Multiple Sclerosis: The Latest Developments in Diagnosis and Treatment

After two decades of treating patients with multiple sclerosis (MS), Flavia Nelson, M.D., offers patients more hope today, thanks to increased awareness about the disease, more treatment options and a growing body of research.

Multiple Sclerosis (MS) is a complex and often debilitating disease of the central nervous system (CNS). Researchers are still unclear what causes the disease, which is critical to finding a cure. However, the many treatment options today mean Dr. Nelson, chief of the CNS Autoimmune Disorder Division and director of the MS Center of Excellence at the University of Miami Health System, can help many patients remain in remission.

Nearly 1 million people in the United States are diagnosed with MS.

The disease is more common in women, who are typically diagnosed in their 30s.

For patients with MS, the immune system mistakenly attacks the protective covering of nerve fibers called myelin. This leads to communication issues between the brain and the rest of the body. Symptoms vary widely, depending on what part of the brain or spinal cord is affected.

These can include fatigue, vision problems, muscle weakness, difficulty with balance and coordination and cognitive changes.

While there is no existing cure for MS, treatment can slow the disease’s progression and even keep patients in periods of remission where they don’t experience any signs or symptoms.

Early diagnosis of MS is key, but a challenge.

While early diagnosis of MS leads to better outcomes, there are no known genetic markers or lab tests to indicate a person has the disorder.

Researchers know the body’s natural immune cells, B cells, play a role in MS, but they haven’t found a specific antibody to predict or diagnose it. This means most patients are diagnosed once the disease progresses and they notice symptoms.

“We look at the patient’s clinical presentation, hear their story, do a neurological exam and look for lesions typical of multiple sclerosis on an MRI,” says Dr. Nelson.

Neurologists at UHealth’s Multiple Sclerosis Center of Excellence analyze patients’ spinal fluid for markers of inflammation present within the CNS, a common indicator of MS.

A new study published in Nature in April 2024 holds promise for about 10% of MS cases where the body produces a distinctive set of antibodies against its own proteins years before symptoms emerge.

With a vast database of blood samples from more than 10 million people, scientists looked at the antibody profiles of hundreds of MS patients before and after they developed the disease. Years before experiencing MS symptoms, they found that about 10% of patients had a specific group of antibody activity and higher levels of a protein called serum neurofilament light (sNfL), which is linked to nerve damage.

This antibody pattern stayed the same over time, suggesting an active immune response years before MS symptoms appeared. The researchers validated these findings by examining the spinal fluid and blood samples of a second group of MS patients.

While the early indicator was only present in 10% of patients, this discovery could help this particular group of MS patients. This might become a valuable tool for identifying people at high risk for MS, even before they show symptoms.

“Once we can learn the exact ‘malfunction’ in a patient’s immune system, then we will be able to learn the best treatment for them, regardless of what caused the disease,” says Dr. Nelson.

The link between Epstein-Barr virus (EBV) and MS has been a focal point of research for years.

EBV, which causes mononucleosis (commonly known as mono), is strongly suspected to be associated with MS.

Multiple clinical trials are currently underway to test vaccines against EBV, with the hope that preventing the viral infection in the first place could significantly reduce the incidence of MS.

“The outcome of preventing mononucleosis, which is the one infection associated with developing MS, could be huge,” says Dr. Nelson.

The ongoing research into EBV and MS is part of a broader effort to identify the root causes of the disease. While early detection is a promising strategy, preventing the disease altogether would be a game-changer. If successful, the EBV vaccine could become a cornerstone of MS prevention, potentially saving countless individuals from the disease’s devastating effects.

Stem cell transplant treatment may be available for Florida patients soon.

Stem cell transplantation is another area where significant strides are being made in MS treatment. Over the past two years, Dr. Nelson has developed the necessary infrastructure at UHealth to become a site for stem cell transplant treatments.

Historically, stem cell transplants have been considered a high-risk, last-resort treatment for patients with advanced MS. However, recent advancements in stem cell therapies have improved safety and efficacy, making them a more viable option for some patients. In a stem cell transplant, an MS patient is treated with immunosuppressant medications and then infused with healthy stem cells to reset their immune system.

By the end of this year, UHealth will be one of the sites enrolling patients in a multi-center clinical trial, BEAT-MS, comparing outcomes from stem cell transplants to the most high-efficacy MS medications. The trial’s outcome will help patients and their physicians determine whether the benefits of stem cell transplants outweigh the risks of complications.

Participants need to have been diagnosed with relapsing-remitting or active secondary progressive multiple sclerosis (MS) and have had incomplete benefits while taking prescription medicine for MS within the last three years. “Until now, patients with MS in Florida haven’t had a place to go within the state to participate in stem cell transplants, so this is a significant development,” says Dr. Nelson.

In addition to the BEAT-MS trial, UHealth will enroll patients in another clinical trial of bone marrow transplant treatment for patients with advanced stages of MS. This is particularly exciting, says Dr. Nelson, because these patients have minimal treatment options. “This method, currently being tested in patients with advanced MS, could potentially promote repair and improve outcomes in cases where traditional treatments have failed,” says Dr. Nelson.

UHealth will be one of only a few sites in the country to offer this trial.

High-efficacy MS medication options continue to expand.

The Multiple Sclerosis and CNS Autoimmune Disorder Division has historically been involved in industry-sponsored clinical trials. New, highly effective medication options are continuously being developed to help MS patients treat symptoms and keep the chronic disease in remission.

Currently, 15 clinical trials for newer MS medications are ongoing at UHealth.

Even as treatment options for MS continue to expand, Dr. Nelson says she can’t emphasize the importance of early diagnosis enough. “I encourage people in general not to ignore any vague or strange symptom that they may have, especially if they have a family history of MS,” she says.

Speak to your physician about your family history to ensure an MS diagnosis isn’t missed. Early treatment helps prevent disease progression.

“There is plenty of research that will help us improve treatments and outcomes, but if we cannot diagnose MS early in the first place, that limits the options,” she says.

Wendy Margolin is a contributor for UHealth’s news service.

Tags: Dr. Flavia Nelson, immune system attacks, part of the central nervous, people with ms