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Pot offers comfort but no cure for multiple sclerosis

Siegel is an internist and an associate professor of medicine at New York University's School of Medicine.

“Eli Stone”

“The Humanitarian” episode, ABC, Nov. 18

The premise: Attorney Eli Stone (Jonny Lee Miller) has a rich client, Jim Cooper, whose teenage son J.J. has an illness the show characterizes as multiple sclerosis.

J.J.'s supposed multiple sclerosis manifested itself with an attack when he was a young teen. The attack lasted several weeks, during which he couldn’t feel anything in his arms. Since then, with symptoms in remission, he has resumed a normal life and is a competitive high school swimmer.

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Cooper wants to begin a clinical trial using medical marijuana as a cure for his son, and he is petitioning the Drug Enforcement Administration to allow him to grow his own marijuana for medical purposes (this is legal in California but not under federal law). Cooper says the National Institutes of Health has two ongoing studies about the effects of cannabis on multiple sclerosis.

Cooper’s mother died of the disease, and now he fears the same fate for his son.

The medical questions: How common is it for multiple sclerosis to affect children? Are J.J.'s symptoms accurately portrayed? What is the standard treatment and prognosis for the illness? Is there a tendency for cases to recur in future generations? Does marijuana have any potential as a cure?

The reality: Although multiple sclerosis is much rarer in children than adults, it still affects 8,000 to 10,000 individuals in the U.S. under age 18, according to the National MS Society. An additional 10,000 to 15,000 have experienced a symptom suggestive of multiple sclerosis, and some of these will go on to develop the disease as adults.

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J.J.'s episode of loss of sensation in his arms followed by remission is realistic, although a first episode like that is not strictly diagnostic of multiple sclerosis, says Dr. Barbara Giesser, clinical director of the multiple sclerosis program at UCLA.

Rather, the term for such a first attack is clinically isolated syndrome, a sign that there has been damage to the insulation (myelin) in the brain, spinal cord or optic nerve.

Clinically isolated syndrome has an up to 80% chance of progressing to clinically definite multiple sclerosis. But that diagnosis would require evidence of a second attack and additional lesions in the brain, spinal cord or optic nerve.

The show doesn’t mention J.J. receiving treatment, but a first episode would be treated with interferon or glatiramer acetate, says Dr. Howard L. Weiner, director of the Partners Multiple Sclerosis Center at Brigham and Women’s Hospital in Boston. “The response is reasonably good.” Both Weiner and Giesser say that there is sometimes a role for steroids in reducing symptoms during an acute attack. For nonresponsive cases, natalizumab (Tysabri) is used. It’s been quite effective but has been associated with a rare but serious viral brain infection.

If the diagnosis of multiple sclerosis is made, the prognosis of the type J.J. has (known as relapsing-remitting because episodes are recurrent with some recovery in between) is good, and the show’s portrayal of J.J.'s condition as inevitably disabling and likely fatal is extremely inaccurate. Further, though there is a genetic component to the disease -- with a 4% risk of multiple sclerosis in offspring or siblings -- “it may often be severe in one and mild in the other,” Weiner says.

There is anecdotal evidence as well as research suggesting that cannabis may be helpful in treating the pain, anxiety, spasticity and tremors associated with the disease in humans.

But, Weiner says, “it has no real potential as a cure.”

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marc@doctorsiegel.com


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