Multiple sclerosis eludes doctors

By Jeff Raymond

Published: April 20, 2008

Michelle Floyd woke up one morning about four years ago, her body numb from neck to feet.

The sensation — if being numb is a sensation — went away in slices, like lights were turned off sequentially from one end of a long room to the other.

Multiple sclerosis often strikes people in the prime of their lives; it hit Floyd, now 29, when she thought she was in perfect health.

The autoimmune disease, in which neurons in the brain and spinal cord lose the fatty covering that allows them to effectively conduct the electricity of nerve impulses, happens commonly in women in their 30s. It may eventually leave them in wheelchairs, their minds clouded and their muscles uncontrolled.

Or it may not. One of the hallmarks of multiple sclerosis is its unpredictability — perhaps the disease's only real consistency is that it is inconsistent. Some patients are unsteady, while others are blinded. Some have numbness, slurred speech. Many have weakness.

"It's exactly the lack of repetitiveness of it from patient to patient that gives you the clue to the diagnosis,” said Dr. Gabriel Pardo, medical director of the MS Center of Oklahoma at Mercy NeuroScience Institute and the state's only physician who specializes in the disease. He called the disease "fascinating.”

MRIs show ghostly lesions on patients' brains — scar tissue where healthy neurons once were.

"Awareness is important that any of these manifestations — neurological manifestations — can be a sign of MS,” Pardo said. "How patients experience MS varies tremendously.”

Patients' symptoms can even vary between "episodes.” Although multiple sclerosis is irreversible, treatment can blunt its attack and stall its progression. Six medications are available and dozens more are in the research and development pipeline. Catching multiple sclerosis early is critical.

"All of these are good medications, but all they really do is prevent the appearance of new problems,” Pardo said of available drugs. He conducts clinical trials at the MS Center on new medications and medical devices. The center offers the state's only comprehensive care for multiple sclerosis.

"We decided it was something that needed to be done,” he said of creating the center in 2002.

About 60 of his 1,700 patients, including Floyd, are enrolled in one or more of 10 clinical trials underway there. The center, he said, is one of a handful nationwide that is testing all four oral multiple sclerosis drugs. Currently- used drugs must be injected.

"We are making medical history with MS right now,” he said.

For one of the medical devices Pardo is evaluating, patients are strapped into a parachute harness and stand on a swaying platform. They are then given visual cues to test their balance.

Pardo sees about 12 new patients a week with the disease. He estimated about 3,000 Oklahomans have multiple sclerosis. He said the "new frontier” is to find ways to help patients recover from neurological losses, protect nerve cells and induce them to regenerate.

Floyd is studying at Oklahoma State University to be a dietitian. Her balance is tenuous, and she walks with a cane, so she can't ride a bicycle. She rides a tricycle instead, even though heat and exercise make for a difficult combination.

"Both of those will absolutely exhaust me,” she said. "I say that I've made my body angry.”

Nevertheless, Floyd is determined to get her degree and not be shy about her limitations, which include visual problems. She leans on another student with multiple sclerosis for help in class and calls herself outspoken and stubborn. She wants to treat her disease aggressively.

"You sort of build up a little bit of a shell and get tired of hearing what everybody thinks,” she said.

Marina Rogers, 30, had an experience similar to Floyd's. She woke up one morning about three weeks ago with no sensation on the rightside of her body. Thinking it was a pinched nerve, Rogers, a fitness and wellness coordinator for the Oklahoma Publishing Company, visited the emergency room before going to work.

The doctor did a CT scan and told Rogers she likely had MS. The scan showed a lesion on the right side of her brain.

"I just wasn't prepared to hear that,” she said. "No one in my family has ever had a neurological disease like this.”

A spinal tap used to rule out other conditions left her bedridden for six days with an excruciating headache.

Rogers was accustomed to exercising four or five times a week. She hasn't been able to set foot on a treadmill since the numbness began. It hasn't gone away, and might not.

"Right now, I'm just trying to do what I can, just keep my regular exercise schedule ... I try to eat healthy,” she said, noting that depression is an issue with multiple sclerosis patients and something she'll need to look out for.

Rogers is one of Pardo's patients. She said he is waiting until she has another episode before diagnosing her with multiple sclerosis.

"I'm just kind of hoping that I don't have another episode but I'm preparing myself if something does occur,” she said.

Pardo said the disease likely is the result of "molecular mimicry.” Immune system T cells remember being exposed to bacteria and viruses. In people who are predisposed to multiple sclerosis, the cells enter the brain and attack something that resembles objects to which they've already been exposed.

"Your immune system misrecognizes myelin as something that's foreign to you and starts attacking it,” he said of the fatty sheath that insulates nerve cells.

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