Multiple Sclerosis Relapses: How to Deal with Them
Participants:
Dusan Stefoski, MD - Associate Professor of Neurology, Rush University Medical Center
Patrick Parcells, MD - Hampton Roads Neurology, VA
Webcast Transcript: Recorded Live: April 29 2003
ANNOUNCER: Some diseases are tricky. Such is the case with multiple sclerosis, a disease that attacks the central nervous system. While the condition may be life-long, there are often long periods during which people with MS feel relatively well. Then suddenly there is a relapse and symptoms reappear.
DUSAN STEFOSKI, MD: Relapses occur in about 90% of all people with multiple sclerosis, and what relapse implies is that symptoms have worsened relatively abruptly over a period of hours, perhaps over several days, maybe up to a week or a bit longer.
ANNOUNCER: The symptoms of a relapse can be unpredictable.
DUSAN STEFOSKI, MD: That can be various types of numbness and tingling, weakness in one limb or more, double vision, loss of vision (usually in one eye), difficulties with bladder and bowel control, trouble with balance when walking and standing. Trouble with coordination of hands. That sort of thing; even trouble speaking, swallowing, and breathing at times.
ANNOUNCER: In a person already diagnosed with MS, a relapse will mean a new symptom or the worsening of an old one. And the duration of the relapse is unpredictable.
PATRICK PARCELLS, MD: It's probably going to take a few weeks to potentially even a month to get better, but it may take up to six months. That if you still have any residual problems in six months, that that may last indefinitely. There's a good chance, most of the time, particularly early in MS, most relapses do recover fully.
ANNOUNCER: currently ms is not curable, but there are medications called interferons that can decrease relapses, and in some cases lessen the damage done.
PATRICK PARCELLS, MD: The average, if you'd look at all MS patients, of relapses, is actually about one per year. And in the studies with the interferons, that average was diminished by about 30%.
ANNOUNCER: Relapses may occur even on interferon therapy.
PATRICK PARCELLS, MD: It doesn't mean that there's a failure of interferon. It just means that that relapse still occurred in spite of interferon. I always tell patients there's a greater risk you would be even worse if you weren't on treatment; that you certainly need to stay on treatment.
ANNOUNCER: if treated early, the symptoms of a relapse can be lessened with steroids.
PATRICK PARCELLS, MD: That can certainly make patients feel better, shortens the length of time the relapse will occur, and they will improve more quickly.
ANNOUNCER: Sometimes there is "break-through MS" which means too many relapses or too much progression of disabilities. At that point other drugs may be added to interferon. This is called combination therapy.
PATRICK PARCELLS, MD: We might add steroids intravenously once a month or every three months. We might add oral prednisone at times, occasionally once a month. We might add other chemotherapy drugs, oral chemotherapy such as methotrexate, CellCept, azathioprine. And then there is an approved treatment called Novantrone, which is given intravenously every three months. There are some people that have looked at combining interferon with Copaxone, because they do have different mechanisms of action.
ANNOUNCER: Experts feel it's preferable to stay with one form of interferon rather than changing.
DUSAN STEFOSKI, MD: I consider combination or add-on therapies superior to giving thoughts to switching from one interferon to the next or the third.
ANNOUNCER: Relapses, no matter how mild, are always a disturbing reminder that a person has MS.
DUSAN STEFOSKI, MD: Relapses are very significant in the lives of people with MS because they can stop them in their tracks. They make people weaker, more difficult to function. They have to refocus their energies on addressing the issues of the relapse including therapy, at times even requiring hospitalization for intravenous medications.
ANNOUNCER: Dealing with relapses is best done with help.
DUSAN STEFOSKI, MD: A person needs obviously a health professional to help that person guide with medications and various other aspects of therapy such as physical therapy, occupational therapy, exercise therapies; that sort of thing. People with MS also need help from other people who have MS, those are the so-called patient self-support groups. They can be very enlightening.
Family members, relatives and friends are very important because these people can find themselves, at times, in dire need of getting groceries because they can't get out for a while, or just to talk to someone or to go get the medications or to share the burden of the disease both physically and psychologically
ANNOUNCER: What's crucial is that a person with MS addresses the issue of their relapse.
PATRICK PARCELLS, MD: It's important to realize that we do have treatment for relapses. It's important to realize that relapses of and by themselves doesn't mean that the outcome of their MS 10 or 20 years from now is going to be better or worse depending on their relapses. And it's important to realize that they need to really take a positive approach to treating relapses and not to avoid contacting their doctor. And so I always encourage that they do something positive rather than just sit and wait for the relapse to go away by itself.
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Multiple Sclerosis Relapses: How to Deal With Them
Posted - 08/07/2004 : 01:50:30
