NEWS: Neurologist examines the complexities of MS

[Guest guest]

Neurologist examines the complexities of MS

By Joanne Fox Journal staff writer

Although there is no cure for multiple sclerosis (MS), Dr. F. Pary

of Sioux City is enthusiastic about emerging treatments for this

condition.

" What I like about this disease is that once you diagnose it, you can

treat it with drugs that can reduce the chance of further attacks, " he

said enthusiastically. " There are also several symptomatic treatments

for problems related to MS that can improve patients' quality of life. "

It's the reason the 31-year-old native of Brazil decided to study

neurology, which is his specialty at CNOS, the Center for Neurosciences

Orthopaedics & Spine, PC, in Dakota Dunes.

" I always wanted to be in medicine, " he reflected, with just a hint of

a Portuguese accent. " Neurology really interested me because I felt I

could really help my patients from being disabled. "

That is the reality of MS, a disease of the central nervous system

(which includes the brain, the spinal cord and the optic nerves) that

may last for years and eventually can cause serious disabilities,

including paralysis and loss of vision.

In its initial stages, individuals may experience weakness, numbness

and/or tingling in their extremities; extreme fatigue, vision loss,

double vision, unexplained dizziness or difficulty walking.

MS could be characterized as a stealth disease, because many times,

people will look and act perfectly normal for much of the time.

Individuals with symptoms of multiple sclerosis need to call their

doctor for further evaluation as many of these symptoms may also be

caused by other neurological disorders.

" Any of these symptoms should warrant a check-up with a physician, "

Pary insisted. " The diagnosis is clinical, but tests like a brain MRI

and lumbar puncture are also helpful in confirming MS and excluding

other disorders that may mimic it. "

Surrounding and protecting the nerve fibers of the central nervous

system is a fatty tissue called myelin, which helps the nerve fibers

conduct electrical impulses. In MS, myelin is lost, leaving scar

tissue. The brain MRI (Magnetic Resonance Imaging) shows the physician

" multiple " areas of demyelinization and scar (sclerosis), hence the

term multiple sclerosis.

When the myelin is damaged or destroyed, the ability of the nerves to

function is disrupted and that causes the various symptoms of MS.

" Neurologists are trained to determine if a symptom like weakness is

secondary to a brain, nerve or muscle disorder, " said Pary, referring

to the confusion between multiple sclerosis and muscular dystrophy, a

disease of the skeletal muscles that causes weakness and stiffness. " A

good history and exam can help the neurologist decide what tests should

be used to diagnose a brain or muscle disorder. When evaluating

multiple sclerosis, I usually order a lumbar puncture and brain MRI to

be sure the symptoms are not being caused by another condition that may

look like MS. "

Pary emphasized the need for appropriate testing to exclude diseases

that mimic MS. Those include Lyme Disease, a tick-borne illness

characterized by flu-like symptoms and joint pain; sarcoidosis, a

multisystemic disease that can affect a variety of organs, most often

in the pulmonary system; Vitamin B-12 deficiency, in which patients may

have memory problems and unsteadiness; and Lupus, a chronic autoimmune

disease in which the immune system turns against the body and harms

healthy cells and tissues.

Researchers are still trying to understand the cause of multiple

sclerosis. It is still not known what causes the immune system to

produce an abnormal reaction against cells in the brain and spinal

cord. Normally, the immune system fights viruses and bacteria, but an

abnormal immune system allows the body's white blood cells to destroy

the myelin, thus leading to MS.

In the late 1970s, researchers speculated that certain genes are

associated with MS and may react with environmental factors to produce

a condition that can lead to the destruction of the myelin, thus

resulting in MS.

Today, researchers believe the combination of heredity, the immune

system, and possibly a virus may play a role in a person developing MS.

Individuals may inherit a susceptibility to the disease, but not the

disease itself.

Fortunately, there are many drugs that can slow down the immune system

attack and hopefully decrease the burden in patients with multiple

sclerosis.

" Treating patients with drugs like interferons and glatiramer acetate

reduce the risk of having a subsequent attack, " Pary pointed out. " By

modulating the immune system, we can decrease the chance of a relapse

and hopefully decrease the amount of disability. "

That again goes back to Pary's philosophy of neurology. He decided to

study in the U.S. to receive the best training he thought possible. He

did his residency at the University of Iowa, where he met his wife, the

former Synhorst of Spencer, Iowa. She, too, was studying

neurology and now also works as a neurologist after completing special

training in stroke.

Following his fellowship in neuromuscular disorders at Duke University,

Durham, N.C., the couple decided to locate in the Midwest. Both have

been associated with CNOS since August 2004.

" I think the biggest change in the past 10 years in helping people with

MS is that new treatment options are now available, " Pary stressed.

" The medications work on the immune system, preventing further attacks

of the disease on the brain cells. "

He continued, " Many other treatments for multiple sclerosis are

currently under study. Future medications may be even more promising.

Our hope is that multiple sclerosis will be better treated and will

become a less disabling disease. "

http://www.siouxcityjournal.com/articles/2005/04/25/news/local/

5a93eb6d6cd37fd586256fee0014808c.txt