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Expert sees hope on the horizon for multiple sclerosis cure

Special Correspondent
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Promising work underway with stem cells, molecules on regenerating lost tissue

In honour:Venu Srinivasan, chairman, TVS Motor Company, presents a medal to Richard A. Rudick, Director, Mellen Centre for Multiple Sclerosis Treatment and Research, U.S., who gave an endowment oration in Chennai on Saturday.— Photo: R. Ragu
In honour:Venu Srinivasan, chairman, TVS Motor Company, presents a medal to Richard A. Rudick, Director, Mellen Centre for Multiple Sclerosis Treatment and Research, U.S., who gave an endowment oration in Chennai on Saturday.— Photo: R. Ragu

Modern medicine stands somewhere half way in its race for a cure for Multiple Sclerosis, an inflammatory disease of the central nervous system, and the next couple of years could see a larger choice of drugs and advances in personalised medicine, Richard A. Rudick, Director of the Mellen Centre for Multiple Sclerosis Treatment and Research, Cleveland Clinic, U.S., said on Saturday.

Delivering the 32{+n}{+d}T.S. Srinivasan Endowment Oration hosted by the T.S. Srinivasan Charitable Trust and the TS Srinivasan Institute, Voluntary Health Services (VHS), Dr. Rudick said neurology which had gone past the stage of “ABCR” drugs (Avonex, Betaseron and Copaxone and Rebif), had now entered an era of personalised medicine where an array of about ten drugs could be optimised to completely block multiple sclerosis disease (MS) activity.

There was also promising work with stem cells and molecules on remyelination or regenerating lost tissue. He was optimistic of a solution in five years, while farther into the future the search was for means to restore lost functions and while the final frontier was in preventing MS altogether, Dr. Rudick said.

The old world-view that MS was only intermittently active over a series of relapses and remissions and that there was a “switch,” an age threshold that transformed the disease into a progressive problem, had given way to current understanding of MS as a disease that was active throughout its lifecycle even it did not produce any symptoms, and rather worryingly, involved ongoing brain damage even in early stage of onset.

One of the challenges for neurologists was the extreme variability of the disorder that made it difficult to predict the way MS would unfold, for instance why in identical twins with MS one would be consigned to a wheelchair while the other would be fine.

Also, while it is now recognised that there is a genetic basis for MS susceptibility, neurologists were still on a learning curve on the impact of genetics on diagnosis and treatment and in fully understanding variability.

While the lack of diagnostic test and the non-specific nature of early-stage symptoms made MS a conundrum, neurologists were on much firmer ground when it came to identifying environmental triggers for MS such as low vitamin D levels, a history of Epstein-Barr virus ( EBV ) infection and smoking while the important unknowns included lifestyle, diet and stress, Dr. Rudick said.

Pointing out that the prevalence of multiple sclerosis in the U.S. was 100 per lakh of population, Dr. Rudick said prevalence of the disease in India remained unclear and possibly underestimated but would only go up as neurology grows and awareness about the condition improved.

During the Q&A session that followed, Dr. Rudick said while he was all for clinical research to test the widely debated hypothesis (advanced by Italian physician Paolo Zamboni) that multiple sclerosis was triggered by a block in the jugular vein, he did not feel that the proposition constituted a treatment advance in MS.

The hypothesis, exciting though it was in the quest for a cure, was not likely to hold up and would perhaps only add to the list of therapeutic claims seen in MS, he said.

Earlier, Venu Srinivasan, Chairman, TVS Motor Company, who presented the endowment award to Dr. Rudick, said what had started as a small lecture had grown into a major event in the diary of neurology in India.

The annual conclave had also led to two books, one defining the global approach to dementia and the other on epilepsy.

Krishnamoorthy Srinivas, Chairman Emeritus, The Institute of Neurological Sciences, VHS and E.S. Krishnamoorthy, Director, The TS Srinivasan Institute, VHS also participated.

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