An Ounce of Early Intervention: Can early treatment of neurologic disorders such as multiple sclerosis and Parkinson's disease slow disease progression?

[Guest guest]

I don't know if everyone here gets Neurology Now magazine? (it's free btw) There was an excellent article in the new issue. You can read the article at the link below. I've also copied it below. SharonThis email is a natural hand made product. The slight variations in spelling and grammar enhance its individual character and beauty and in no way are to be considered flaws or defects.http://journals.lww.com/neurologynow/Fulltext/2011/07020/An_Ounce_of_Early_Intervention__Can_early.15.aspxAn Ounce of Early Intervention: Can early treatment of neurologic disorders such as multiple sclerosis and Parkinson's disease slow disease progression?

Gordon, Debra M.S.

Arlie Barber (not her real name) knew something was wrong

when, in the spring of 2008, she found herself running to the bathroom all the time. Her gynecologist diagnosed her with overactive bladder. But Barber, then 35, was an avid runner who had never had children. The diagnosis didn't seem to fit.

Figure. ILLUSTRATION...Image Tools

A few months later, she woke up with half her face numb. Her doctor blamed it on the Botox injection Barber had received a few days earlier, but the numbness spread over the next few weeks to her hands and feet. Along with balance problems and a sense of just not “feeling right,†Barber knew something was amiss. But it wasn't until she described her symptoms to a second doctor in October 2008 that she started to get answers that made sense. “When a woman your age describes

symptoms like these,†the doctor told her, “the medical community thinks multiple sclerosis (MS).â€

Sure enough, an MRI of Barber's brain showed multiple lesions, the hallmark of the disease. Because her spinal tap was clear, a

neurologist diagnosed her with a clinically isolated syndrome (CIS), defined as a “neurologic episode†that lasts 24 hours or more. The symptoms are caused by inflammation or loss of the protective covering on nerve cells in the brain or spinal cord and often involve vision or balance problems that eventually improve. A second CIS, however, along with evidence of brain lesions, leads to a diagnosis of “clinically definite†MS.

Given Barber's symptoms and lesions, the doctor strongly

suspected Barber would eventually be diagnosed with MS, so he offered to start her on treatment. But many of the drugs used to treat the condition require injections and can have significant side effects. “He told me that it was really serious stuff and to be really sure that's what I wanted to do,†she says.

By now, however, Barber's symptoms had disappeared as mysteriously as they arrived. She decided to forego treatment and just live her life—until an MRI in April 2009 showed more lesions, leading to

a confirmed diagnosis of MS. Now her doctor didn't just offer treatment; he strongly recommended it.

“I was in shock,†Barber recalls. “I felt so good that I

didn't want to believe this was happening.†So Barber did what many patients do these days—she went for a second opinion and hit the Internet. The second specialist told her that if she were his daughter, he would start her on medication immediately. But it was the response from members of an online support group that decided the issue.

“So many people with disabling problems from MS said they wished they could go back in time and start therapy, but that it wasn't available,†Barber says. “Others told me they didn't start because they were scared of the shots, and that they would always regret

not starting early. They thought maybe they wouldn't be as bad off today if they'd started earlier.â€

Back to Top | Article Outline

EARLY TREATMENT IN MULTIPLE SCLEROSIS

Today, several studies—including at least one following patients for 10 years—have found that beginning treatment after a CIS but before a definite diagnosis of MS can significantly reduce the likelihood that someone will be diagnosed with MS in the next two years or longer, even though it can't prevent MS altogether. (See box, “Slowing the Development of MS.â€) Even a two-year delay can be important, however, because MS is a lifelong, progressive disease. The longer you have it, the more likely you are to become disabled.

There is also some evidence that starting treatment as soon as possible after an MS diagnosis can delay disease progression, enabling people with MS to live independently longer.

Yet starting treatment immediately after a CIS is not the standard of care, says Marc Wasserman, M.D., of Phoenix Neurology and Sleep Medicine in Arizona. “Study-wise, there is little doubt that early treatment slows the progression to MS and, from there, to disability,†he says. “But when you have a patient come in and you say, you have lesions that are suggestive of MS and we want you to take an injection every day and you'll get flu-like symptoms and it will cost $10,000 a year and it may or may not slow a disease we're not sure you'll get ... well, you can see why many patients opt for the wait-and-see approach.†The interferons and glatiramer acetate do not “cure†MS, stresses Dr. Wasserman, but they can slow disease progression

when taken early. “I tell patients that they might have an exacerbation

in 2017 instead of 2015,†he says.

