas with an affinity for the drug, it may prove possible to develop synthetic cannabinoids with increased therapeutic benefits and minimal toxicity. MS Campaigners Call for Compassion on Cannabis is a summary of a BBC News story (incorrectly dated November 11, 1999 !) outlining a plea by the Multiple Sclerosis Society to the Government to stop criminalising sufferers who use cannabis while tests continue. The text refers to the report by the House of Lords Science and Technology Committee, published on 11 November 1998, which concluded that the Government should allow doctors to prescribe cannabis for medicinal use. The full report is at Science and Technology - Ninth Report, but the gist is contained in the Press Release which is the last item in the list of contents.

Unsurprisingly, those who suffer from MS have numerous patient-oriented Web sites to turn to. The Multiple Sclerosis Web Ring alone has 165 separate links - a record in the Disease category of Web Ring sites and, according to WebRing Stats, is the third most popular in terms of hits. But none of these can compare with our final site - the International MS Support Foundation. This professes to be 'The #1 Multiple Sclerosis Website on the Internet', and with an astonishing figure of 53,000 visitors daily (that's roughly 37 hits every minute), who can dispute the claim. Started and maintained by Jean Sumption, who contracted MS in 1986, this stimulating site has just about everything in its 57 item menu: five bulletin boards, five medical advisers, a comprehensive Medications section and much more. And although it wasn't functioning when I last visited the site, there's even a Live CAM showing Jean working at her desk. To MS patients Jean's efforts in creating such a valuable resource must be inspirational and are exemplified by her words of encouragement: 'My heart, prayers and thoughts go out to each of you as you struggle daily to overcome the obstacles and deficits MS has left with you. All I can say is the future for MS patients looks brighter every day and the medical community is making great strides in technology and research. Hang in there and don't give up. Do as much as you can within your limitations and live in today, not tomorrow.' I'm sure we all say amen to that.

To make any comments on this article, or to ask a question of the author, please contact the publisher. If you would like to submit an article please subscribe to our Pharmalicensing Intelligence service.

The opinions expressed in the articles published in this section do not necessarily reflect those of Innovaro Pharmalicensing or Innovaro Corporation. No actions including proposals to or agreements with other companies should be taken by any reader without obtaining specific business or legal advice. Neither the publisher nor the authors accept any liability for any actions or activities undertaken by any reader or other third party as a consequence of these articles or for any errors or omissions therein.