| **TREATMENT APPROACHES TOAUTOIMMUNE NEUROLOGIC DISEASES**

**P. K. Coyle, MDProfessor of NeurologyDirector, MS Comprehensive Care CenterSUNY at Stony Brook, New York**

A number of autoimmune diseases involve the nervous systemto produce devastating problems such as paralysis, blindness and loss of thinking ability.Most of these diseases affect women in their prime years. They include multiple sclerosis(MS) (70% are female), neuropsychiatric lupus erythematosus (90% female), myastheniagravis (>50% female), Guillain-Barr� syndrome and other peripheral nerve disorders,and HTLV-1 associated myelopathy.

As we learn more about how the immune system works ingeneral, and how it goes awry in a specific disease, we are developing exciting and noveltreatment strategies that manipulate the immune response to benefit the patient. We nowhave new and improved ways to apply time-honored anti-inflammatory and immunosuppressanttherapies, such as corticosteroids and cytotoxic drugs (cladribine, methotrexate,cyclophosphamide, azathioprine).

In addition, several therapies are being applied to a broadarray of neuroimmune disorders. These include plasmapheresis, which washes out thepatient’s blood to remove circulating antibodies, immune complexes, and otherfactors; and infusion of intravenous immune globulin, which downregulates autoimmunereactions through a wide array of immunomodulatory effects. For severe myasthenia, removalof the thymus gland takes out abnormal body tissue that has become an immune factoryattacking the nervous system.

In particular, the therapy of MS has entered a new era. Forthe first time, we have treatments that truly ameliorate disease severity. Treatment withan immune system hormone, the cytokine, interferon beta, not only decreases MS diseaseattacks, severity of attacks, and disease disability, but it actually reduces the totalbrain lesion load of treated patients. Treatment with a drug that mimics brain myelin,copolymer 1, also reduces MS attacks and disease disability.

Major treatment studies are now underway in MS patients toevaluate oral myelin in an attempt to shut down abnormal immune response to myelin. A neworal agent, liomide, will be evaluated in a study of more than 700 patients to determinewhether it can help correct the immune abnormalities that occur in MS. Another study willdetermine whether interferon therapy has benefit in the very early and the progressivestages of MS. Other immune treatments have moved from the laboratory (testing in animalmodels) to the hospital (testing in MS patients) at a rapid pace. These strategies (T cellvaccination, peptide vaccination, monoclonal antibodies against adhesion molecules) aredesigned to rid the body of the abnormal immune system cells that are causing the braindamage, or to block these cells from entering the brain to cause damage.

This is an exciting time for patients with immune-mediatedneurologic disorders. Treatments are becoming available that not only slow down theirdisease, but can even repair fixed damage. With the advances being made in medicalscience, cures for autoimmune neurologic diseases are now on the horizon.

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