As many of us know, the neurological disease Multiple Sclerosis (MS)  has multiple forms [1]:

  • Relapsing-Remitting  (RRMS):    Unpredictable attacks (relapses) followed by periods of relative remission with no new signs of disease activity
  • Secondary Progressive (SPMS) :     Neurologic decline without acute relapses: A sign that one is evolving from RRMS to SPMS is that the baseline drugs[ CRABT]  work less well (Copaxone, Rebif, Avonex, Betaseron and Tysabri); Disability has progressed. This group is fairly large : about 50 % of RRMS evolves into SPMS within age 40.
  • Progressive Relapsing (PRMS) :     Steady neurologic decline and superimposed attacks.
  • Primary Progressive  (PPMS) :    Decline from the beginning without attacks; problems walking, which gradually get worse; slowly worsening tremor; problems with balance.
This still could boil down to two overarching types: Relapsing Remitting and Progressive

Most Multiple Sclerosis (MS) new drugs, (See for example, our post on Alemtuzumab [2]), apply primarily  to the Relapsing Remitting Multiple Sclerosis form.

We have posted through the year on the Progressive forms of MS [4-8], and  checking on current research, we gathered the following.

First we bring you, through YouTube, a presentation by Dr Yaung Mao-Drayer, U. Of Michigan [3]. This is a good summary of the challenges of treating progressive MS.

 

 

 The most important Chart of this presentation is below. Progressive MS according to Dr Mao-Draayer

 

 

Progressive MS, Dr Mao Draayer, UMHS

 

Here you would have it, most , if not all the MS big guns address the inflammation phase of RRMS, as opposed to the Neuro-Degenerative phase of the progreesive types of MS.

Is it really that simple?

  • Another study from Denmark [10],  shows that inflammation and neurodegeneration go and progress hand in hand :  “…emphasise a relationship between inflammation, axonal damage and demyelination…”
  • From Austria [11]: “...In progressive MS, as in relapsing-remitting MS, active tissue injury is associated with inflammation, but the inflammatory response in the progressive phase occurs at least partly behind the blood-brain barrier, which makes it more difficult to treat.  
We did publish about attempts to bring drugs to bear behind the Blood Brain Barrier [6]. intranasal delivery, is being studied for that purpose. Other methods use ”…biodegradable polymeric nanoparticles…” [12]
Other research avenues against Progressive MS include: Attacking the free radicals oxidation process [a nutraceutical favorite], by administration of oral treatments with Fumaric Esters [13]. Fumaric esters can be found in ”…Fumaric acid is found in fumitory (Fumaria officinalis), bolete mushrooms (specifically Boletus fomentarius var. pseudo-igniarius), lichen, and Iceland moss…” (Wikipedia).
Problem Dimethyl fumarate is a potent irritant. Look before you jump…
Other methods we discussed in previous posts are
  • Stem Cells:  Stem cells that can differentiate into a variety of cell types, including blood cells [4]
  • Masitinib   [5]“… Masitinib, a selective oral tyrosine kinase inhibitor, effectively inhibits the survival, migration and activity of mast cells…”
  • Statins: Usually for cholesterol concerns,  Zocor  (Simvastatin)   [7]
Discuss with your Doctor…

Sources:

  1. About.com ; Julie Stachowiak
  2. medinewsdigest ; “Big Pharma’s Slight Of Hand: Genzyme’s Alemtuzumab Disappears as a Leukemia Drug, Only To Be Reborn as a Multiple Sclerosis Drug”, Nov 2012
  3. medinewsdigest ; IN BRIEF: Management of Secondary Progressive Multiple Sclerosis” ;April 2012
  4. medinewsdigest ; “Progress in Stem Cell Treatment of Secondary Progressive Multiple Sclerosis” ; Feb 2012
  5.  medinewsdigest ; “Possible New Treatment of Progressive Multiple Sclerosis: Masitinib” ; June 2012
  6. medinewsdigest ; ”IN DEPTH: Multiple Sclerosis Research And The Blood Brain Barrier” ; Aug 2012
  7. medinewsdigest ; “IN BRIEF: Zocor Shown to Slow Disability in Secondary Progressive Multiple Sclerosis” ; Oct 2012
  8. medinewsdigest ; ”New Study shows Multiple Sclerosis caused primarily by inflammation, not neurodegeneration” , Dec 2011
  9. youtube; “Progressive Multiple Sclerosis – 2012 Patient & Caregiver Conference”
  10. Multiple Sclerosis ; ” CSF inflammation and axonal damage are increased and correlate in progressive multiple sclerosis.”; Nov 2012
  11. Nature Reviews Neurology ; “Progressive multiple sclerosis: pathology and pathogenesis.” ; Nov 2012 Multiple Sclerosis ; “Intravenous immunoglobulin in primary and secondary chronic progressive multiple sclerosis: a randomized placebo controlled multicentre study.” ; Nov 2007
  12. Journal of Controlled Release ; “Transport of drugs across the blood-brain barrier by nanoparticles.”; July 2012
  13. Int. Journal Of Molecular Science ; “Mechanisms of Oxidative Damage in Multiple Sclerosis and Neurodegenerative Diseases: Therapeutic Modulation via Fumaric Acid Esters.” ; 2012
  14. Alternative Holistic Health Answers ; ”Study Confirms Efficacy of Oral Fumarate in Multiple Sclerosis” ; Christopher Maloney, Naturopathic Doctor, April 2012
  15. uptodate.com ; ”Treatment of progressive multiple sclerosis in adults” ; Oct 2012
  16. Multiple Sclerosis Journal ; “Setting a research agenda for progressive multiple sclerosis: The International Collaborative on Progressive MS” ; 2012
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