Multiple sclerosis: therapeutic pessimism

Nonprescription medicine use in a multiple sclerosis clinic population

AIMS

To determine the use of nonprescription medicines in a cohort of multiple sclerosis (MS) patients and to identify a subgroup of patients liable to spend more on nonprescription medicines

METHODS

A questionnaire was given to MS patients attending a neurology out-patients clinic during the previous year. Medicines from a General Practitioner (GP), pharmacy and 'other' sources utilized in the last month were determined, along with demographic data. Additional information was obtained from hospital notes.

RESULTS

One hundred and seventeen MS patients responded to the questionnaire, giving a response rate of 79% (117/148). Responders differed from nonresponders only in age, with responders being significantly older than nonresponders (P = 0.011). Over one-third of medicines taken in the last month were nonprescription medicines (35%; 219/627). A gamolenic acid containing preparation was the most popular, purchased by 28% of patients. Fifteen percent (17/117) of MS patients had exceeded the recommended daily allowance of a vitamin (frequently vitamins A, D and E), and one exceeded the upper safe level for daily self-supplementation of vitamin A and D. Females spent significantly more than males in the previous month ( pound10. 09 compared with pound5.53, respectively; P = 0.022). Patients who were older, reported worsening MS symptoms in the last year and those who exhibited greater disability were more likely to have been prescribed medicines by a GP (P < 0.0005), although they were not more likely to self-prescribe or take alternative remedies (P > 0. 05). However, those with poorer mobility were significantly less likely to have purchased a pharmacy medicine in the last month (P = 0.033).

CONCLUSIONS

MS patients were high users of nonprescription medicines. A typical subgroup of MS patients that spent more on nonprescription medicines could not be identified, aside from females. Furthermore, the strong predictors for increased use of prescription medicines (increasing age, severity of symptoms in the last year and poorer mobility) were not found for nonprescription medicines. Excessive intake of the fat soluble vitamins could lead to hypervitaminosis, the effects of which could exacerbate or mimic MS symptoms. Health professionals should be aware of these issues and counsel the MS patient accordingly, particularly as the majority purchased products from 'other' sources where typically there is no health-professional available to give advice. The limited use of pharmacy medicines by the more disabled patient could indicate a problem with access to the pharmacy, or could reflect the greater use of prescription medicines.

Therapeutic advances: beta-interferon for multiple sclerosis

Multiple sclerosis (MS) is a very distressing condition for which there is no effective treatment. Two randomized double-blind placebo-controlled trials of beta-interferon in mildly disabled patients with relapsing remitting MS have been published. Although promising, beta-interferon is not a cure for MS and the clinical significance of the small effect of beta-interferon on disease progression is not known. The high cost of beta-interferon, the distressing nature of MS and the small benefit demonstrated in clinical trials mean that purchasers and clinicians will face hard decisions in managing the introduction of these drugs.

On the pathogenesis of multiple sclerosis. A revised model of the cause(s) of multiple sclerosis, especially based on epidemiological data

Data from an epidemiological study are used to analyse the course of multiple sclerosis. It could be proved that the course of MS is not as haphazard as was often supposed. In general the course is described as being a chronic progressive one, in the majority of patients preceded by a relapsing-remitting period. In contrast to the relapsing-remitting phase the chronic progressive phase of the course does not show marks of being an autoimmune process. From recent data obtained by MRI and NMR spectroscopy it can be concluded that the chronic progression of handicaps in multiple sclerosis is related to neuronal and axonal damage. The relation between these different pathogenetic processes should be the aim of further research.

Polyomavirus models of brain infection and the pathogenesis of multiple sclerosis

Multiple sclerosis (MS) is generally considered to be an autoimmune disorder with myelin as the target and with several unidentified viruses playing ancillary roles, possibly through molecular mimicry. Although this paradigm has led to important progress on potential mechanisms of myelin loss, neither a target antigen in myelin nor a triggering mechanism has yet been identified, leaving the etiology of MS still unknown. Animal models of viral demyelination and studies showing that JC virus (JCV), the polyomavirus which causes progressive multifocal leukoencephalopathy (PML), may be latent in some normal human brains suggest another possibility. A host immune response targeting proteins expressed at low levels from viral DNA latent in the central nervous system (CNS) might underlie a focal demyelinating disease such as MS. A shift from autoimmunity to a latent-virus model is not a trivial substitution of target antigens. This shift would expand the search for a definitive laboratory test for MS and could lead to improved therapeutic and preventive approaches.