Treating Early MS

" Hi and welcome to our webcast I'm doctor David Marks. It's early stages multiple sclerosis comes and goes in a series of attacks that can be separated by months -- years. But doctors can't diagnose and mess until patient has at least two attacks that I used to mean that treatment clintons start until long after symptoms first appear. But now some experts are calling for a different approach. Joining me to talk about this as one expert doctor Stephen -- out -- neurologist at the University of Pennsylvania welcome what is and that's to begin."

" MS is an immune attack against the central nervous system that is the brain and spinal cord. And the immune cells tactic coverings of the cables of your brain -- You know we talk about and that's coming and going. Describe. What patient goes through and how it's diagnosed there are attacks what we -- exacerbate shifts that may involve typically over several days and then orphaned in the early stages and then as remit usually that is the patient improves. After their neurological problem. It may take several weeks to maybe a few months to improve so these are attacks that are somewhat unpredictable. In the early stages of the disease. That may occur. Separated by many months or even years at a time. Do they occur in the same parts of the body each time though I think it's a random type of events in many people inferences they could occur the first time in the optic nerves the next time it might be an event that occurs in the spinal cord is this the only -- and that's the parents. Well that's the earliest days of MS and accounts for 85%. Of patients in the early stages of multiple sclerosis that is they have a an event that occurs and then it often remix there are other stages -- a -- secondary progressive MS. Really is characterized. By episodes that have occurred and now disabilities thoughts to accumulate. Over top and so. The -- had a number of attacks and now they may have trouble walking for instance that's secondary progressive MS and there are. Rarer forms of MS in which the courses it is a steady. Downhill course and we refer to that all of MS is a primary progressive MS if a person has. The first event. Can they be diagnosed with -- announced by clinical definition we have traditionally required that -- patient have. A clinical tax say optical -- and then separated by a month they have a second attack so. MS to fulfill the clinical standard definition of that mass required two episodes. Of clinical attacked separated by a month. We've come to recognize however that there is a group of patients who have a single attack that first attack. That at high risk to develop and -- and we are determined that by their MRI -- Those patients have had a single attack with an abnormal MRI scan. Are at increased risk of multiple sclerosis. Vulnerable to short and long term. Traditionally when the doctors started treating patients as we've recognized. That and that's may in the early stages be quite silent only evidence on an MRI scan. We push this treatment envelope to earlier and earlier and in fact many patients who have had a single attack. Who have a positive MRI scan our candidates for early therapy. What's the benefit of starting therapy so early in other any downsides for them. Well I think that the benefits to catch some disease early is to lessen the risk. A disability. We don't have a lot of long term studies with any of the current available medications for multiple sclerosis. Well we feel that there is evidence to suggest that those patients that's thought early on therapy. Are doing better than those that I have waited or those that we're in trials that were on placebo one of the treatments that doctors should think about. With patients who maybe are early on in the course of the disease early on and cause disease for -- laps remaining and mess we now have. Ford drawings that are most often used and they are -- the next phase in Iran compacts sound and I'll read it. For the earliest stages the -- symptomatic cases that we've just been talking about. At the next has been the drug that's been studying in this sub group patients and this study is unknown is the chance study which established the efficacy of this medication. Is it hard to convince a patient who is maybe only had. One event. To undergo treatment but has potential side effects the other it is it's a lot for a patient to absorb the first time they come into your office. You can go to -- lot of you know different things -- explained to them. What this event was what's the prognosis. And then there's a very complicated. In some sense regiment that we have to go through we have to get an MRI scan. The CEO or established the risk. Of future events because it may well who knew these animal rights here and that really tells us that they have. -- most of that time even though they didn't clinically have an event. BMO lies told is that diseases active and in this is multiple. That we do have a second event separated in time by at least one mom. So I think that would. Neurologists and now using MRI scan a lot more frequently. To help them diagnosed multiple sclerosis now for the money question. Do you think it. Every patient with a single event should be treated with one of these drugs I think you should be carefully considered and I think he should be carefully considered in those patients that have positive MRI scans MRI scans that show. Reasons other areas doctor a lot of thanks for being with us. And thank you for joining our webcast on doctor David Marks combined."