Doctors don't wait until someone with diabetes goes blind or develops kidney problems before treating their high blood sugar, notes Dr. Wasserman, or until someone with high blood pressure has a heart attack before treating their hypertension.

Part of the problem is that physicians can't predict exactly which patients with CIS will go on to develop MS. Data suggest that between 40 to 100 percent will, depending on the type of lesions seen on MRI. In fact, some patients diagnosed with CIS may already have MS even though they don't meet all the criteria for the disease.

The risk of diagnosing someone with CIS who doesn't go on to develop MS is low, says Reder, M.D., professor of neurology at the University of Chicago Medical Center and MS specialist.

“We have large studies of 1,000 or more patients now, and when we go back two to five years later and look at these patients, we almost never

see someone who is misdiagnosed,†he says.

Dr. Reder recalls a recent patient who had been seen at another academic institution and came to his clinic after her third attack with a positive spinal tap. She had not been started on any medication yet. The reason? “Too much reliance on the MRI,†which showed

very mild changes. “But the clinical history was classic for MS,†he says—a stark reminder that although MRI is a primary means of diagnosis,

MS still remains a clinical diagnosis, reliant on the patient's symptoms and the physician's assessment.

Another obstacle to having an open discussion about the risks and benefits of early treatment, says Dr. Wasserman, is the mindset of youth. Because so many people diagnosed with CIS or early MS are in their twenties or early thirties, they still have a sense of invulnerability. “Their basic reaction is that they don't want to be on a

drug for something that has never happened,†he says. Even once people receive a diagnosis of clinically definite MS, many still delay treatment.

In a survey conducted between November 2008 and February

2009 by the National Multiple Sclerosis Society, 18 percent of the 250 people living with MS surveyed reported a delay in the start of their MS

treatment, saying they were not told why they should start drug treatment early. However, nearly all of the 250 physicians interviewed said they always explain the benefits of starting drug therapy early.

As for Barber, she has now been on therapy for eight months. Unfortunately, she has had at least one other attack. But she's sticking with her treatment even though she hates the shots. She says they are manageable and she would never suggest someone not start medication because of the shots. If her MRI continues to show disease progression over the next few months, she'll likely switch to a different drug.

Barber is learning what all patients with a progressive,

neurologic disease like MS need to know, notes MS specialist Fred D. Lublin, M.D., who is the Saunders Family Professor of Neurology and the director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai Medical Center in New York, NY: Treatment of such diseases is for the “long haul.†“We want to start you early to try

and keep you healthy for a long, long time,†he says.

Back to Top | Article Outline

EARLY TREATMENT FOR PARKINSON'S DISEASE

Another neurologic disease experts hope can be contained

with early treatment is Parkinson's disease (PD). In recent years, researchers have unearthed tantalizing evidence that there may a “pre-PD†phase of the disease that begins long before the first tremor or other motor symptom. Symptoms include loss of smell, problems urinating, increased perspiration, sleep difficulties, constipation, restless legs, and fatigue, among others. These symptoms may appear up to 10 years before any movement-related symptoms or diagnosis.

The problem, notes Dr. Wasserman, is that some of these symptoms occur in other neurologic conditions as well, including Alzheimer's disease. “There is no test for PD,†he says. It's all up to the neurologist to diagnose it based on the patient's clinical symptoms and history. (See box, “Parkinson's Disease: The Basics.â€)

Still, there is evidence that changes in the brain, including loss of neurons in the substantia nigra, where most dopamine is produced, begin up to 6.5 years before the first movement-related symptoms.

This got researchers thinking. What if there was a way to not only diagnose PD in the pre-movement phase but to treat it and prevent any further damage? The concept, called “disease modification†or “neuroprotection,†means protecting remaining neurons from further damage. To date, researchers don't even know how to diagnose people in that pre-PD phase, but they are still hopeful that early treatment after

diagnosis could slow the disease.

For instance, there is some evidence that levodopa, the drug most patients with PD eventually take, may slow the progression of PD or even provide some protective effects after patients stop taking it. However, most doctors wait as long as possible before starting levodopa because the benefits eventually fade and side effects, such as dyskinesias and motor fluctuations, increase.

