Answered on: 3/23/2006
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I heard that more than just myelin is destroyed in the brain by MS and that the brain actually shrinks. Is that true and is any research taking place to try and stop it?
Yes, the brain actually shrinks in MS. This is due to continuing degeneration (neuro-degeneration) of constituents within the brain as the disease progresses. These constituents include not only myelin and the oligodendrocytes that make myelin in the first place, but also nerve cells (neurons) and their fibers. The shrinkage of the brain, referred to as “brain atrophy”, can be detected by MRI scans of the brain when conducted over periods of years. At autopsy, the loss of brain tissue can be quite obvious to the naked eye.
Neuro-degeneration and brain atrophy are the major factors that account for the progress of disability in patients with MS that deteriorate neurologically. It is thus critical to prevent neuro-degeneration and brain atrophy in MS. Scientists worldwide are actively researching on the reasons for neuro-degeneration and they are beginning to understand some of the molecules that cause this. As a result, a number of medications are being tested in animal models of MS in attempts to prevent the loss of brain tissue. There are indeed many “neuro-protective agents” that seem promising in laboratory studies. Providing for neuro-protection is in fact one of the most active areas of research in MS currently.
There is evidence that the two major types of immunomodulators used in MS, glatiramer acetate (Copaxone) and interferon-betas (Avonex, Rebif and Betaseron), not only affect the immune system but that they also can confer some degree of neuro-protection. The mechanisms by which these immunomodulators provide for neuro-protection seem different, with glatiramer acetate’s action being more direct within the brain tissue, while that of the interferon-betas may be considered more indirect by preventing the entry of molecules that go into the brain to destroy that structure. Many neurologists therefore advocate the use of these immunomodulators in relapsing-remitting MS and to encourage patients to stay on their medications.
We currently have no clear evidence that the loss of brain tissue in progressive MS can be reduced. However, research is quite active in this area.
Overall, we now recognize that neuro-degeneration is very significant in MS, leading to the loss of brain tissue. Research to stop this is very active and several potential neuro- protective medications are in the pipeline.
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