Rarity, Intrigue and Enigmas in MS
One often gets the impression from the world of Consensus Science that all human disease is beautifully understood, that new information is harmoniously added to enhance understanding and that certain knowledge is here and there tweaked to simply clarify a few loose ends.
Then these pesky monkey wrenches get thrown in to the mix. For example, it looks like an HIV vaccine doesn’t work, raising important questions about the precise unfolding of AIDS and subsequent illness. A recent trial testing the effect of an anti-amyloid drug in Alzheimer disease yielded a negative result to the consternation of the mainstream "amyloid is an important cause of Alzheimer" community. An energetic Tim Russert suffered a very untimely death despite all we know about cardiovascular disease.
It’s not my intent to throw a wet blanket on all things happy and light re: Multiple Sclerosis (MS) clinical issues here. I’m interested only in pointing out that sometimes stuff outside of the straight and narrow is worth considering; there are also links between diseases that are unexpected that may have implications for simultaneous dual disease management and therapy.
Again, this flies in the face of a unitary diagnosis fixation in medicine (which often is the situation- one disease explains a high percentage of signs and symptoms).
Out of the good ol’ USA ,Gee, Chang, Dublin and Vijayan (2005) found an association of brainstem lesions in MS patients with migraine-like headache. Migraine is a common disorder and headache problems are common in MS. It’s no mystery that young women, the largest subgroup for MS and Migraine will have overlappers with both diseases. What Gee and the gang did was to ascertain that if there was a plaque in a certain brainstem region (periaqueductal grey) on MRI (not commonly noted in MS), then the MS patient had a four-fold likelihood of having a migraine-like headache. A central pain center may be triggered. Worthy of consideration is the proposition that there is more brain stem pathology in "pure migraineurs" and that some of those lesions were missed because a Head CT didn’t show them.
Meanwhile, Barun et. al from cool Croatia (2008), found a couple of cases of coexisting Parkinson disease (PD) and Multiple Sclerosis with improvement of Parkinsonian features with steroids. One wonders whether this is just a rare bird connection or might there be larger numbers of young Parkinson disease patients who might benefit from a relook from the MS standpoint. Even if they don’t fulfill MS criteria, might their PD benefit from steroids?
Meanwhile Zamboni et. al (2007) from the free thinking country of Italy, pursued a commonly described but poorly understood phenomenon- MS plaques often occur in the brain around veins (as opposed to arteries). Blood flow in these venous systems was disordered in many patients. Disability in MS was high in a certain pattern of venous blood flow affecting gray matter. Implications? We might consider exploring novel therapies to improve blood flow in brain veins do improve MS outcomes
Hietaharju and colleagues in freezing Finland (2001) found the coexistence of Lupus and MS in a mother and daughter. Autoimmunity and genetics fused twice! One wonders whether other relatively rare autoimmune diseases should be better hunted down in MS patients. Unusual "MS complaints" may be the result of even more unusual immune mediated unsuspected conditions. To reiterate, this is a comment, not an attack on the typical situation wherein a bizarre neurological complaint need not require another diagnosis when MS alone can explain so much.
Finally, from the land of Israel, Miller et. al (2005) highlighted the intriguing link between Vitamin B12 deficiency and MS. Both can cause spinal cord syndromes. Both are related to immunological problems. B12 is important in myelin formation. Low B12 levels have at times been recognized to exist in MS patients. The authors suggest a "potential requirement" for Vitamin B12 supplementation in MS patients receiving immunotherapy.
Kenneth Gross, M.D. wrote about multiple sclerosis for HealthCentral. He is the head of Fusion Clinical Multimedia, Inc., a medical education company in Miami, Florida, dedicated to areas that involve interspecialty issues.