New Visibility Helps Stanford's Multiple Sclerosis Center Gain Recognition as one of the Nation's Best
By Diane Rogers
Everyone diagnosed with multiple sclerosis lives under a virtual sword of Damocles—continually anxious about when the next debilitating attack on their central nervous system will occur.
“Even when they’re feeling physically well, there’s always an uncertainty about a new attack,” said Jeffrey Dunn, MD, the new associate director of Stanford’s Multiple Sclerosis Center, perhaps the fastest-growing MS center in the nation, currently treating more than 600 patients. “One of the best treatments for that uncertainty is the certainty that we will be there for them.”
Dunn was recruited last year from the Evergreen Multiple Sclerosis Center in Seattle, formerly known as the MS Hub, to enhance the effort of Stanford Hospital & Clinics to diagnose and treat patients with this autoimmune disease. “Jeff had the second-largest MS clinic in the country, and we were excited about bringing in a major clinician who has cared for thousands of patients,” said Frank Longo, MD, PhD, professor and chair of neurology and neurological sciences. “We are raising our profile as a clinical center, and we’re now expanding the services and support that we can offer patients.”
Neurologist Les Dorfman, MD, who has directed Stanford’s MS program for more than three decades, continues in that position, and May Htwe Han, MD, an acting assistant professor of neurology who trained at the University of Washington, joined the team in April. Nurse Practitioner Jong-Mi Lee facilitates a wide range of services for Stanford’s MS patients.
The center’s new visibility was recognized in recent months when Stanford was invited to join the national Consortium of Multiple Sclerosis Centers, and also was named one of 10 academic medical centers that are part of the Accelerated Cure Project for Multiple Sclerosis. That organization aims to find an ultimate cure for the autoimmune disease that afflicts some 500,000 people in the United States and 2 million people worldwide.
Jeffrey Dunn, MD (Left) and Les Dorfman, MD, of Stanford's Multiple Sclerosis Center.
“MS affects everything—your mind, your mood, your thoughts, speech, vision, coordination, strength, endurance, sexual function and the way your bowel and bladder move,” said Dunn, who is also a clinical associate professor of neurology and neurological sciences at the medical school.
With a typical age of onset between 20 and 40, it is the second-leading cause of disability in young adults, behind trauma. MS affects women more than men, by a three-to-one ratio, and 85 percent of MS cases are marked by relapse, with recurring attacks that persist over days or even weeks.
As a clinician who has treated MS patients for decades, Dunn calls this “the most exciting time in history as far as MS care goes.” Twenty years ago, there were no known treatments for MS. Today there are six treatments approved by the U.S. Food and Drug Administration. “Four are delivered by injection, and two are by infusion,” he said.
What’s more, Dunn said, the MS pipeline is robust. “There are five oral medications now being tested in FDA phase-3 trials, and there are several other novel and emerging monoclonal antibody therapies that offer significant promise.”
Recovery from an MS attack is usually less than 100 percent, Dunn added. “And as the disease wears on, people tend to get worse.” The coming treatments offer hope in terms of decreasing relapse rates.
“The problem is, we don’t really know how they’re best used,” Dunn said. “Should we be using different treatments at different stages? Or using different treatments in combination? Can we predict which patient might respond optimally to what treatment in advance? Are there differences among races that we should better understand in selecting appropriate treatment? There are lots of questions.”
Longo noted that the goal of Stanford’s MS program is to “build a full spectrum of services, from cutting-edge MS research, through translational study, all the way to a robust clinical program.” He predicted that Stanford soon would be counted among the top programs nationally—joining UCSF, Columbia, Massachusetts General Hospital, the Cleveland Clinic and Mayo Clinic—by building on novel approaches such as sophisticated imaging and proteomics, the study of proteins that are involved in the progression of the chronic inflammatory disease.
The program, Longo noted, continues to build on the foundational work of Lawrence Steinman, MD, professor of neurology and neurological sciences and of pediatrics, who “has played a leading role worldwide in developing MS treatments.” Steinman’s research helped spur development of the MS drug natalizumab, sold under the name Tysabri. Last year he reported promising results of a DNA vaccine to tame the immune system in relapsing remitting MS. The results from a phase-2 trial in nearly 300 patients, which appeared in Annals of Neurology in 2008, showed that the vaccine could suppress immune responses to myelin and attenuate activity on brain scans. In August, Steinman published new findings suggesting that another, less-expensive drug, Lisinopril, could be an effective treatment for the disease, though it still needs to undergo clinical trials and be approved for this use by the FDA.
Just down the hall from the MS center, Dunn said, are the offices of neurophysiologists and neuro-opthalmologists, as well as neurological specialists in physical therapy, occupational therapy and speech pathology. “We have put together an interdisciplinary team to be able to take care of patients,” he said. If they see an MS patient with “drop foot”—a condition in which the patient has difficulty raising the front part of his foot—the Stanford team can, in addition to prescribing medication, send the patient to a physical therapist, who can provide an exercise program and recommendations about whether to use a brace. If an MS patient has failing eyesight, a neuro-ophthalmologist is now available with more advanced testing equipment to make more precise diagnoses.
While the question “How long am I going to have to fight this?” still can’t be answered, Dunn said new therapies definitely are on the horizon. “Right now we don’t have a cure—we can’t cut it out by surgery, we can’t eradicate it by antibiotics, we can’t irradiate it like a tumor,” he said. “But we can tell people that early treatment can make a huge difference. And we can promise to walk alongside our patients, keeping close and providing support and encouragement.”
About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. Consistently ranked among the top institutions in the U.S. News & World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. It is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford. For more information, visit http://stanfordmedicine.org.