Seeking a clearer view of multiple sclerosis

People with multiple sclerosis (MS) face devastating uncertainty, not knowing how the disease will progress or disrupt their daily lives. But scientists are developing new diagnostic tools to aid treatment and ease the unpredictability for patients.

Symptoms of MS are:

• Blurred vision
• Weak limbs
• Tingling sensations
• Unsteadiness
• Fatigue

Over time, MS leads to permanent nerve damage and progressive loss of function.

Now a novel imaging tool is offering hope for more clarity in diagnosing MS. A short, painless and inexpensive eye examination called optical coherence tomography (OCT) may become the most effective way to diagnose and monitor the progress of this disabling disease.

Need for new diagnostics

There is no single diagnostic test for MS. Neurologists use a range of methods – medical history, physical examination and electrical measurement of brain wave transmissions – to confirm a diagnosis and to rule out other neurological illnesses with similar symptoms.

One of the most widely used tests is magnetic resonance imaging (MRI) of the brain and spinal cord. MRI can identify damage to the myelin layer and brain shrinkage, which is caused as neurons are attacked and die.

“...the earlier we get someone on medication the quicker we can stop the disease from causing more harm,”

says Peter Calabresi, Johns Hopkins Multiple Sclerosis Center

But MRI has limitations. The scans provide no reliable means of producing images of early neurodegeneration, which is a main cause of many MS symptoms. And in established MS, MRI findings show only modest correlation with the clinical signs of disease, such as disability.

A clearer view through optical coherence tomography

OCT has the potential to offer what may be the clearest picture of the status of MS, and its progression, by specifically measuring nerve cell health.

OCT scans the layers of nerve fibers that cover the retina in the back of the eye. These fibers are unique in the central nervous system because they are ‘nude’ – having no myelin sheath. Using special light sources to create an image of the retina similar in appearance to an ultrasound scan, OCT enables physicians to monitor the loss of structure or function of nerve cells down to a few microns (millionths of a meter).

Moving toward earlier treatment

Neurology Professor Peter Calabresi, who heads the Johns Hopkins Multiple Sclerosis Center in Baltimore, Maryland, US, says OCT may enable earlier treatment of MS in the future. Novartis is one of several companies supporting MS research at Johns Hopkins.

Many of the disabilities MS patients suffer – numbness, tingling, vision problems, tiredness, weakness and bladder disturbance – are the result of nerve cell degeneration, Calabresi noted. MRI is an imperfect tool for measuring nerve damage, he said, but with OCT “we can see exactly how healthy these nerves are, potentially in advance of other symptoms.”

“Treatments for MS cannot reverse the damage but they can arrest it, so the earlier we get someone on medication the quicker we can stop the disease from causing more harm,” Calabresi said. He added that OCT scans take roughly one-tenth as long and cost one-tenth as much as MRI.

A Novartis commitment

Novartis is committed to helping patients manage MS through our primary mission – providing innovative medications – as well as supporting research into causes and diagnosis.

In 2009 Novartis launched Extavia, a branded version of interferon beta-1b, a current standard of care for relapsing forms of MS, in more than 20 countries.

The company also has submitted regulatory applications in the United States and Europe for FTY720.