Question

Kathy, a 20-year-old woman, awakens one morning to a tingling, numb sensation covering both of her feet. This has happened to her a number of times throughout the year. In the past, when experiencing this sensation, within a couple of days to a week the numbness would subside, and so she is not too concerned. About a week later, she notices that the numbness and tingling not only persists, but has also spread up to her knees. Again, she ignores the abnormal sensation. By the end of a month’s time, the numbness spreads to the midline of her body. At this point, she becomes alarmed.

Kathy sees the nurse at her college who tells her that she should see a doctor. Kathy calls her doctor’s office to schedule an appointment, but the soonest slot is in two weeks. She makes the appointment and goes about her daily routine.

The next morning, Kathy wakes, but when she attempts to get out of bed, she comes crashing to the floor. Because she is still groggy from sleep, she doesn’t really understand what has just happened. As she tries to stand up, the muscles of her left leg engage, but as she also attempts pushing up with her right leg, she again falls to the floor. She sits in bewilderment as she tries to make sense of what has just happened and realizes that she has seriously scraped her knee in her fall. She does not feel the pain from her wound.

Kathy thinks about how odd this year has been. She remembers another medical issue she has earlier in the year when she had lost hearing in her right ear and wonders if there is a connection to her current condition. At that time, Kathy underwent extensive testing, but the ear, nose, and throat specialist remained baffled. He thought that a severe inner ear infection could have destroyed her ability to hear on that side, but there was no conclusive evidence to support this. In an attempt to recover any hearing he could, the doctor prescribed very high dosages of steroids; he told Kathy that she probably wouldn’t see a change, but there were rare occurrences where steroids helped. To both Kathy and her doctor’s surprise, after about a week of steroids, she completely regained hearing in her right ear. It was a “miracle.”

Kathy wonders whether she can count on a new miracle to heal her current medical issues.

Kathy realizes that she cannot wait until her appointment to receive medical care; she quickly goes to the emergency room. After a mountain of questions about Kathy’s symptoms and medical history, the doctors decide to admit her for further testing. She is transferred to the neurology unit and the doctors request she undergo a series of laboratory tests, including an MRI and spinal tap. In the meantime, the doctors prescribe high dosages of steroids to help alleviate the symptoms.

Upon reviewing Kathy’s medical history and the results of the various laboratory tests, the neurologists diagnose her with multiple sclerosis (MS). They explain to Kathy that MS is an autoimmune disease and that her own immune system has been attacking the myelin sheath that surrounds the nerves of her CNS. She remains in the hospital for a week until sensation is fully recovered in her lower body and strength is restored in her legs. She is discharged from the hospital and schedules a follow up appointment with the neurologist.

When she returns to the neurologist, they discuss Kathy’s different options for treatment. Because there is no cure for the disease, options in medication vary greatly. She decides to try daily injections of Copaxone, a medication that is similar in structure to a protein found in myelin.

Kathy continues to see the neurologist on a regular basis and gives herself an injection every evening. Over the course of seven months of therapy, she only experiences one occurrence of numbness, which subsides after a couple of days. She tries to stay positive and tries to minimize the disease’s impact on her life.

1. If you were going to develop a medication to alleviate the symptoms of MS, briefly describe how that medication would work?

Copaxone is the primary treatment for MS. Outline its mechanism of action below. How is this drug’s mechanism similar and/or different from your suggestions in Q9 which is Steroids decreased the inflammation around her vestibulocochlear nerve, allowing hearing sensory information to be better relayed to the cortex.

Answer 1

The mechanism of action of Capoxone (glatiramer acetate) is actually unknown. The proposed mechanism is immunomodulation by interfering with the pathogenesis of multiple sclerosis. Various inflammatory mediators are involved in multiple sclerosis that causes inflammation of nerves. This drug will affect these mediators and decrease the inflammation.

Steroid (corticosteroids) also have anti inflammatory action that can supress any inflammatory response initiated by the body. But it is not the same way by which glatiramer acetate acts. The main role of steroids are to suppress the inflammation and thereby edema. That's why in this case the hearing is improved as a result of reduction of edema of vestibulocochlear nerve.