MS is characterized by unpredictable attacks of neurologic symptoms that vary greatly in type and severity. After being diagnosed, all patients are familiar with at least one symptom. They are concerned about recovering from the difficulty as soon as possible. Generally, recovery follows all attacks whether treatment is given or not. The speed of recovery is the only predictable outcome that is affected by treatment.
If a patient cannot perform his or her responsibilities at home or at work, shortening these more severe attacks by using drugs would seem to be of paramount importance. However, adrenocorticotrophic hormone (ACTH), also called corticotrophin, is the only FDA-approved treatment for attacks (relapses) of MS. Nevertheless, currently, most neurologists prescribe either oral or high-dose intravenous steroids (methylpred-nisolone, Medrol) for exacerbations of MS. Some neurologists prescribe them chronically. There is no scientific basis for this practice. There are many potential side effects, however. Steroids do reduce fatigue in MS patients and often induce a sense of well-being. Their many side effects, however, do not justify their use for those reasons. The optic neuritis study did show accelerated recovery from attacks of optic neuritis after the use of IV methylprednisolone (Medrol). In con
Progressive multifocal leukoen-cephalopathy (PML)
a serious infection of the brain caused by the JC papilloma virus. Cataracts any opacification (loss of transparency) of the lens or its capsule. Osteoporosis a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. Necrosis tissue death; a state of irreversible tissue damage.
trast, oral steroids had no effect except to double the risk of relapse of optic neuritis as compared with IV Medrol. There often is a rapid response to either drug in patients with acute, severe relapses, but there are no good studies of either IV compared with any dose of oral steroids to evaluate this in MS. The side effects of steroids include an increased risk of infection, including viral, bacterial, yeast, fungal, and parasitic types. This includes progressive multifocal leukoen-cephalopathy (PML), which has been recently reported in two study patients treated with Avonex and Tysabri. Other complications include psychiatric problems, cataracts, osteoporosis, and ischemic necrosis of hips and other joints (as well as others).
To steroid or not to steroid? Dr. Sheremata is in the minority on this issue. However, I have followed his advice not to take the customary steroids and instead consider rest and ACTH. Despite the side effects of steroids and the factual knowledge that we have about them, it has been hard not to take them when I have a flare-up.
When I have a flare-up, I will call or e-mail Dr. Shere-mata and ask him to remind us again about his view. The desire on my part and those around me is to do something to alleviate the flare-up. The fear, the lack of control, the symptoms themselves, and the uncertainty all make it dijfi-cult to take the rest approach and not to take the steroid approach. However, I have followed the rest regimen, and I believe that I have recovered faster and stronger than if I had gone the steroid route. Furthermore, I do not have to recover from the steroids. Nonetheless, if and when I have my next flare-up, I imagine I will still re-ask the question.
Perhaps this book should be titled 100 Times the Same Questions About MS Are Asked!
76. What is ACTH?
ACTH (or corticotrophin) is a hormone that is made in the brain and is stored in the pituitary gland, which is situated at the base of the brain. This hormone is normally released in miniscule amounts during the early hours of the morning to stimulate the adrenal glands' production of steroid hormones. Cortisol, the active form of cortisone, is one product of ACTH stimulation. Dr. Leo Alexander began using ACTH a half-century ago at Harvard Medical School. He showed in a series of studies that it speeded recovery from MS attacks. Later, a national study, published in 1970, proved that it did indeed significantly speed the recovery for patients with acute exacerbations of MS.
ACTHAR gel, the commercial product, was withdrawn from the market when Parke Davis stopped manufacturing many drugs a number of years ago. However, as a result of the efforts of The National Organization for Rare Diseases (NORD) and the recognition of the value of ACTH, ACTHAR gel is again available. The intravenous form of ACTHAR is no longer available, and the synthetic form for intravenous use is in extremely short supply.
Pituitary gland an endocrine gland about the size of a pea at the base of the brain. The pituitary gland secretes hormones regulating a wide variety of bodily activities. Adrenal glands glands secrete steroid hormones that are important in the body's response to stress. Cortisol the primary steroid hormone produced by the adrenal gland. It is the biologically active soluble form of cortisone. Cortisone the stored form of cortisol produced by the adrenal cortex.
A quarter century of research has shown that ACTH also has neuroprotective properties, although clinical neurologists are rarely aware of this fact. In recent scientific studies of experimental optic neuritis at MIT in Boston, it has been shown that high-dose IV steroids actually induce the death of brain nerve cells, the opposite effect of ACTH.
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