MS-Therapy - a Holistic Approach
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Ii is kind of crowded on the MS arena. An estimate of the number of patients World-wide is 2,5 millions, the incidence in temperate climate is in order of 0.1 %. An innumerable amount of therapies are suggested, many hypotheses have been raised, national MS-societies pay large amounts of money into the research and still, at the end of 2001, the question remains how much has really been achieved.

Five years ago, it seemed as if therapy was on the move. At first, drugs were shown to be effective in halting disease progression, though not actually stopping it. Today, a question mark is set of, how much reduction has really been achieved, and at which price. This picture has all the time been blurred by the spontaneous victories in the majority of patients, who experienced a halt in the disease progression (the most natural course) and inevitably related it to what they preferred to believe in. And since mental processes are known to play a significant role in the course of MS, who would dare to contradict those claiming a victory? „If it makes you happy, you should do it,“ could silently be understood, when clever neurologists supported anything that their patients claimed would help them. In consequence, many books have been written, many cures suggested, quite generally helping some and not all

– which reminds me of the warning that if you are expecting a similar miraculous cure here, you are on the wrong track and better use your time for something better, i.e. the alternative approach.

The industry is working for us – or are they just working for themselves? The immense prices of the first drugs which can reduce disease progression has shown that here is more to earn. Currently some 40 drugs are under investigation for MS therapy, and some of these are certainly going to be registered. Will they change the picture? At least, the intensified investigation of commercial drugs is distinctly different from other approaches, which have not received the mercy of current attention. It is indeed the purpose of these pages (being upgraded as I learn more) to help inducing a fraction of the balance, with this ‚Holoistic Approach‘ as its summary, but the pressure towards commercial solutions is immense and I am unable to regard the patients‘ societies in the position to exert some moderation here. Moreover, my resistance to unethical studies (e.g. placebo-based for years in the presence of some proven therapy) has placed me personally in opposition to most of my colleagues. It is then of little comfort that this scientific abuse is much less pronounced in neurology as can be recognized in other branches of medicine where death and disability prevails in the control group.

I wanted to establish a ‚jungle-model‘ for cells and humoral substances at work in an MS disease process, with an ironical emphasis of the good and the bad ones. Today, I have given up to make such an approach. Not only do a large number of figures exist, with different indications according to their authors belief, it is also slowly getting clear that such a large number of disturbances, as have been shown in MS-lesions, cannot be of importance when dealing with the disease. This is where the desire has grown to cook up the essentials, even when this does not lead to the magical potion as hoped for by all.

The Disease, in Summary:

It still remains unclear whether MS is one disease or the mutual symptom of different ones. There are good reasons to consider it an autoimmune disease, although an absolute proof seems to be missing. Slowly, having seen this statement expressed innumerous time as a suggestion, you start wondering how such a proof could look. Different courses can be recognized, although without making any prognosis in this respect possible. There is also no big help in the genetical aspects recognized so far. These can merely be regarded as confirmative for a genetical disposition and they offer no help for diagnosis or therapy. Whether exposition to some virus or chlamydia at early ages was of importance in some cases and whether such again persist in a few of these cases, is a matter of continuing controversy. It would appear easier if only one micro-organism was accused.

The vascular components pose another issue of continuing conflict. No doubt, MS-lesions are accompanied by blood-brain-barrier defects, but are they causing or being caused of the attack? This controversy may be further puzzled in that different phases pose different answers.

Going back to autoimmunity, both the myelin components and the cells attacked may offer some clue of therapeutical value. Antigenic mimicry may occur at various levels, different from one patient to the other. The cellular defects, at least what the T-Lymphocytes are concerned, are hardly repairable. In contrast, Oligodentrocytes do have a substantial potential for recovery. In fact, remyelinization, a magical word for MS-patients and currently awaiting its therapeutical exploitation, must be rather prominent, or a rapid, progressive course is what could have been expected for most cases.

And that is all I want to mention in the pathology. Little comfort will be found in that the therapeutic suggestions in their simplicity (and exclusively positive mention) are worse.

Therapeutic Approaches, in Summary:

Lacking the magical potion to cure the disease, I have slowly merged towards considering it dependant of a number of ‚factors,‘ among which none are exclusively causative (or their correction curative).

Reducing the number and duration of the attacks helps reducing the disease. This statement is indeed in conflict with some quotations upon how steroids failed to influence the disease although they were of great importance in reducing the relapses. Sceptical analysis of these data, prompted by logical expectations, have yielded me this conclusion. Whether alternatives to high dosed steroids, themselves in possession of significant adverse effects, will prevail at a later time, still remains to be proved.

High dose interferon beta is of significant modulating importance. Whether there is any difference between beta 1b and beta 1a remains to be proved, as does the role of interferon antibodies, controversially discussed in the literature. Low-dose interferon beta 1a and interferon alpha are inferior in effect. I am also not amazed of the successes reported to in other studies, but that can change.

Environmental factors do undoubtedly play a role. Correction is cheap (but not recognized by the health insurances) and may well be much more important than the expensive drug therapy – and still it is not enough. The recommendations for fish oil, sunflower oil (or similar), Vit. D3 and avoidance of some adverse factors related to dairy products and some meat are the ones best argued for in the literature. With less impressing weight, a lot of other dietary suggestions are being made.

The mental condition is important, but what can be done to it? Depression is hardly a pathological reaction to the social, economical and health related aspects of this disease. No doubt, however, important advances have been made upon all these aspects and they may indeed have led to the impression that the disease today is less malignant than it was some decades ago. Unfortunately, we do not strictly know, immense data are left unanalysed while energy and money are used instead for smaller scaled controlled studies of expensive drugs.

At the moment (September 22, 2001), these are the only positive aspects I can summarize as valid in the control of MS. They are not very enthusiastical but also not strictly conservative. However, I should love adding to this conclusion at a later time.

Inserted September 22, 2001
Revised October 4, 2001

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