Drug Therapy for MS Patient

[Websurfer]

Thank you for your answer to one of our previous questions. I am writing to get advice on a new topic for my mom, who has had MS for more than two decades. She is currently in a wheelchair and suffers from many other symptoms, including neuropathic pain. Recently she has worried that her arms are starting to get weaker. Instead of returning to her usual neurologist, she decided to see a new neurologist who is both closer to her home and with whom she might have an easier time communicating. The new neurologist sent her home with information about Avonex and Betaseron, which she has never taken. Now she is trying to decide what to do.

Some medical history: although my mom used to have relapses along with chronic symptoms, she has not had any relapses for a few years. Her disability continues to gradually worsen. In the past, steroids were helpful for treating the relapses, but the last couple of times she had such treatments they did not help her. She has never been treated with any of the ABC drugs, but she did undergo experimental treatments at Barnes Hospital (Washington University in St. Louis) a decade or so ago. She received by IV a drug used in chemotherapy, but I don't know which one. She has a history of heart attacks, but after she had bypass surgery a few years ago she was told that her heart was in good shape, and she has had no more trouble. Currently she takes a variety of medications, including Elavil, Protonix, Celebrex, Lasix, Lipotor, Neurontin, Baclofen, Oscal, Vitamin D & A, and aspirin. She is 64 years old.

If one of the interferon therapies could help her maintain her arm strength, she would very much want to try it. I wonder, however, how much we can hope for since she no longer has relapses. What I have read suggests that the relapsing group of patients might be the ones who are helped by these drugs.

If the drugs might still help her, is there any reason not to try one? I wonder in particular if her history of heart attacks would make either or both of the beta-interferon treatments risky for her. I have read that there is a risk for patients with heart disease who take Avonex but didn't see a warning for Betaseron. On the other hand, now that she has had bypass surgery she was told that her heart is ok.

Finally, I have read about new drugs for treating progressive MS, and I wondered if one of those might be a good idea for her. Here my concern is that her prior treatment by what I think are drugs in that family (the experimental treatment a decade ago) or her history of heart attacks could rule out the possibility.

Your comments about which therapy or therapies that you think she should discuss further with her doctor would be greatly appreciated.

[KatieW]

Like many patients with MS could you tell me about the chemo-meds?  Like all the good & down falls.  I tried Betaseron, then Rebif.  I'm getting tired of feeling like a chicken waiting for my baby chicks to hatch.  I don't think my body can handle any more auto-immune diseases.  Have Diabetes I and MS.

[tigemgiz]

I also have MS (d/x '93) and am now considered with secondary progressive.  For about 9 mos now I have been taking dbl strength avonex.  I started in a 2 yr dble blind study but found I was getting the placebo.  Now I get the real drug but I really see no benefit to it.  Does anyone know of this study?  My dr does not like novantrone because of the heart problems.

[CCF-Neuro-M.D.-RPS]

Dear Websurfer:

I am sorry to hear that your mother has MS and wasn't treated with the interferons, as they have been out for 5-6 years now.  They do work and have been shown to slow down the development of new lesions.  However, what is done is done and once a new lesion develops it progresses.  The interferons work best for relapsing remitting MS as usually this is the newly diagnosed patient and the one with most to loose.  Chronic progessive stage is not as sensitive to the interferons as at this point, the brain has suffered many lesions and the disease begins it progressive stage.  Likely the beta interferons would not have a great effect at this stage.  There is another medication Narvartone, which acts via a different mechanism.  It might be of some help, but there is a lifetime dose limit and there are effects on the heart.  Much would depend on how the brain looks on MRI and the physical exam.  If there is still much left normal, with only a limited focality and spasticity then maybe a course of the drug might be warranted.  Wihtout seeing and examining your mother it is difficult to tell.  It is my personal view that ife is short, we should live it to the maximum potential.  Treatment may help her live the rest of her days alittle better.  

Sincerely,

CCf Neuro MD