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Bits with a benefit

April 11, 2005|by JULIE E. GREENE

julieg@herald-mail.com

Bill Scrivener has been trying various treatments for his multiple sclerosis for years, the latest of which is not a pill, shot or intravenous medication.

It's bits of physical therapy - bits being the benefit.

Physical therapy has been used for multiple sclerosis patients for a long time, but the new theory is to have patients exercise frequently for brief periods, as brief as a minute instead of for 30 to 40 minutes, three times a week, said Stephen D. Ryan, owner of Ryan Physical Therapy Associates on Mount Aetna Road.

The theory came from a clinical bulletin at the National Multiple Sclerosis Society's Web site that was authored by Pat Provance, a senior physical therapist and MS-certified specialist with Kernan Orthopedics and Rehabilitation in Baltimore.

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"It's a more practical approach," Provance said.

Often MS patients become exhausted and frustrated by physical therapy and conclude they cannot exercise, she said.

Provance said the keys are short periods of time - how long depends on the patient - and focusing on functional exercises.

MS patients who want to walk better, farther and smoother should focus on exercises in which they are on their feet rather than lying on a mat doing sets of leg lifts, Provance said.

One exercise that Scrivener, 39, of Mount Aetna, does are partial squats by grabbing the edge of the sink and bending his knees. The exercise helps him strengthen muscles that he uses to get in and out of his wheelchair, he said.

According to the National Multiple Sclerosis Society, about 400,000 Americans acknowledge having MS, with two to three times as many women as men having it. Genetics make certain people more likely to get MS, but there is no proof MS is directly inherited.

About 200 people a week in the United States are diagnosed with MS, which might affect 2.5 million people in the world.

J.J. Bain, 52, of Keedysville, likes the physical therapy because it is a nonpill treatment.

Bain said she prefers natural treatments over drugs, although her condition necessitates her taking four medications, including Copaxone.

Copaxone fools the immune system so the body doesn't attack its own myelin as much, said Dr. Sanjay Keswani, an MS neurologist and assistant professor at Johns Hopkins Hospital.

Multiple sclerosis is thought to be an autoimmune disease that affects the central nervous system, according to the National Multiple Sclerosis Society's Web site.

With multiple sclerosis, the myelin - a protective tissue around nerve fibers - gets stripped off, leaving scar tissue called sclerosis, according to the NMSS's Web site and Keswani.

Myelin also helps transmit impulses from nerve fibers. When this is damaged, it affects the brain's messages to the body, leading to various symptoms.

In Scrivener's case, those symptoms include dragging his right foot, short-term memory loss and tremors in his hands, especially his right hand, he said.

In addition to physical therapy, Scrivener takes several medications, including Novantrone, an intravenous medication administered every three months. Novantrone is a brand name for Mitoxantrone, which is a chemotherapy agent that suppresses the immune system and has been proven to help people with secondary progressive MS, Keswani said.

Eighty-five percent of MS patients have relapsing, remitting MS in which patients experience a relapse that usually lasts several weeks before going into remission, Keswani said. With each relapse, the patient's condition gradually worsens.

When the disease's progression becomes significant, the patient has entered the secondary progressive phase, he said.

While secondary progression happens to most MS patients, about 10 percent of MS patients start out with primary progressive MS, Keswani said.

In addition to Mitoxantrone and Copaxone, treatments approved by the Food and Drug Administration for MS are Avonex, Betaseron and Rebif, Keswani said. Those three drugs are interferons that decrease the number of relapses by about one-third and reduce the disability MS patients accumulate over time, Keswani said. They basically are the same drug with different formulations so they are administered differently.

"(The five treatments are) not cures, but they're pretty good with respect to decreasing relapses," Keswani said.

An additional medication, Tysabri, was recalled because two people who received the combination of Tysabri and Avonex died, Keswani said.

The combination created a serious infection called progressive multifocal leukoencephalopathy, he said.

"Obviously, we would not want to give a medication that even (comes) with a small risk of death. Essentially MS is not a fatal disease," Keswani said. "It can cause disability, but is not a deadly disease."

Keswani is part of a team at Hopkins looking for and testing agents to treat MS.

One of them, erythropoietin, increases red blood cell levels and is approved by the FDA for anemia, Keswani said.

The agent also prevents nerve cells from dying, which is very exciting for MS research, he said.




More on MS

For more information about multiple sclerosis, visit the National Multiple Sclerosis Society Web site at www.nmss.org.

To learn about clinical trials in your state, go to www.nationalmssociety.org/Research-trialsrecruiting.asp.

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