Today someone asked “Selma Blair today tweeted she is getting sicker with her MS. Given her personal wealth and access to the best treatments. And we now have treatments that effectively shutdown ms in rrms. Also given she has had plasma exchange. My question is why is she getting sicker? “
The simple answer is I don’t know because I am not familiar with her particular case.
However, getting worse despite being on treatment does not surprise me because there is biology at work.
At the moment we think that one of the problems with MS are white blood cells entering the brain and causing damage.
This aspect can be treated by current MS drugs. However, some people do not respond to them and so they can get worse. These people may need to switch to a stronger drug. But worsening on strong drugs can also occur
Once the damage is triggered by one type of inflammation involving T and B white blood cells, a different type of inflammation will continue to cause damage to the nerves and this damage will take time to become manifest and die out.
This may take 2-3 years. At present we do not have effective treatments to limit this type of inflammation in the brain and so disease can get worse.
Plasma exchange removes antibodies from the circulation but if they are being produced in the brain these wont be touched.
To see it more simply. If you think of the cause of MS to be a match and when the match lights, MS attacks occur.
These matches cause damage and light a fuse which burns slowly and the damage acccumulates as the fuse gets to the dynamite. This will be the slow nerve damage.
Now you can blow the match out so it doesn’t light any more fuses, but thi bit of puff is not enough to blow out the lit fuse and this is going to continue to burn and so damage accumulates despite effective treatment. Therefore the drug can be working even if you feel you are worsening.
This is why it is important to get treatment, and that treatment needs to be effective, as soon as possible to stop those fuses being lit because for every attack you notice there may be 7-10 match strikes without you noticing.
There may be other reason why someone may worsen despite being on MS treatments