Now
Weinshenker, MD (Mayo
Clinic, Rochester, Minn.), was
chosen by peers to receive the
2011 John Dystel Prize for MS
Research, awarded for outstanding contributions toward understanding, treating, or preventing
MS (see box, p. 61).
Observing MS to predict
outcomes
Dr. Weinshenker made some of
his earliest contributions to the
field simply by watching people
with MS over time. Together
with a team at the University of
Western Ontario led by George
Ebers, MD, they observed 1,099
people with MS between 1972
and 1984.
“Natural history” studies
describe what a disease looks
like if nothing is done to treat
it. These studies were possible
because at that point, there were
no disease-modifying therapies
for MS. “We tried to identify
early factors in the course of MS
that would predict individuals’
long-term outcome,” said Dr.
Weinshenker. “We also analyzed short-term outcomes that
could help researchers who were
conducting clinical trials of MS
drugs, so that they could determine whom to study, how many
people to study, and what kind
of group to use for comparison.”
The result was a series of landmark papers, providing crucial
information for trials of the first
drugs approved by the FDA to
treat MS.
Setting standards for treating
severe MS attacks
The Mayo Clinic presents a
unique opportunity to MS clinicians. “Because serious cases tend
to be referred to the Clinic, we
can mount effective studies in
people with severe cases of MS,”
said Dr. Weinshenker. Many
people who experience severe
MS exacerbations, or relapses,
improve with short courses of
corticosteroids, but some don’t.
Dr. Weinshenker was
intrigued when his colleague
Moses Rodriguez, MD, found
that six people whose attacks did
not respond to steroid treatment
improved dramatically with
plasma exchange therapy. Plasma
exchange, or plasmapheresis, is a
process in which whole blood is
withdrawn from an individual;
plasma (the liquid portion) is
removed and replaced; and the
blood, with all its red and white
blood cells, is transfused back
into the person. This process
removes molecules in the plasma
that are thought to be active in
the autoimmune process that
may occur in MS.
“I thought Dr. Rodriguez’s
claim was incredible,” said Dr.
Weinshenker. “With the major
effect that he observed, a small
but well-designed clinical trial
should be definitive one way or
the other. It would have to be a
small trial—because most people
do improve with steroids—but it
would have to be a credible study
to convince neurologists.”
Dr. Weinshenker carefully
designed a novel study, includ-
ing a control group that received
a fake, inactive procedure. More
than 40% of those in the plas-
mapheresis group had marked
improvement in symptoms,
compared with 5% in the control
group. Annals of Neurology
1999;46:878-86
Getting it right
The diagnosis of MS is notori-
ously tricky. Dr. Weinshenker is
involved in medical education
efforts at Mayo and worldwide,
and his most important lesson
for clinicians is, “Make sure the
diagnosis is right. We see a lot
of people who are put on MS
treatments, but who do not have
MS.”
Dr. Weinshenker worked
on each of three task forces
convened by the National MS
Society to update the diagnostic
criteria of MS in 2000, 2005 and
2010. He also led a subcommit-
tee of the Society’s Task Force on
the Differential Diagnosis of MS:
A differential diagnosis of a dis-
ease basically eliminates the other
possibilities. The resulting paper
