Multiple sclerosis

Multiple sclerosis in remission under Avonex treatment
Short Summary

A 23 year old female was diagnosed 7 years ago with multiple sclerosis. The patient had 4 acute attacks 7 years ago, and since then she has been treated by Avonex. The patient had no attacks since then, feel healthy and lead a normal healthy life as a busy university student. She enjoys sports several times a week, and there are no problems regarding her physical and mental function. Neurologically, the only reminiscence of her illness is a positive Babinsky sign in the left leg and a temporal blindness in the left eye.

Patient's Questions
  1. Can the patient stop the AVONEX treatment?
  2. Is there any danger in stopping this treatment?
  3. Is it possible to try to stop treatment for several weeks and see what happens?
Medical Background

23 year old female.
7 years ago the patient had three episodes of hemiparesis, dysmetria and paresthesis which resolved spontaneously.
MRI at that time showed: Multiple bilateral peri-ventricular & centrum as well as bilateral posterior brainstem and anterior left paracentral pons hyperintense T2 & flair foci are present with enhancement of left centrum focus. A demyelization process with active enhancing focus is likely.
Later that year, the patient was hospitalized with Left Retro-Bulbar Optic Neuritis. Analysis of the cerebro-spinal fluid showed no oligoclonal bands. The patient was treated with high-dose steroids which were later tapered over a month and replaced with weekly injections of AVONEX (Interferon beta-1a).
A follow-up MRI, that was performed 3 years ago, showed: As compared to previous study, the pontine lesions are resolved and there are fewer supratentorial lesions and no enhancing lesions. Venous angioma of left cerebellar hemisphere.
From the time of the hospital discharge (7 years ago) and until now, the patient feel healthy and lead a normal healthy life as a busy university student. She enjoys sports several times a week, and there are no problems regarding her physical and mental function. Neurologically, the only reminiscence of her illness is a positive Babinsky sign in the left leg and a temporal blindness in the left eye.

Expert's Opinion

The medical history and MRI findings of this case are consistent with multiple sclerosis. This disease is an autoimmune disease where the immune system reacts against myelin (the covering of nerves in the brain and spinal cord). This disease does not go away; it’s like diabetes, or rheumatoid arthritis. The symptoms improve with treatment but the disease is still there.
Treatment referred to as immunomodulating therapy includes Avonex, Betaseron, Copaxone, and Rebif. These medications decrease the progression of multiple sclerosis through decreasing relapse rate, MRI lesions, and disability. The immunomodulators will not give relief to acute symptoms. Intravenous steroids called methylprednisolone (Solumedrol) are used to treat acute attacks and may relieve a number of symptoms. Residual symptoms after an untreated or treated attack, such as pain, tingling, and fatigue, may remain.
This means that the patient should not stop Avonex, unless it stops working for her and in that case she should be treated with another medication. There are several oral medications that are in clinical trials right now and should be approved in the near future.
If the patient stops Avonex now, there is a chance that she will have another exacerbation and there is no assurance that she will recover completely from an exacerbation, meaning that she may be left with neurologic residual dysfunction. So it’s better to prevent exacerbations from happening. This is what Avonex or other interferons or copaxone are supposed to do.
I would suggest for the patient to look at our website www.partnersmscenter.org for more information under patient information.

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