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Published in CenterView on November 05, 2012

UMMC neurologist’s research may help to eradicate multiple sclerosis in the future

By Jack Mazurak

The Friday afternoon multiple sclerosis clinics that Dr. Robert Herndon and two postdoctoral fellows ran during the late 1970s and early ‘80s grated them like a rasp.

“People would come in on stretchers and in wheelchairs,” said Herndon, professor of neurology. “You could put out the fires, treat the episodes with steroids, but there was nothing you could do to stop the disease. You just watched them get worse.

“We probably would see a dozen patients each. It was really a traumatic experience. Emotionally draining.”

The three doctors often drank martinis in the faculty club afterwards to cope with the stress.

Many physicians and nurses treating multiple sclerosis in those days burned out quickly, Herndon said. Were it not for his own research into the disease and the hope it engendered, Herndon, too, would have flamed out.

“I had research and it’s what kept me going,” he said.

In MS, the body’s immune system turns on the central nervous system, often attacking the myelin sheathing that insulates nerve fibers. Symptoms range from mild numbness in hands or feet to loss of vision, ability to walk and cognitive function.

The disease worsens with age, there’s no cure and its causes remain elusive.

The National Multiple Sclerosis Society estimates about 400,000 Americans have MS, or about one in 779 people.

During a conference at the Cleveland Clinic in late September, Herndon delivered a presentation and discussed with other MS experts the possibility of totally shutting down the disease.

“It’s a ways off yet,” he said. “But just the idea that we are thinking about this is major. Only in the past two-to-three years have the leading people in the field been talking about doing this. Before that, it was just about slowing down the disease.”

Herndon’s first encounter with MS research came during a visit to UMMC in the late 1950s in his second year at the University of Tennessee College of Medicine. In five decades, he’s witnessed and participated in key advances in MS drugs, therapies, imaging and the overall understanding of the disease.

Compared to today’s MS treatment standards, the late 1950s methods tilted on the edge of cruelty and disservice to patients. Treatment guidelines instructed doctors to delay diagnosis as long as possible. The average time between symptom onset and diagnosis stood at eight years.

Professional associations recommended giving oral steroids for exacerbations and not discussing the eventual cognitive problems patients would face.

“The dogma was that it would cause anxiety and insurance problems for the patient,” Herndon said. “At the time, the only imaging available was to x-ray the skull. That was of little-to-no use for diagnosing multiple sclerosis.”

Introductions of CT technology in the 1970s, then MRI through the ‘80s and ‘90s, brought an understanding of the disease process and the body’s ability to heal. Along with better drugs and steroids, those changes decreased the time to diagnosis and helped patients live longer lives with fewer symptoms.

Some of Herndon’s research showed that oligodenrocites could be regenerated and that remeylination could occur. Both were previously thought not to happen, so Herndon at times backed his findings vociferously.

He also helped with nearly a dozen clinical trials for drugs, steroids and interferons. The first serious clinical trials for MS drugs started in the late 1960s. Clinical trials throughout the past 30 years further refined the treatments available.

“Progress in MS research didn’t really pick up until there was improved technology and clinical trials,” he said.

In 2005, researchers found ways to definitively separate neuromyelitis optica, or Devic’s disease, from multiple sclerosis. That made diagnosing the problem much quicker.

Today’s high-resolution scanners help physicians pinpoint telltale signs in patients, rule out other diseases and diagnose the disease in a matter of months.

“We start treating patients right from the first episode,” Herndon said. “Better drugs and more willingness from physicians to change drugs based on the individual’s reaction have all helped.”

In September, the Food and Drug Administration approved teriflunomide, an oral drug that modulates the immune system to help control the disease. Herndon called it another tool in the armamentarium.

But a better hope may lie in dimethyl fumerate, an orally administered drug, he said. It’s still pending FDA approval after getting derailed from its initial fast track. That bothers him.

“It’s a terrific drug, one of the most promising we’ve ever had,” Herndon said. “I’ll be putting patients on it as soon as it’s approved. It’s had more safety information gathered on it than anything out there, and a close cousin has been used 20-plus years in Germany to treat psoriasis.”

This month, Herndon will start another clinical trial, this one for drug developer Genzyme.

“We’re getting more tools, more treatments, all the time, and that’s very important,” he said. “Much progress has been made, but we still have a long way to go.”

Even though there’s no cure yet, Herndon and his two former postdocs enjoy their martinis when they get together, knowing MS patients can now live long, healthy lives.