Multiple Sclerosis: The Importance of Early Treatment

It took three years for Michele Maglione to be diagnosed with multiple sclerosis (MS).

Her first attack came in 1988, when she experienced a frightening bout of numbness from the waist down. She assumed she had a slipped disk or pinched nerve from a recent move. Her doctor sent her to a neurologist, who told her she had a ruptured disk and sent her to physical therapy. After a few months the numbness receded. Maglione, then 30 and in an active career with a New York City nonprofit, put it out of her mind.

But the symptoms returned with a vengeance three years later, when she was visiting friends overseas. "My right arm and my left leg went numb," she recalls. Returning home, she found a different neurologist, who officially diagnosed her with multiple sclerosis in June 2001. One month later, she began regular treatment with a new disease-modifying drug that's been shown to slow progression of MS.

A Fortunate Diagnosis

Amazingly, Maglione feels lucky. "Between the time of my diagnosis and when I got on the medication, I had started to lose my peripheral vision," she says. "That, to me, was even more scary than the other physical symptoms I was going through."

After two months of treatment, she got her peripheral vision back, and some of her other symptoms subsided. She still has some symptoms -- like tingling in her left hand -- but she knows it could have been much worse if her diagnosis had been missed for much longer.

Not long ago, it wouldn't have made much difference whether Maglione was diagnosed with MS early or later in the course of the disease. "We didn't have a treatment, and theoretically there could be insurance and job implications," recalls Patricia Coyle, MD, professor of neurology at the State University of New York at Stony Brook and director of the Stony Brook MS Comprehensive Care Center.

But today, that's all changed. Experts now agree that disease-modifying drugs for MS, which include Avonex, Betaseron, Copaxone, Novantrone, and Rebif, offer the best chance of holding the disease at bay when started early. In fact, the latest research indicates that it may be more protective to start drug treatment right after the first "clinically isolated syndrome" occurs -- even though multiple sclerosis can't be officially diagnosed until you've had two attacks.

What's a Clinically Isolated Syndrome?

A "clinically isolated syndrome" or CIS, Coyle explains, can be thought of as the "first attack" of multiple sclerosis. It's a single clinical event that points to demyelination -- the loss of the protective substance in the brain or spinal cord that insulates nerve endings. For example, an attack of optic neuritis in one eye, or an episode of numbness on one side, would count as a clinically isolated syndrome.

A CIS is usually unaccompanied by any other clinical sign or symptom, and like Maglione, you may imagine many other possible explanations for your numb right arm or vision problems. But if your doctor rules out other syndromes and also finds certain abnormalities in your brain MRI, a CIS should spur you to talk to your doctor about treatment with an MS drug, says Coyle.