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Neurologists almost always wait until a second attack of symptoms before diagnosing multiple sclerosis - the potentially severe and incurable autoimmune disease in which the myelin coating of the nerves in the central nervous system is attacked by the body. Only then do they try to treat it with Copaxone or various types of interferon injections to slow the frequency of attacks and reduce their severity.
The fewer the attacks - which can involve a tingling of the extremities, muscle weakness or paralysis, blurred vision, tics, slurred speech, vertigo and swallowing problems, among others - the less the accumulated disability, thus delaying attacks and minimizing their long-term effects.
New research, however, indicates a need to take action with the first symptoms, says Prof. Mark Freedman, a senior neurologist at the University of Ottawa and head of the MS research division at the Ottawa Hospital General Campus.
Freedman, who was born in Toronto but speaks near-fluent Hebrew after studying at the Weizmann Institute as well as in London and Montreal, was in Israel recently to present this new research at a meeting of the Israel Society for Neuroimmunology.
The published clinical trial examined the results of treating patients with initial symptoms and whose MS was confirmed by magnetic resonance imaging. Some of the patients received interferon beta (Betaferon of Schering Pharmaceuticals) injections immediately, while others waited for subsequent attacks.
"Confirmed patients should be started on the drugs immediately; if you wait for the second attack, they don't work as well," Freedman told The Jerusalem Post. All patients are going to be studied for at least five years.
The two-year study showed that early intervention is effective in delaying attacks and reducing their severity. When the medication is injected every other day, patients were half as likely to develop the full-fledged disease.
"It is not a cure, but it could push disability far into the future," said Freedman, who urged neurologists to take a proactive approach.
"Using clinical criteria and MRI, we can know in 85% to 90% of patients when it is MS. It is not wise to wait for therapy, even though the drugs are expensive."
Early intervention, he said, would probably work for Teva's Copaxone and Biogen's Avonex or Serono's Rebif (both interferon beta 1-a), and not only for Schering's Betaferon (interferon beta 1-b). Preliminary studies have already been started abroad on interferon beta 1-a and Copaxone, he said.
Some researchers are giving MS patients two or more kinds of medications simultaneously, as this may have a synergistic effect, he said.
Freedman is quite hopeful there will eventually be a cure for MS.
"We in the field have made substantial progress in the past two decades, and new agents are being developed. Stem cells could someday be used to heal the myelin or cause regeneration."
CLOWNING GETS SERIOUS
A new academic program for medical clowns - the first of its kind in Israel - has opened at the University of Haifa. The clowns will study for a BA in theater and participate in specially designed nursing courses to learn a wide range of skills for working in hospitals. The program will teach things you don't learn in acting school, such as the relationship between caregiver and patient or the psychological state of a patient in pain.
"I believe this program will create better medical clowns," said theater department head Dr. Ati Citron
The idea for the program was born during a chance meeting in Switzerland between Prof. Ada Spitzer, the university's vice president for external affairs and a nursing researcher, and a group of medical clowns who suggested that medical clowning become an academic subject. Less than five months later, it happened.
"Clowning opens avenues of communication with patients when the medical staff doesn't succeed. When a clown arrives, he uses skills that open gates, cross boundaries and reach places that most people don't allow themselves to go to in a hospital setting. We create distraction, so the patient won't feel his pain and can fly with us to fantasy lands. This is actually a type of therapy - clown therapy," says Herzl Tziony, a member of the "Dream Doctors" and a student in the new Haifa program.
The importance of medical clowning has become increasingly clear in recent years - at least among the clowns. "Academic training will help to create standards as to who can treat patients and who cannot. There is a tendency to see medical clowning as something not serious and temporary. Training will bolster the idea that this is not a passing phenomenon, and will advance the professionalism of the clown, enabling him to use clowning as an accepted form of treatment," Tsiony stressed.
"They have already studied the profession," added Citron. "We want to expand their understanding in the realm of theater and in the field of nursing. In addition to the studies that each student completes, specific courses have been designed. For example, they will be offered a course on the Sociology of Humor and Clowning - a course not given anywhere else in Israel. There is an entire field of study within nursing that relates to the relationship between patients and caregivers," Citron continued. "A caregiver needs to understand the psychology of a patient in a hospital setting, a patient in pain or with a serious disease. A medical clown needs to understand his role within this context, and therefore we believe that at the end of their studies they will not only know more about the theoretical aspects, but will be much better clowns."
The first class has 19 students from the "Dream Doctors" group, but numerous requests have been received to expand the program.
"Today we accept students who are already medical clowns, and build on their knowledge," said Citron. "My goal is to open a complete course of study at the University of Haifa that will include both the practical aspects of medical clowning and the academic aspects."