That's why PD expert Rezak, M.D., Ph.D., director of the Movement Disorders Center at Central DuPage Hospital Neurosciences Institute, starts his patients on rasagiline. It is also the only drug to show any disease-modifying effects on patients with early PD.

In one study, researchers randomly divided 1,176 people with recently diagnosed, untreated PD into two groups. The first group received 1 or 2 mg of rasagiline for 72 weeks, while the second group received a placebo for the first 36 weeks followed by rasagiline for 36 weeks. The idea was that if the first group had fewer changes after 72 weeks than the second group, the drug was able to slow PD progression. And, indeed, patients receiving 1 mg of rasagiline in the first group did show fewer changes on tests to measure PD symptoms. However, only those with the worst scores prior to taking the drug benefitted from the

higher dose. Since researchers expected a greater benefit with the higher dose, most experts consider the results inconclusive, but Dr. Rezak prescribes it to patients even with very minimal symptoms. “It is very controversial,†he admits, “but I happen to believe it has some disease-modifying effects.â€

For now, neurologists must work with their patients to find the right drug cocktail or, in some instances, surgical intervention such as a deep brain stimulation, to keep symptoms at bay. In the meantime, researchers are working hard to identify drugs or other

compounds that slow the progression of PD and/or protect remaining dopamine-producing neurons.

The National Institute of Neurological Disorders and Stroke (NINDS) is running a series of clinical trials at more than 50 centers throughout the U.S. and Canada trying to find a way to slow the progression of PD. Currently, researchers are recruiting people who have

been diagnosed with PD in the last five years and treated with dopamine

agonists, ropinirole, or levodopa for at least 90 days but no longer than two years for a trial evaluating a special formulation of the nutritional supplement creatine being developed by the pharmaceutical company Avicena Group, Inc. In animal studies, the compound has been shown to protect brain cells. Other compounds NINDS researchers are evaluating include coenzyme Q10, a synthetic compound called GPI-1485, and minocycline.

“Where we get stuck with PD is that you have to find a way to replace dopamine,†says Dr. Wasserman. “So while we may have drugs that treat PD better, or boost the effect of existing drugs, as far as really stopping the disease . . . I'm not sure that's on the horizon.â€

One thing you can do on your own is exercise—something Dr. Rezak prescribes to all his PD patients. A study presented at the 2010 AAN meeting in Toronto had people with PD practice “exaggerated movements†such as pushing their arms out before them, lunging forward, swinging their arms while walking, and kickboxing for 45 minutes a day, three days a week for 12 weeks. Symptoms improved significantly in exercisers compared to a similar group who didn't exercise. Dr. Rezak is

a big believer in exercise, considering it one of the cornerstones of treatment for PD. “It's probably as important as taking the medications,†he says, and he thinks it does slow disease progression as

well as help patients better handle the ravages of PD. He maintains a database of his patients and says those who exercise regularly seem to progress more slowly and require less medication.

While researchers continue to search for ways to slow progression in diseases like MS and PD, experts agree that ignoring symptoms until later is a mistake. Discussing them with a neurologist is

the critical first step in finding out what—if anything—is wrong, as well as having an informed discussion about the risk and benefits of treatment.

Back to Top | Article Outline

Slowing the Development of Multiple Sclerosis (MS)

This table depicts the results of four major studies showing that beginning treatment at the “pre-MS†stage of the disease, after the first clinically isolated syndrome (CIS), extended the time until the MS diagnosis compared to people who were not treated after a CIS.

Back to Top | Article Outline

Multiple Sclerosis: The Basics

Image Tools

Multiple sclerosis (MS) is thought to be an autoimmune disease in which immune system cells and inflammatory chemicals damage the myelin sheath that covers nerve cells in the brain and spinal cord. This, in turn, leaves the neurons open to further damage and impairs their ability to communicate, leading to problems with vision, movement,

balance, and thinking. Most people are diagnosed in their twenties and thirties. Although studies suggest that about half of people with MS use

a cane for walking and 15 percent require a wheelchair 10 years after diagnosis, the disease-modifying drugs used in treatment today can significantly slow the progression of the disease and the development of

disability.

