Response : Intrathecal Interferon for Multiple Sclerosis

Abstract

was administered by serial lumbar puncture to ten patients with multiple sclerosis (MS). Their clinical courses were compared with those of ten MS control patients who did not receive IFN-\g=b\.As of this writing, the recipients have been followed up for 1.8 to 2.0 years (mean, 1.9 years), and the controls for 1.5 to 1.7 years (mean, 1.6 years). During the study, two recipients suffered four exacerbations, and six controls suffered 11 exacerbations. The recipients' rates of exacerbation during the study were significantly less than their rates both for the entire prestudy duration of the disease and for the 1.8 to 2.0 years immediately preceding entry into the study. The controls' rates of exacerbation before the study and during the study period did not differ significantly. Clinically, the conditions of five recipients and two controls improved, those of three recipients and four controls were unchanged, and those of two recipients and four controls worsened. Headaches, sometimes accompanied by fever and rarely by nausea and vomiting, occurred after injections of IFN\x=req-\ \g=b\.Toxic symptoms usually disappeared within 24 hours; rarely, they persisted for seven to ten days. Each recipient had transient CSF pleocytosis and elevated levels of total protein (the latter remaining elevated in seven). These findings show that intrathecal administration of IFN-\g=b\is feasible in patients with MS, warrant cautious optimism that intrathecal IFN-\g=b\may be effective in altering the course of the disease, and support concepts of a viral or dysimmune cause of MS. (Arch Neurol 1982;39:609-615) large body of evidence suggests that multiple sclerosis (MS) is caused (at least in part) by viral infec¬ tion.12 Interferon has been shown to have potent effects against a variety of viruses that infect animals and humans.317 Only minute amounts of interferon cross the blood-brain bar¬ rier when it is administered systemically, but it can be safely adminis¬ tered intrathecally.6·12·1823 For these reasons, we assessed the effect of intrathecal administration of human fibroblast interferon (IFN-/3) in patients with MS, using a randomized, controlled study. Preliminary results of this study were reported ear¬ lier.24'26