David Perlmutter's "Letter to Doctors and Patients"
Posted: Tue Nov 23, 2004 5:53 am
From David Perlmutter's "letter for Doctors and Patients" from Nov. 2003, but still very relevant.
Multiple sclerosis (MS) is a fairly common and generally progressive disease of the central nervous system with a prevalence in the United States of approximately 350,000 cases annually. Although the onset of MS typically occurs between the ages of 10-59 years, onset as early as 2 years of age has been described. Annual expenditures for the treatment of this disease in the United States exceed $2.5 billion. While typically regarded as a cause of morbidity, more than 3,000 Americans die each year as a direct consequence of MS--a disease in which the cause has remained stubbornly elusive.
The historical attempts to identify the cause of Multiple sclerosis have been filled with bleak commentary. As Godfried Sonderdank, Court Physician of Schiedam, Holland, reported in the 14th century when describing a disease now thought to represent MS: "Believe me, there is no cure for this illness. It comes directly from God. Even Hippocrates and Gallenus would not be of any help here."
Over a century ago, the genesis of Multiple sclerosis was attributed to some form of infection. As the French physician Pierre Marie reported in his lectures of 1891:
"Before concluding this enumeration, a paragraph must be devoted to unnamed infections, so frequent, so little known, I might add so much disregarded. There are no special symptoms at the onset which indicate its existence; fever is known to have occurred, prolonged discomfort with or without gastrointestinal symptoms, occasionally jaundice or pulmonary trouble, nothing else being known about the disease. In such a case, gentlemen, you must not doubt that this is certainly a case of infection, but of a kind that it has not received any definite clinical name. As regards the patients in whom insular sclerosis (Multiple sclerosis) seems to occur from the influence of injury or physical cause, my conviction is that these cases are also due to infection, but that the infection has passed away completely unperceived, while some less important but more dramatic incident has alone attracted the attention of the patient or those who are with him."
By 1998, at least 16 infectious agents had been identified as possibly causing Multiple sclerosis. Under strict scientific scrutiny, none has been found to specifically induce the disease.
But recently, the most convincing data ever presented relating infection with a specific organism to Multiple sclerosis has been reported from the Department of Neurology and Pathology, Vanderbilt School of Medicine, Nashville, Tennessee. Dr. Subramaniam Sriram and co-workers, publishing their results in the July 1999 issue of Annals of Neurology, have demonstrated the presence of a specific type of bacteria in 100% of the 37 Multiple sclerosis patients they studied. As the authors reported, "The evidence of Chlamydia pneumoniae in both progressive MS and relapsing-remitting patients suggests that the infection of the central nervous system with Chlamydia pneumoniae occurs early and persists perhaps throughout the course of the disease and does not differentiate between different clinical subtypes of the disease." (7) This purported relationship between risk for Multiple sclerosis and infection with Chlamydia pneumoniae was recently substantiated in a study appearing in the March 2003 issue of Epidemiology. In this report, Harvard researcher Kassandra Munger found a 70% increased incidence of Multiple sclerosis in women seropositive for the presence of Chlamydia pneumoniae specific immunoglobulin G antibodies using microimmunofluorescence.
This organism, Chlamydia pneumoniae, is a fairly recent addition to the list of bacteria known to affect humans. It is now recognized as a cause of pneumonia, pharyngitis, bronchitis, and several chronic diseases. More importantly, Chlamydia pneumoniae has now been recognized as playing at least some causative role in reactive arthritis and coronary artery disease--medical conditions which, like MS, are characterized by ongoing inflammation.
The idea that Multiple sclerosis may be caused by some form of infectious agent is supported by several interesting observations. On the Faroe Islands prior to 1920, MS was essentially unknown. Subsequent to the invasion of British troops, the incidence of MS increased dramatically. (9) This would support the contention that MS, at least on the Faroe Islands, was caused by some infectious agent to which the native population had not been previously exposed.
