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Cytoxan & Steroids and 4-AP

  My husband is starting his second round of a new protocol for his secondary progressive MS. He will get 1gram of solumedrol for five days and then one dose of Cytoxan.  How long before any improvement will be seen.  How long should he have to stay on it?  any contraindication for someome in their 60's?
  I have also heard about 4 AP(Aminopyridine).  Is this safe?  Could he use this as well as Cytoxan?  He has bad cognitive, bladder symptoms.  MRI shows extensive lesions throughout and some black holes.  
  Thanks for any information!
Dear Effie:
There is some evidence to suggest that cyclophosphamide (cytoxan) used intermittently ("pulses") may have a beneficial effect on the course of secondarily progressive MS. This is meant to mean halting of the disease process with stabilization of deficit, or a slower rate of deterioration. Cytoxan is not expected to cause a substantial reversal of deficits. In fact, unfortunately there is no treatment the reverses any MS deficit that has persisted for six months or longer. The effect of cytoxan may be seen in a few to several weeks. Cytoxan is a very toxic drug that has numerous unpleasant and debilitating side effects in high doses. These side effects are less well tolerated in the elderly.
4-Aminopyridine is a potassium channel blocker that has a transitory effect on improving the transmission of nerve impulses through demyelinated regions of the brain. There may be improved vision, sensory function, and even motor and cognitive function for a short period after an oral or IV dose of 4-AP, specially in patients with temperature-sensitive (worse in a hot bath) symptoms. It may be of significant benefit to individuals like your husband, who may have a slightly better level of functioning on 4-AP. Unfortunately, 4-AP is a difficult drug to use in view of its toxicity (specially seizures) with even slightly high levels.
4-AP has no effect on the natural history or progression of the disease process of MS. Its use in MS remains investigational. 4-AP and cytoxan may be used in the same patient.
In case your husband and you want to address these and other options in greater depth, he is welcome for a consultation with any of the MS specialists at the Mellen Center for MS at teh Cleveland Clinic. Appointments can be made by calling (800)223-2273, or (216)444-559 locally.

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