Since 1993, our MS Center has worked to provide state-of-the-art neurological consultation and care for persons with multiple sclerosis in North Texas and the surrounding area. In addition to clinical activities, the MS Center is dedicated to all phases of clinical research for new, potential MS treatments from first-in-man Phase I through Final Phase III studies for FDA review.
Medical Director, Multiple Sclerosis Center at Texas Neurology
J. Theodore Phillips MD PhD is the Director of the Multiple Sclerosis Center at Texas Neurology, Dallas, and Clinical Professor, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas.
Dr. Phillips is an honors graduate of the University of Texas at Austin receiving a bachelor of science in chemistry, and subsequently received both medical and doctor of philosophy degrees with a focus on immunogenetics from the University of Texas Southwestern Medical Center in Dallas. Dr. Phillips completed his internal medicine internship at Baylor University Medical Center and neurology residency at University of Texas Southwestern Medical Center, and has specialized in Multiple Sclerosis research and patient care for almost 25 years in the Dallas area. Prior to establishing the Multiple Sclerosis Center at Texas Neurology, he was director of the MS clinic at the University of Texas Southwestern Medical Center for 9 years.
Dr. Phillips is a member of the Multiple Sclerosis Comprehensive Treatment Training Program at the University of Texas Southwestern Medical Center at Dallas, as well as several professional societies, including the American Academy of Neurology and the National Multiple Sclerosis Society, where he serves as a member of the national Medical Advisory Board and national Clinical Education Committee, and the Lone Star Chapter Clinical Advisory Committee. He is a principal investigator in several ongoing experimental treatment trials in MS, and additionally, is a frequent lecturer to professional and patient groups. He has also authored or co-authored over 50 scholarly publications in neurology and immunology relating to MS, and has been selected as one of the “Best Doctors in Dallas” by
D Magazine, Dallas,
“Best Doctors in Texas” by Texas Monthly, and “Best Doctors in America” by
BestDoctors.com.
What is MS?
Multiple Sclerosis (MS) is a chronic, inflammatory and neurodegenerative human disease which results from the autoimmune destruction of myelin and associated collateral tissue damage within the human central nervous system.
MS affects approximately 2.5 million persons worldwide. In the United States, MS is the most common cause of non-traumatic, long-term neurological disability in young adults, affecting at least 400,000 persons. Although MS is found throughout the world, marked regional variability is well known and likely reflects a combination of multiple interacting genetic and environmental influences. MS is usually first noted in young adults, affecting women two to three times more frequently than men.
Despite the common description of MS as one disease, several subtypes are recognized clinically. The established clinical subtypes include: relapsing-remitting (RRMS), primary progressive (PPMS), secondary progressive (SPMS), and progressive-relapsing (PRMS) forms. Over decades most untreated persons with RRMS will become “secondarily progressive”; i.e. will develop SPMS. At least 85% of the entire MS population is represented within the combined categories of RRMS and its subsequent form, SPMS. Persons with primary progressive MS (PPMS) are those who never have relapses and remissions, and comprise about 10% of all persons with MS. Progressive-relapsing MS (PRMS) is progressive from the onset without remission and is later punctuated with relapses and remissions. This form of MS affects about 5% of persons with MS.
Figure. The Natural History of MS: Clinical and MRI Features (Compiled from numerous sources.)
A common individual course of MS is shown in the figure. As shown, the first clinical evidence of RRMS is usually preceded by subclinical disease activity most sensitively detected by changes in magnetic resonance imaging (MRI) of the brain. Eighty to 90% of new MRI events may not cause clinical symptoms perhaps due to their relatively small size, preferential distribution within the brain white matter, and redundancy of brain circuitry.
A new MRI event is an area of inflammation which is typically detected with a gadolinium (Gd)-enhanced MRI of the brain or spinal cord. After a period of a few weeks, the inflammation subsides, leaving an area of scar tissue (sclerosis) behind. The descriptive diagnostic term “multiple sclerosis” derives from the multiplicity of these scarred (sclerotic) areas accumulated over time.
Clinical relapses can be associated with a variety of symptoms due to MS-related damage in brain and spinal cord. These may include disturbances of sensation, limb weakness, changes in vision or speech, balance or coordination problems, bowel and bladder control problems, excessive fatigue, and cognitive problems. As more inflammatory events occur over time, some of which actually reach clinical prominence (clinical relapses), the overall clinical and MRI extent of disease mounts (as shown in the Figure, white and orange lines, respectively).
At the same time, and now known to begin at even the earliest stages of MS, brain tissue loss also starts to occur, especially in untreated individuals. These changes correlate with long term irreversible physical and cognitive disabilities seen in many persons with MS. After 10 years disease duration, approximately 50% of untreated RRMS individuals will transition to SPMS.
This evolution is currently only recognizable after slow clinical worsening is noted in the absence of clinical relapses. All of these processes together lead to gradual MS worsening such that half of untreated persons with MS require a walking aid after 15-20 years of illness. The goals of early treatment of persons with MS are to help prevent the accumulation of brain and spinal cord damage that results in the disabling features of MS.
What causes MS?
The answer still remains obscure. Many studies suggest that both genetic and environmental influences play important interacting roles in determining risk for developing MS. MS prevalence varies with geographic location such that MS is more common in high northern or southern latitude regions and less common in equatorial regions. This peculiar finding is perhaps due in part to emigration patterns of higher risk groups, but most recently have been suggested to be related to less sun exposure and abnormalities in vitamin D metabolism more prominent at higher latitudes.
Various infectious causes have also been considered over the last 60 years, although none have shown a clear association with the disease. Recently, attention has been re-focused on the Epstein-Barr virus as a possibly important influence early in life, but there is no evidence that MS is infectious. Neither is MS is an inherited illness in any classic sense, but genes do appear to play some role in determining susceptibility to acquiring MS.
Disease Modifying Agents (DMAs) in MS:
In 1993, the first disease-modifying treatment for MS was approved by the US FDA (interferon beta-1b subcutaneous; Betaseron). Since then, five additional disease modifying agents have been approved for use in MS: Avonex (interferon beta-1a intramuscular), Copaxone (glatiramer acetate; copolymer-1; Cop-1), Rebif (interferon beta-1a subcutaneous), Novantrone (mitoxantrone intravenous), and Tysabri (natalizumab intravenous). These agents are called “disease modifying” because each is capable of altering the individual’s MS course for the better. Specifically, the approved DMAs all tend to suppress further worsening of MS, particularly regarding relapses.
As of 2008, approximately 20 new possible DMAs are in Final Phase III testing. These include new agents attacking many different aspects of MS, and these also include oral medications. The future holds true promise for developing new, effective, safe, and more convenient treatments for MS. New and exciting approaches to repair MS-related brain and spinal cord damage are on the near horizon. The future, we feel, is bright and encouraging.
Multiple Sclerosis Clinical Research Opportunities:
Texas Neurology is currently conducting several MS research protocols for patients with Relapsing MS and Secondary Progressive MS. If you would like additional information about any of these protocols, please contact Janey Phillips at 214.827.3610 ext 258.
Multiple Sclerosis Web Links:
The National Multiple Sclerosis Society (NMSS): http://www.nationalmssociety.org/
The Consortium of Multiple Sclerosis Centers (CMSC): http://www.mscare.org/cmsc
The Multiple Sclerosis Association of America (MSAA): http://www.msassociation.org/
International Organization of Multiple Sclerosis Nurses (IOMSN): http://www.iomsn.org/
Multiple Sclerosis International Foundation: http://www.msif.org/