Between 250,000 and 350,000 people in the United States,

primarily women, have been diagnosed with MS. The disease is likely related to a combination of genetic and environmental causes. People with a family history of the disease have a much higher risk of developing MS themselves.

The criteria for diagnosing MS have been a moving target

over the past few years, as more evidence accumulates about the benefits of early treatment. The latest guidelines from the International Panel on Diagnosis of MS base diagnosis on the type of brain lesions seen on an MRI, allowing for diagnosis on the basis of a single MRI rather than waiting for two or more. While the new criteria do allow for a quicker diagnosis, there is some concern that they could also increase the risk of misdiagnosis.

Back to Top | Article Outline

Parkinson's Disease: The Basics

An estimated 1 million people in the US have been diagnosed with Parkinson's disease (PD), a progressive neurologic disease that can result in disabilities in movement, speech, and thinking over decades. The disease results as cells that produce dopamine, a brain chemical important in transmitting messages related to

movement, are destroyed. Recent evidence has shown that other areas of the brain may be involved even before the dopamine neurons are lost. People with the disease are typically diagnosed in their fifties or older, although it can occur in those younger than 30. By the time the first movement-related symptoms appear, it is believed that people have usually had the disease for years.

The primary motor symptoms leading to diagnosis include tremor; stiffness of the arms, legs, and trunk; slowed movements, called

bradykinesia; and balance problems. Because there are no blood or imaging tests for PD, you need to be as specific as possible in describing your symptoms—when they began, and how they affect your life—so your doctor can make the right diagnosis. Researchers are looking for biomarkers to help diagnose the disease earlier, particularly changes in the brain visible with various brain imaging techniques like single photon emission computed tomography (SPECT) and positron emission tomography (PET). But to date, symptoms are still the only way to diagnose the disease.

©2011 American Academy of Neurology

[Guest guest]

I don't

receive the magazine since I don't have a PO box any

longer.  You are right, though, this IS a good read. 

It's also nice to think that, we as a group, might possibly actually

had an influence on someone deciding whether to start treatment

early. Even with all our goofiness! LOL

HUGS

|)onna

I don't know if everyone

here gets Neurology Now magazine?  (it's free btw)  There was an

excellent article in the new issue.  You can read the article at

the link below.  I've also copied it below. 

Sharon

This email is a natural hand made product.

The slight variations in spelling and grammar enhance its

individual character and beauty and in no way are to be

considered flaws or defects.

http://journals.lww.com/neurologynow/Fulltext/2011/07020/An_Ounce_of_Early_Intervention__Can_early.15.aspx

An Ounce of Early Intervention: Can early treatment of

neurologic disorders such as multiple sclerosis and

Parkinson's disease slow disease progression?

Gordon, Debra M.S.

Arlie Barber (not her real name) knew something

was wrong when, in the spring of 2008, she found herself

running to the bathroom all the time. Her gynecologist

diagnosed her with overactive bladder. But Barber, then

35, was an avid runner who had never had children. The

diagnosis didn't seem to fit.

Figure.

ILLUSTRATION...

Image Tools

A few months later, she woke up with half her

face numb. Her doctor blamed it on the Botox injection

Barber had received a few days earlier, but the numbness

spread over the next few weeks to her hands and feet.

Along with balance problems and a sense of just not

“feeling right,†Barber knew something was amiss. But it

wasn't until she described her symptoms to a second doctor

in October 2008 that she started to get answers that made

sense. “When a woman your age describes symptoms like

these,†the doctor told her, “the medical community thinks

multiple sclerosis (MS).â€

Sure enough, an MRI of Barber's brain showed

multiple lesions, the hallmark of the disease. Because her

spinal tap was clear, a neurologist diagnosed her with a

clinically isolated syndrome (CIS), defined as a

“neurologic episode†that lasts 24 hours or more. The

symptoms are caused by inflammation or loss of the

protective covering on nerve cells in the brain or spinal

cord and often involve vision or balance problems that

eventually improve. A second CIS, however, along with

evidence of brain lesions, leads to a diagnosis of

“clinically definite†MS.

Given Barber's symptoms and lesions, the doctor

strongly suspected Barber would eventually be diagnosed

with MS, so he offered to start her on treatment. But many

of the drugs used to treat the condition require

injections and can have significant side effects. “He told

me that it was really serious stuff and to be really sure

that's what I wanted to do,†she says.

