Partial and significant reversal of progressive visual and neurological deficits in multiple sclerosis: a possible therapeutic effect.
A 24-year-old woman developed over 18 months fluctuating and progressively increasing visual and cerebellar deficits, due to multiple sclerosis. The minimum visual acuities were 3/19 on the right and the perception of finger movement at 1 m on the left. She became able to walk only with a wide base and with support. Her condition deteriorated despite the use of methylprednisolone, prednisone and interferon beta-1b, so these were ceased. Azathioprine, 25 mg daily increasing to 100 mg daily, reducing following abnormal liver function tests to 50 mg daily, and glatiramer acetate 20 mg daily were commenced. The visual acuities two months later were 3/7.5 on the right and 3/6 on the left and after 4 months 3/4.5 on the right and 3/3 on the left. She was able after 2 months to walk unaided on a narrow base and after 4 months to jog half a kilometre without difficulty. Progressive multiple sclerosis has been held to be irreversible. The response in the present case therefore raises the possibility of a drug effect. It indicates the need for trials of combined immunomodulatory and immunosuppressive therapies in progressive multiple sclerosis.
Milder
Dan G
DG
Institute of Neurological Sciences, The Prince of Wales Hospital, Sydney, New South Wales, Australia. dmilder@ozemail.com.au
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D000068717:Glatiramer Acetate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D009422:Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010455:Peptides / Q000627:therapeutic use*; D014786:Vision Disorders / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity
D007166:Immunosuppressive Agents; D010455:Peptides; D000068717:Glatiramer Acetate; D001379:Azathioprine