MS Section Head

Dorothy Anne H. Cross, MD

MS is a disease that attacks primarily the white matter of the central nervous system (brain and spinal cord). It is very common, striking 1 in a thousand people in the US. MS can cause a wide variety of symptoms which vary from patient to patient. The past 20 years have seen great improvements in the diagnosis of the disease and its treatment. Recent breakthroughs in treatments have revolutionized care of people with MS. In the early 1990's, for the first time, medications were found that decreased MS attack rates and slowed progression of disability. Beginning in the late 1970's, MRI scans of the brain and spinal cord enabled the diagnosis to be made much easier and quicker in most patients.

The MS neurologists at Washington University are on the cutting edge of new therapies and new imaging techniques. We have been involved in the development of many of the drugs used for treatment now, and newer drugs still under investigation. We also have been developing new diagnostic and prognostic techniques using newer imaging methods.

Facilities:

Barnes-Jewish Hospital at Washington University provides comprehensive services with an inpatient neurology division, neurologic intensive care,rehabilitation facilities, home health, subacute care, extended care, home medical equipment and out patient care. We see outpatients at the Center for Advanced Medicine and at the NeuroClinical Research Unit on Tuesdays. Barnes-Jewish Hospital and the Dept. of Neurology at Washington University have each been rated among the top ten in the nation for many years.

The John L. Trotter MS Center at Barnes-Jewish Hospital also recognizes its responsibility to provide for the medically indigent, a long standing tradition at Barnes-Jewish Hospital. The MS Clinic, which is supported in part by the Multiple Sclerosis Society Gateway Chapter, is supervised by MS Center faculty neurologists and staffed by Barnes-Jewish Hospital resident physicians. This clinic is held in the NeuroClinical Research Unit.

Working on a Cure

There are 3 basic approaches to therapy in MS

• Shorten exacerbations and expedite the return to a remission.
• Prevent future worsening
• Provide symptomatic relief for the disabilities caused by MS

Treatments aimed at the underlying disease process to prevent future worsening are available for the most common types of MS and are being researched in clinical trials for other types of MS. These include: beta-interferons 1a and 1b, glatiramer acetate, natalizumab, and mitoxantrone. The MS specialists at the John L. Trotter MS Center use all of these medications. In addition, we are doing research on new medications that are not yet FDA-approved.

Treatments to relieve symptoms are very valuable to the MS patient, even if they may not directly alter the underlying disease process. We believe that our multidisciplinary team can improve the life style of our patients so that they can maximize the use of body functions that are healthy. Symptomatic treatments, for example, can help pain, stiffness, tremor, fatigue, bowel and bladder function and activities of daily living in general. Moreover, we also are doing research on several exciting new medications that relieve symptoms and improve nervous system functioning in MS patients.

Research

The cause of MS is unknown. MS appears to be caused by a complex pathologic process involving the impaired regulation of the immune system that may be triggered by a yet unknown environment or infectious agent in people with a genetic propensity to get the disease. White blood cells, including lymphocyte, monocytes, and plasma cells, enter the central nervous system (brain, spinal cord, optic nerves) and ultimately cause destruction of myelin, which covers projections of nerve cells that are called axons. When myelin is damaged, conduction of nerve impulses is impaired, leading to problems with motor skills, sensory perceptions, coordination or other functions. The exact types of impairments depend upon the location of the damage and the extent of the damage. In many cases, not only is the myelin destroyed or injured, but also are the axons. In some cases axons are completely destroyed, and this may be the cause of severe disability.

Research at the John L. Trotter MS Center goes from the cell culture stage, to mice with a model of MS, to research on human cells and tissues to clinical trials of new therapies. Clinical trials ongoing at the John L. Trotter MS Center include several that are testing new drugs, or different formulations of older drugs, whereas others involve studies to improve imaging of the nervous system in MS patients.
Some of the agents that have been tested in recent clinical trials at the MS Center include the beta-interferons combined with glatiramer acetate, estriol, rituximab, fampridine, MBP82-98, and anti-IL-12. The studies we are doing are continually changing as we complete some studies and begin others.

Ongoing laboratory studies are directed toward uncovering the mechanisms that underlie the development of MS. At present, we are studying antibodies to myelin in the blood and spinal fluid, endogenous immune suppressors, mechanisms by which oligodendroglial cells die (these are the cells that make myelin), newly recognized immune molecules involved in cell activation, adipokines and endogenous hormones and several other promising leads. Our hope is that some of these research studies may result in future clinical trials.

A large 5 year PO1 grant was awarded in Sept 2008 by the NINDS of the National Institutes of Health to Drs. Cross and Naismith and collaborators Drs. Sheng-Kwei "Victor" Song, and Robyn S. Klein to investigate ways to determine pathology of MS lesions using diffusion tensor imaging ( a type of MRI) in living patients and in the animal models.

Regulation of the inflammatory response is being examined by Dr. Laura Piccio and Dr. Cross. Researchers at The John L. Trotter MS Center are working on ways to modulate the immune system to lessen the damaging effects of activated immune cells in MS.

The John L. Trotter MS Center continues to work to identify specific components of myelin that are targeted by the immune system. This line of research was originated at the Center by our founder, Dr. John L. Trotter (1943-2001).

Multiple Sclerosis Center - John L. Trotter MS Center