In addition, the cerebrospinal fluid (CSF) in patients with documented Multiple sclerosis, is typically found to contain high amounts of specific proteins known to be elevated in other nervous system disorders in which infectious causes have been clearly identifie
If there is such a strong relationship between the presence of Chlamydia pneumoniae and Multiple sclerosis, how could its presence have been missed by researchers for so many years? The answer lies in the fact that the discovery of Chlamydia in the spinal fluid of MS patients required the development of a very sophisticated test to detect a unique protein found on the cell wall of the Chlamydia pneumoniae organism itself. Indeed, this is not the first example of a profound delay in the identification of an elusive bacterium as the cause of a specific illness. It has been only in the past few years that the bacteria Helicobactor pylori has been demonstrated to be the causative agent in most cases of gastric ulcers. Incredibly, Helicobactor pylori has been identified in the stomachs of humans since the early 1900's, but medical researchers couldn't bring themselves to admit the possibility that a disease like gastric ulcers could be caused by a simple bacterium.
Another observation supporting the relationship between Chlamydia pneumoniae and Multiple sclerosis is based on the discovery that two commonly used medications for Multiple sclerosis, interferon-beta and methotrexate, profoundly inhibit the growth of the Chlamydia bacterium. This is interesting and provocative information as we don't yet fully understand why these drugs are sometimes effective in MS treatment.
Over the past several years, the medical literature has published various articles describing specific viruses thought to be the causative agent for Multiple sclerosis, only to have these reports subsequently refuted. But this new research describing the possible relationship between Chlamydia pneumoniae and Multiple sclerosis is most compelling. And the good news is that unlike viruses, specific antimicrobial medicines are available to treat Chlamydia pneumoniae.
Based upon this research, it is not unreasonable for patients with Multiple sclerosis to consider an empiric treatment for Chlamydia pneumoniae. As this discovery is so new, no specific treatment protocols have as yet been created. And it will likely be several years until clinical trials have been designed, approved, funded, completed, and ultimately published, until we know for sure that MS patients should be treated. But in light of the present evidence, empirically treating MS patients for Chlamydia pneumoniae seems reasonable. Obviously this decision should be discussed with the treating physician. Antibiotics generally quite effective in treating Chlamydia pneumoniae infections include doxycycline and tetracycline. Doxycycline may be the more effective treatment since it is more able to penetrate the blood-brain barrier to enter the brain.
Sarah
Multiple sclerosis (MS) is a fairly common and generally progressive disease of the central nervous system with a prevalence in the United States of approximately 350,000 cases annually. Although the onset of MS typically occurs between the ages of 10-59 years, onset as early as 2 years of age has been described. Annual expenditures for the treatment of this disease in the United States exceed $2.5 billion. While typically regarded as a cause of morbidity, more than 3,000 Americans die each year as a direct consequence of MS--a disease in which the cause has remained stubbornly elusive.
The historical attempts to identify the cause of Multiple sclerosis have been filled with bleak commentary. As Godfried Sonderdank, Court Physician of Schiedam, Holland, reported in the 14th century when describing a disease now thought to represent MS: "Believe me, there is no cure for this illness. It comes directly from God. Even Hippocrates and Gallenus would not be of any help here."
Over a century ago, the genesis of Multiple sclerosis was attributed to some form of infection. As the French physician Pierre Marie reported in his lectures of 1891:
"Before concluding this enumeration, a paragraph must be devoted to unnamed infections, so frequent, so little known, I might add so much disregarded. There are no special symptoms at the onset which indicate its existence; fever is known to have occurred, prolonged discomfort with or without gastrointestinal symptoms, occasionally jaundice or pulmonary trouble, nothing else being known about the disease. In such a case, gentlemen, you must not doubt that this is certainly a case of infection, but of a kind that it has not received any definite clinical name. As regards the patients in whom insular sclerosis (Multiple sclerosis) seems to occur from the influence of injury or physical cause, my conviction is that these cases are also due to infection, but that the infection has passed away completely unperceived, while some less important but more dramatic incident has alone attracted the attention of the patient or those who are with him."
By 1998, at least 16 infectious agents had been identified as possibly causing Multiple sclerosis. Under strict scientific scrutiny, none has been found to specifically induce the disease.
