Ask The Doctor

Q: Please explain how Tysabri® is administered so I know what to expect. Do I need to prepare in any way? What effects might I feel during or immediately following the procedure, and what side effects might I experience during the time between doses?

A: Tysabri (formerly Antegren) is given in the vein every four weeks in an "infusion center" or at the doctor's office. No patient preparation is required. The infusion lasts about one hour and you must wait for another hour to observe for a potential allergic reaction, such as wheezing. These reactions are not common but can be serious and require immediate attention. Hives is another uncommon side effect. Headaches, menstrual disturbances, fatigue, and infections are other potential side effects. However, most people tolerate the treatment well. More complete information will be available when the final two-year data is released later this year.

Q: Should individuals already on a self-injected immunomodulating therapy (Avonex®, Betaseron®, Copaxone®, or Rebif®) ask their doctor about adding Tysabri to their treatment plan?

A: Discussing the role of Tysabri with your doctor is an excellent idea. Only one-year data is available on adding Tysabri to Avonex and no data is available for combining Tysabri with Betaseron, Copaxone, or Rebif. Tysabri plus Avonex was more effective than Avonex plus placebo at one year in a group of patients on Avonex who were having attacks or new MRI activity. In my opinion, this is a very selected group of patients and may not be relevant to Copaxone or high-dosed interferons. More studies are needed before the effectiveness, and/or potential complications of combination therapy using Tysabri, are known.

Q: Why don't doctors routinely order an MRI of the brain and the spine, versus just the brain alone? I have heard of people having few lesions in the brain but many along the spine.

A: The two major reasons for ordering an MRI of the brain are (1) to make a diagnosis of MS and (2) to evaluate possible progression of the disease. The brain MRI is usually more sensitive for these two indications than a spine MRI in patients with relapsing-remitting and secondary-progressive MS. I order spine MRIs if the brain MRI is inconclusive and/or I suspect another disorder may be present in the spine (such as a herniated disc), causing neurological symptoms. Also in primary-progressive MS, the spine MRI may be more sensitive than the brain MRI in some patients. In summary, the rationale for the doctor ordering a spine and/or brain MRI depends on the specific clinical situation.

Jack Burks, MD, is a neurologist who specializes in MS. He is vice president   chief medical officer for MSAA, as well as president of the Multiple Sclerosis Alliance. Additionally, Dr. Burks is a clinical professor of medicine in neurology at the University of Nevada School of Medicine in Reno, Nevada, and a member of the Medical Advisory Board of the National MS Society. He has edited two textbooks on MS, and in the 1970s, Dr. Burks established the Rocky Mountain MS Center in Colorado, one of the nation's first comprehensive MS centers.

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