Multiple Sclerosis

Treatment of Early MS: What Are Your Options?

Summary & Participants

In its early stages, multiple sclerosis comes and goes in a series of attacks that can be separated by months or years. An actual diagnosis can't be made until after at least two attacks have occurred in different parts of the nervous system, meaning that treatment wouldn't start until long after the disease first appeared, but there's a new school of thought that calls for a different approach. Tune in as Dr. Steven Galetta talks about the treatment for early multiple sclerosis.

Medically Reviewed On: January 31, 2006

Webcast Transcript

DAVID MARKS, MD: Hi and welcome to our webcast. I'm Dr. David Marks.

In its early stages, multiple sclerosis comes and goes in a series of attacks that can be separated by months or even years. But doctors can't diagnose MS until a patient has at least two attacks. Now that used to mean that treatment couldn't start until long after symptoms first appeared. But now some experts are calling for a different approach.

Joining me to talk about this is one expert: Dr. Steven Galetta, a neurologist at the University of Pennsylvania. Welcome.

Now what is MS to begin with?

STEVEN GALETTA, MD: MS is an immune attack against the central nervous system; that is, the brain and spinal cord. And the immune cells attack the coverings of the cables of your brain called "myelin."

DAVID MARKS, MD: Now we talk about MS coming and going. Describe what a patient goes through and how it's diagnosed.

STEVEN GALETTA, MD: There are attacks, what we call "exacerbations" that may evolve typically over several days and then, often, in the earliest stages of MS, 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 earliest stages of the disease that may occur separated by many months or even years at a time.

DAVID MARKS, MD: Do they occur in the same parts of the body each time?

STEVEN GALETTA, MD: No, I think it's a random type of event in many people. For instance, it could occur the first time in the optic nerve. The next time, it might be an event that occurs in the spinal cord.

DAVID MARKS, MD: Is this the only kind of MS that there is?

STEVEN GALETTA, MD: That's the early stage of MS and it accounts for 85 percent of patients in the earliest stages of multiple sclerosis. That is, they have an event that occurs and then it often remits. There are other stages of MS -- secondary progressive MS -- really is characterized by episodes that have occurred and now disability starts to accumulate over time. So the patients had a number of attacks and now they may have trouble walking, for instance. That's secondary progressive MS, and there are more rare forms of MS in which the course is a steady downhill course and we refer to that form of MS as a "primary progressive MS."

DAVID MARKS, MD: If a person has the first event, can they be diagnosed with MS?

STEVEN GALETTA, MD: By clinical definition, we have traditionally required that a patient have a clinical attack, say optic neuritis, and then separated by a month they have a second attack. So MS -- to fulfill the clinical standard definition of MS required two episodes of clinical attacks separated by a month.

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