But recently, the most convincing data ever presented relating infection with a specific organism to Multiple sclerosis has been reported from the Department of Neurology and Pathology, Vanderbilt School of Medicine, Nashville, Tennessee. Dr. Subramaniam Sriram and co-workers, publishing their results in the July 1999 issue of Annals of Neurology, have demonstrated the presence of a specific type of bacteria in 100% of the 37 Multiple sclerosis patients they studied. As the authors reported, "The evidence of Chlamydia pneumoniae in both progressive MS and relapsing-remitting patients suggests that the infection of the central nervous system with Chlamydia pneumoniae occurs early and persists perhaps throughout the course of the disease and does not differentiate between different clinical subtypes of the disease." (7) This purported relationship between risk for Multiple sclerosis and infection with Chlamydia pneumoniae was recently substantiated in a study appearing in the March 2003 issue of Epidemiology. In this report, Harvard researcher Kassandra Munger found a 70% increased incidence of Multiple sclerosis in women seropositive for the presence of Chlamydia pneumoniae specific immunoglobulin G antibodies using microimmunofluorescence.
This organism, Chlamydia pneumoniae, is a fairly recent addition to the list of bacteria known to affect humans. It is now recognized as a cause of pneumonia, pharyngitis, bronchitis, and several chronic diseases. More importantly, Chlamydia pneumoniae has now been recognized as playing at least some causative role in reactive arthritis and coronary artery disease--medical conditions which, like MS, are characterized by ongoing inflammation.
The idea that Multiple sclerosis may be caused by some form of infectious agent is supported by several interesting observations. On the Faroe Islands prior to 1920, MS was essentially unknown. Subsequent to the invasion of British troops, the incidence of MS increased dramatically. (9) This would support the contention that MS, at least on the Faroe Islands, was caused by some infectious agent to which the native population had not been previously exposed.
In addition, the cerebrospinal fluid (CSF) in patients with documented Multiple sclerosis, is typically found to contain high amounts of specific proteins known to be elevated in other nervous system disorders in which infectious causes have been clearly identifie
If there is such a strong relationship between the presence of Chlamydia pneumoniae and Multiple sclerosis, how could its presence have been missed by researchers for so many years? The answer lies in the fact that the discovery of Chlamydia in the spinal fluid of MS patients required the development of a very sophisticated test to detect a unique protein found on the cell wall of the Chlamydia pneumoniae organism itself. Indeed, this is not the first example of a profound delay in the identification of an elusive bacterium as the cause of a specific illness. It has been only in the past few years that the bacteria Helicobactor pylori has been demonstrated to be the causative agent in most cases of gastric ulcers. Incredibly, Helicobactor pylori has been identified in the stomachs of humans since the early 1900's, but medical researchers couldn't bring themselves to admit the possibility that a disease like gastric ulcers could be caused by a simple bacterium.
Another observation supporting the relationship between Chlamydia pneumoniae and Multiple sclerosis is based on the discovery that two commonly used medications for Multiple sclerosis, interferon-beta and methotrexate, profoundly inhibit the growth of the Chlamydia bacterium. This is interesting and provocative information as we don't yet fully understand why these drugs are sometimes effective in MS treatment.
Over the past several years, the medical literature has published various articles describing specific viruses thought to be the causative agent for Multiple sclerosis, only to have these reports subsequently refuted. But this new research describing the possible relationship between Chlamydia pneumoniae and Multiple sclerosis is most compelling. And the good news is that unlike viruses, specific antimicrobial medicines are available to treat Chlamydia pneumoniae.
Based upon this research, it is not unreasonable for patients with Multiple sclerosis to consider an empiric treatment for Chlamydia pneumoniae. As this discovery is so new, no specific treatment protocols have as yet been created. And it will likely be several years until clinical trials have been designed, approved, funded, completed, and ultimately published, until we know for sure that MS patients should be treated. But in light of the present evidence, empirically treating MS patients for Chlamydia pneumoniae seems reasonable. Obviously this decision should be discussed with the treating physician. Antibiotics generally quite effective in treating Chlamydia pneumoniae infections include doxycycline and tetracycline. Doxycycline may be the more effective treatment since it is more able to penetrate the blood-brain barrier to enter the brain.
Sarah
