(January 7, 2009 - Insidermedicine) On a recent trip to Halifax, we caught up with Dr. Thomas John (Jock) Murray, MD, FRCP(C), OC, who is Professor Emeritus, Medical Humanities and Professor of Neurology at Dalhousie University. Dr. Murray has previously served as Vice President of the American Academy of Neurology, President of the Canadian Neurological Society and Dean of Medicine at Dalhousie University. Dr. Murray is author of "Multiple Sclerosis: The History of a Disease," and is also an Officer of the Order of Canada.
What is multiple sclerosis?
Multiple sclerosis is a disease of the central nervous system involving mostly the white matter, but also the grey matter to some extent, so it involves the central nervous system in the brain, brain stem, and spinal cord. Because it has scattered lesions of inflammation it can produce symptoms in any of the areas that it involves, so the symptoms are commonly things like blurring of vision, numbness in the face, numbness down one side of the body, weakness in the hand, difficulty with walking, difficulty with balance, problems with bladder, problems with sexuality. There are a number of symptoms that can occur because the nervous system centrally can be involved in so many different areas. And because it is multiple in terms of its scattered lesions (that’s the reason it’s called multiple sclerosis), and sclerosis really means scarring, that these areas that develop inflammation can, as they heal, leave some changes that cause things to conduct more slowly.
What if I develop symptoms?
If you develop symptoms that are suspicious of multiple sclerosis, you have to remember that they are symptoms that usually persist. They are not usually symptoms that you develop and they’re gone in ten minutes, or they’re gone later that day, most of the symptoms that develop, if it’s blurring of vision in an eye, or it’s numbness down one side of the body or in a limb, these are symptoms that tend to persist, so they’re there days and weeks later, and then they may go away, but if they persist like that, there should be an explanation, and that’s the time the person should see a physician.
Now many of those symptoms will have an easy explanation; developing numbness in the hand may turn out to be a carpal tunnel syndrome or some other nerve entrapment, you may have migrane that gives you blurring of vision and numbness or difficulty speaking, but it tends to be very transient. It’s very common, for instance, to develop blurring of vision or loss of vision suddenly with migrane, but that tends to be very brief, and last 10-20 minutes, but again, there should be an explanation when those things occur. If it does persist, it really does need an explanation.
When a person sees their physician, if it is suspected of being multiple sclerosis, they will usually be referred to a neurologist for further investigation.
How will I be examined?
When the person is first seen with suspicious symptoms, the first thing is a very careful history, in fact the diagnosis is usually made on the history, because the characteristic findings and changes are often evident just by talking to the person about what their experience has been, including in the past they may have had episodes that they didn’t pay attention to at the time. So, a very careful history is very important, and then a neurological examination to look at those areas for which we would be particularly suspicious in multiple sclerosis, but we do a general neurological exam looking for any abnormalities in an area even where they haven’t experienced symptoms. So the first thing is a careful history, then examination. We would then move, if we were still suspicious of that possibility of multiple sclerosis, to doing an mri. The MRI is very accurate at confirming the presence of MS, because of very characteristic lesions that are scattered within the white matter of the nervous system.
What is the current treatment?
The state of treatment of multiple sclerosis is changing dramatically in the last decade. We first developed four drugs that made a difference in the outcome of the disease; they could reduce attacks, reduce the number of lesions on the MRI, reduce the progression of the disease. Since then, two new agents that are even more powerful have been added to that armamentarium, and right now there are 30 new drugs under study, 14 combination studies, a transplant program that is teaching us a great deal about understanding how we might stop this disease, there are nine oral drugs under trial, and two of them will likely come to market very soon. So there’s a lot happening and so it is a changing situation for an MS patient, now, to realize that when they develop this disease it is not hopeless, that there are things particularly used early that make a big difference in the outcome of the disorder.
What if I get diagnosed?
The first thing I would like to know is that the diagnosis is clear, because there are criteria for the clinical diagnosis, there are criteria for the MRI, so it’s not a matter of having some neurological symptoms and having an MRI with a couple of lesions, there’s very definite criteria for a definite diagnosis of Multiple Sclerosis, so I would first like to be sure, that the diagnosis is definite. Once it is definite, the next thing I would like to be is on therapy as soon as possible. There is no doubt in my mind that the benefits of therapy come from being treated early and mild, even if you think you’re fine. So even if all my symptoms had disappeared, I’d want to be on therapy as soon as possible, and I would stay on the therapy until there was something better coming along, but in the meantime, get on the therapy, stay on the therapy, and manage whatever side effects or problems that occur, but the important thing is to get on therapy and get on therapy early.
If I had MS…
If I had MS and I made sure the diagnosis was clear and I was put on therapy, the next thing that I would like to do is to be able to get an understanding in terms what it means in my life. I want to live my life normally, I want to be productive, I want to do the things that I want to do. I would have to understand that I now have a disease that I am going to have to deal with, I am just going to have to figure out how I am going to achieve the things that I want to do in life despite that. So it is a matter of working around the problems that I might have to still achieve the things that I want to do. I also have to understand that others around me are affected by me having the disease and I have to be conscious of my support system that allows me again to lead a normal life despite my problem of MS. So from a philosophical point of view, life bring problems to everybody, this is just one that I now have to learn how to manage and learn how to manage well. MS patients can have very productive, very happy lives despite the problem, it’s just learning how to deal with it.