By now, however, Barber's symptoms had

disappeared as mysteriously as they arrived. She decided

to forego treatment and just live her life—until an MRI in

April 2009 showed more lesions, leading to a confirmed

diagnosis of MS. Now her doctor didn't just offer

treatment; he strongly recommended it.

“I was in shock,†Barber recalls. “I felt so

good that I didn't want to believe this was happening.†So

Barber did what many patients do these days—she went for a

second opinion and hit the Internet. The second specialist

told her that if she were his daughter, he would start her

on medication immediately. But it was the response from

members of an online support group that decided the issue.

“So many people with disabling problems from MS

said they wished they could go back in time and start

therapy, but that it wasn't available,†Barber says.

“Others told me they didn't start because they were scared

of the shots, and that they would always regret not

starting early. They thought maybe they wouldn't be as bad

off today if they'd started earlier.â€

Back

to Top | Article Outline

EARLY TREATMENT IN MULTIPLE SCLEROSIS

Today, several studies—including at least one

following patients for 10 years—have found that beginning

treatment after a CIS but before a definite diagnosis of

MS can significantly reduce the likelihood that someone

will be diagnosed with MS in the next two years or longer,

even though it can't prevent MS altogether. (See box,

“Slowing the Development of MS.â€) Even a two-year delay

can be important, however, because MS is a lifelong,

progressive disease. The longer you have it, the more

likely you are to become disabled.

There is also some evidence that starting

treatment as soon as possible after an MS diagnosis can

delay disease progression, enabling people with MS to live

independently longer.

Yet starting treatment immediately after a CIS

is not the standard of care, says Marc Wasserman, M.D., of

Phoenix Neurology and Sleep Medicine in Arizona.

“Study-wise, there is little doubt that early treatment

slows the progression to MS and, from there, to

disability,†he says. “But when you have a patient come in

and you say, you have lesions that are suggestive of MS

and we want you to take an injection every day and you'll

get flu-like symptoms and it will cost $10,000 a year and

it may or may not slow a disease we're not sure you'll get

.... well, you can see why many patients opt for the

wait-and-see approach.†The interferons and glatiramer

acetate do not “cure†MS, stresses Dr. Wasserman, but they

can slow disease progression when taken early. “I tell

patients that they might have an exacerbation in 2017

instead of 2015,†he says.

Doctors don't wait until someone with diabetes

goes blind or develops kidney problems before treating

their high blood sugar, notes Dr. Wasserman, or until

someone with high blood pressure has a heart attack before

treating their hypertension.

Part of the problem is that physicians can't

predict exactly which patients with CIS will go on to

develop MS. Data suggest that between 40 to 100 percent

will, depending on the type of lesions seen on MRI. In

fact, some patients diagnosed with CIS may already have MS

even though they don't meet all the criteria for the

disease.

The risk of diagnosing someone with CIS who

doesn't go on to develop MS is low, says Reder,

M.D., professor of neurology at the University of Chicago

Medical Center and MS specialist. “We have large studies

of 1,000 or more patients now, and when we go back two to

five years later and look at these patients, we almost

never see someone who is misdiagnosed,†he says.

Dr. Reder recalls a recent patient who had been

seen at another academic institution and came to his

clinic after her third attack with a positive spinal tap.

She had not been started on any medication yet. The

reason? “Too much reliance on the MRI,†which showed very

mild changes. “But the clinical history was classic for

MS,†he says—a stark reminder that although MRI is a

primary means of diagnosis, MS still remains a clinical

diagnosis, reliant on the patient's symptoms and the

physician's assessment.

Another obstacle to having an open discussion

about the risks and benefits of early treatment, says Dr.

Wasserman, is the mindset of youth. Because so many people

diagnosed with CIS or early MS are in their twenties or

early thirties, they still have a sense of

invulnerability. “Their basic reaction is that they don't

want to be on a drug for something that has never

happened,†he says. Even once people receive a diagnosis

of clinically definite MS, many still delay treatment.

In a survey conducted between November 2008 and

February 2009 by the National Multiple Sclerosis Society,

18 percent of the 250 people living with MS surveyed

reported a delay in the start of their MS treatment,

saying they were not told why they should start drug

treatment early. However, nearly all of the 250 physicians

interviewed said they always explain the benefits of

starting drug therapy early.

