Repairing the damage

One of the reasons why MS is such a difficult disease to cure is that, once the CNS has been damaged, it would involve major repair of the often severe structural damage. Any further process of damage would have to be prevented as well as the previous structural damage being repaired. However, despite these difficulties, there is considerable interest in experimental work on drugs that may be able to ‘remyelinate’ damaged nerves, and drugs that may slow down or halt the process of further damage.

Symptom remission

Most claims for a cure for MS have been made on the basis that the symptoms seem to have disappeared, temporarily at least, but not that the structural damage of MS has been repaired. The problem is that symptoms of MS can be dormant for many years, or dramatic remissions in symptoms have occurred, but the damage to the CNS has not necessarily been repaired. Symptoms can reappear, and there is a significant
possibility that they will do so, but without evidence that the underlying demyelination has been repaired, the disappearance of symptoms appears to be a temporary, although happy, coincidence; it is probably due to the absorption of fluid caused by the inflammatory response to demyelination. A number of newer drugs, particularly the beta-interferons and glatiramer acetate, may have some effects on modifying the disease process.
At present therefore, treatment mainly consists of:

• ameliorating a symptom or its effects;
• preventing or lessening the degree or length of time of a ‘relapse’;
• encouraging the early arrival of a ‘remission’;
• changing various aspects of your lifestyle that will make life with the symptoms of MS easier to manage;
• seeking to slow down the rate of progression of the disease.

In many cases, up until recently, the treatment of MS has been on the basis of symptoms as they occur. Now, in addition to attempts to reduce the number of relapses in MS, there are increasingly promising efforts to alter the course of MS itself. There are some drugs that offer the promise of lower rates of disease progression for some people, although for how many people and for how long is a subject of major controversy. Indeed the acronym DMT is now being used quite widely in discussions of MS, but we are still not talking about a cure, just a possibility of slower pro- gression of the MS.