medical MS Philosophy

Judging risk

Every treatment has risks associated with it. The big, bad risk for the treatment I’m on for MS is a brain infection known by the acronym of PML. It’s pretty nasty. If you’re lucky, you die from it. The ones that don’t are pretty severely brain damaged. When I had started my treatment, it looked as though the incidence of that side effect was 1 in 3000. In addition, the people that did get it tended to have a history that I didn’t have (previous use of immune sup present drugs). That’s not too bad of a risk although I would say that if given the chance to do something that had me dying in 1 out 3000, I wouldn’t do it in regular life.

The factor weighing on me from the other side is that I am in probably the worst of all demographics for MS outcomes. I am male, my symptoms showed up as motor skills first, and it also presented with lesions on the spinal cord. Looking at the data, people with those markers tend to deteriorate faster and end up less mobile than other populations. So disease management is important. Tysabri seems to be the only treatment worth a damn, despite the risk of PML, so that’s what I have been doing.

Now there is some new information out and it is making me question what to do. It turns out that all of the people that got PML also tested positive for JC virus antibodies. The JC virus is  relatively benign virus, unless you are doing something that compromises your brain’s immunity, then you can get PML. Last I read, about 60% of the population has been exposed to the JC virus. The new numbers suggest that if you have the JC virus antibodies, your risk of getting PML while on tysabri is 1 in 500.

That’s a lot worse than 1 in 3000. The risk of infection is still unlikely, but not as unlikely as I would like. The good news is that if I don’t have the antibodies, it doesn’t look as though I’ll be a candidate for PML at all, or at least until I’m exposed to to the virus… I got my blood drawn yesterday to test for the presence of the antibodies. I’m really hoping that they come back negative. If it does, I’ll continue doing my treatment. If it comes back positive, I’m not sure what I’ll do. Without treatment, there is a much better than 1 in 500 chance that I will be put in a very bad way from MS. On the other hand, it won’t kill me or damage my brain either. There really aren’t any other decent proven treatments out there.

So that’s the potential decision I’ll have to face, a more certain bad thing vs. a less certain very bad thing. Let’s just hope for a negative test result, that would make so much easier…

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