As for Barber, she has now been on therapy for

eight months. Unfortunately, she has had at least one

other attack. But she's sticking with her treatment even

though she hates the shots. She says they are manageable

and she would never suggest someone not start medication

because of the shots. If her MRI continues to show disease

progression over the next few months, she'll likely switch

to a different drug.

Barber is learning what all patients with a

progressive, neurologic disease like MS need to know,

notes MS specialist Fred D. Lublin, M.D., who is the

Saunders Family Professor of Neurology and the director of

the Corinne Goldsmith Dickinson Center for Multiple

Sclerosis at Mount Sinai Medical Center in New York, NY:

Treatment of such diseases is for the “long haul.†“We

want to start you early to try and keep you healthy for a

long, long time,†he says.

Back

to Top | Article Outline

EARLY TREATMENT FOR PARKINSON'S DISEASE

Another neurologic disease experts hope can be

contained with early treatment is Parkinson's disease

(PD). In recent years, researchers have unearthed

tantalizing evidence that there may a “pre-PD†phase of

the disease that begins long before the first tremor or

other motor symptom. Symptoms include loss of smell,

problems urinating, increased perspiration, sleep

difficulties, constipation, restless legs, and fatigue,

among others. These symptoms may appear up to 10 years

before any movement-related symptoms or diagnosis.

The problem, notes Dr. Wasserman, is that some

of these symptoms occur in other neurologic conditions as

well, including Alzheimer's disease. “There is no test for

PD,†he says. It's all up to the neurologist to diagnose

it based on the patient's clinical symptoms and history.

(See box, “Parkinson's Disease: The Basics.â€)

Still, there is evidence that changes in the

brain, including loss of neurons in the substantia nigra,

where most dopamine is produced, begin up to 6.5 years

before the first movement-related symptoms.

This got researchers thinking. What if there was

a way to not only diagnose PD in the pre-movement phase

but to treat it and prevent any further damage? The

concept, called “disease modification†or

“neuroprotection,†means protecting remaining neurons from

further damage. To date, researchers don't even know how

to diagnose people in that pre-PD phase, but they are

still hopeful that early treatment after diagnosis could

slow the disease.

For instance, there is some evidence that

levodopa, the drug most patients with PD eventually take,

may slow the progression of PD or even provide some

protective effects after patients stop taking it. However,

most doctors wait as long as possible before starting

levodopa because the benefits eventually fade and side

effects, such as dyskinesias and motor fluctuations,

increase.

That's why PD expert Rezak, M.D., Ph.D.,

director of the Movement Disorders Center at Central

DuPage Hospital Neurosciences Institute, starts his

patients on rasagiline. It is also the only drug to show

any disease-modifying effects on patients with early PD.

In one study, researchers randomly divided 1,176

people with recently diagnosed, untreated PD into two

groups. The first group received 1 or 2 mg of rasagiline

for 72 weeks, while the second group received a placebo

for the first 36 weeks followed by rasagiline for 36

weeks. The idea was that if the first group had fewer

changes after 72 weeks than the second group, the drug was

able to slow PD progression. And, indeed, patients

receiving 1 mg of rasagiline in the first group did show

fewer changes on tests to measure PD symptoms. However,

only those with the worst scores prior to taking the drug

benefitted from the higher dose. Since researchers

expected a greater benefit with the higher dose, most

experts consider the results inconclusive, but Dr. Rezak

prescribes it to patients even with very minimal symptoms.

“It is very controversial,†he admits, “but I happen to

believe it has some disease-modifying effects.â€

For now, neurologists must work with their

patients to find the right drug cocktail or, in some

instances, surgical intervention such as a deep brain

stimulation, to keep symptoms at bay. In the meantime,

researchers are working hard to identify drugs or other

compounds that slow the progression of PD and/or protect

remaining dopamine-producing neurons.

The National Institute of Neurological Disorders

and Stroke (NINDS) is running a series of clinical trials

at more than 50 centers throughout the U.S. and Canada

trying to find a way to slow the progression of PD.

Currently, researchers are recruiting people who have been

diagnosed with PD in the last five years and treated with

dopamine agonists, ropinirole, or levodopa for at least 90

days but no longer than two years for a trial evaluating a

special formulation of the nutritional supplement creatine

being developed by the pharmaceutical company Avicena

Group, Inc. In animal studies, the compound has been shown

to protect brain cells. Other compounds NINDS researchers

are evaluating include coenzyme Q10, a synthetic compound

called GPI-1485, and minocycline.

“Where we get stuck with PD is that you have to

find a way to replace dopamine,†says Dr. Wasserman. “So

while we may have drugs that treat PD better, or boost the

effect of existing drugs, as far as really stopping the

disease . . . I'm not sure that's on the horizon.â€

One thing you can do on your own is

exercise—something Dr. Rezak prescribes to all his PD

patients. A study presented at the 2010 AAN meeting in

Toronto had people with PD practice “exaggerated

movements†such as pushing their arms out before them,

lunging forward, swinging their arms while walking, and

kickboxing for 45 minutes a day, three days a week for 12

weeks. Symptoms improved significantly in exercisers

compared to a similar group who didn't exercise. Dr. Rezak

is a big believer in exercise, considering it one of the

cornerstones of treatment for PD. “It's probably as

important as taking the medications,†he says, and he

thinks it does slow disease progression as well as help

patients better handle the ravages of PD. He maintains a

database of his patients and says those who exercise

regularly seem to progress more slowly and require less

medication.

While researchers continue to search for ways to

slow progression in diseases like MS and PD, experts agree

that ignoring symptoms until later is a mistake.

Discussing them with a neurologist is the critical first

step in finding out what—if anything—is wrong, as well as

having an informed discussion about the risk and benefits

of treatment.

Back

to Top | Article Outline

Slowing the Development of Multiple Sclerosis

(MS)

This table depicts the results of four major

studies showing that beginning treatment at the “pre-MSâ€

stage of the disease, after the first clinically isolated

syndrome (CIS), extended the time until the MS diagnosis

compared to people who were not treated after a CIS.

Back

to Top | Article Outline

Multiple Sclerosis: The Basics

Image Tools

Multiple sclerosis (MS) is thought to be an

autoimmune disease in which immune system cells and

inflammatory chemicals damage the myelin sheath that

covers nerve cells in the brain and spinal cord. This, in

turn, leaves the neurons open to further damage and

impairs their ability to communicate, leading to problems

with vision, movement, balance, and thinking. Most people

are diagnosed in their twenties and thirties. Although

studies suggest that about half of people with MS use a

cane for walking and 15 percent require a wheelchair 10

years after diagnosis, the disease-modifying drugs used in

treatment today can significantly slow the progression of

the disease and the development of disability.

Between 250,000 and 350,000 people in the United

States, primarily women, have been diagnosed with MS. The

disease is likely related to a combination of genetic and

environmental causes. People with a family history of the

disease have a much higher risk of developing MS

themselves.

The criteria for diagnosing MS have been a

moving target over the past few years, as more evidence

accumulates about the benefits of early treatment. The

latest guidelines from the International Panel on

Diagnosis of MS base diagnosis on the type of brain

lesions seen on an MRI, allowing for diagnosis on the

basis of a single MRI rather than waiting for two or more.

While the new criteria do allow for a quicker diagnosis,

there is some concern that they could also increase the

risk of misdiagnosis.

Back

to Top | Article Outline

Parkinson's Disease: The Basics

An estimated 1 million people in the US have

been diagnosed with Parkinson's disease (PD), a

progressive neurologic disease that can result in

disabilities in movement, speech, and thinking over

decades. The disease results as cells that produce

dopamine, a brain chemical important in transmitting

messages related to movement, are destroyed. Recent

evidence has shown that other areas of the brain may be

involved even before the dopamine neurons are lost. People

with the disease are typically diagnosed in their fifties

or older, although it can occur in those younger than 30.

By the time the first movement-related symptoms appear, it

is believed that people have usually had the disease for

years.

The primary motor symptoms leading to diagnosis

include tremor; stiffness of the arms, legs, and trunk;

slowed movements, called bradykinesia; and balance

problems. Because there are no blood or imaging tests for

PD, you need to be as specific as possible in describing

your symptoms—when they began, and how they affect your

life—so your doctor can make the right diagnosis.

Researchers are looking for biomarkers to help diagnose

the disease earlier, particularly changes in the brain

visible with various brain imaging techniques like single

photon emission computed tomography (SPECT) and positron

emission tomography (PET). But to date, symptoms are still

the only way to diagnose the disease.

©2011 American Academy of

Neurology