First patient is about to walk on out of Montebello MS rehabilitation unit


Stuck in a Baltimore County hospital bed just after New Year's while recovering from surgery, Carole Downing was dismayed to find that her inactivity was making her multiple sclerosis symptoms worse.

The lower-body weakness and numbness she had been battling since 1984 threatened to leave her wheelchair-bound.

"She called and said, 'Get me out of here,' " said Dr. Kenneth P. Johnson, neurology chairman at the University of Maryland Medical System.

Dr. Johnson did, and Ms. Downing, 48, of Pikesville, became the first patient at University Hospital's new multiple sclerosis rehabilitation unit at the Montebello Rehabilitation Hospital in Northwest Baltimore.

After 3 1/2 weeks of comprehensive physical, occupational, speech and psychological therapy at Montebello -- which Ms. Downing calls her "20,000-mile tuneup" -- she was due to be discharged today.

"I hope to leave here with forearm crutches," she said.

The new unit "has been like a dream come true for me," Ms. Downing said yesterday at a ribbon-cutting. "I know it's just the beginning of what will be a wonderful future for those of us with MS."

Created with a push and $60,000 from a charitable MS support group in Maryland called United Support Against Multiple Sclerosis, the four-bed unit is expected to serve 50 to 150 MS patients each year, then more as it becomes better-known.

It is the first inpatient rehabilitation facility on the East Coast designed exclusively for MS patients. Dr. Johnson said he knows of only two others in the nation, in Denver and Minneapolis.

"MS patients are a rather unique group," Dr. Johnson said, and most rehab units aren't well-suited for them.

Two-thirds are women, mostly between the ages of 20 and 40 when their symptoms appear. In most neurological rehabilitation units, he said, they would be surrounded by elderly stroke victims, young, male trauma victims -- "motorcycle riders and people who have been shot."

And, because MS patients won't ever fully recover, they and their families need an "intensive educational environment" to prepare them for the challenges ahead.

Treatment on the new unit costs $530 a day, all inclusive, the same flat rate that applies throughout the state-owned hospital.

The MS Unit at Montebello will also serve outpatients and as a research laboratory for scientists at University of Maryland Medical Center. "We'll see what patients do best and what therapies do best," Dr. Johnson said.

Multiple sclerosis afflicts about 2,300 people in Maryland. Scientists believe it is an auto-immune disease in which the body's own defense mechanisms attack the fatty sheaths, called myelin, that protect nerve cells. The damage reduces the cells' ability to carry signals to and from the brain.

The disease's trigger appears to be viral infection in childhood that "teaches" the body's immune system to destroy myelin. "No one knows for sure" what the virus is, Dr. Johnson said, "but measles may be the primary culprit."

The first symptoms of MS -- blurred or double vision, numbness or weakness in the legs -- may not appear for 10 to 15 years.

Ms. Downing was 39 and a busy working mother of two when she began to feel numbness in her fingers and lips. It quickly became a weakness in her legs until she was "practically paralyzed."

For decades, doctors have treated MS attacks with steroids to reduce the nerve inflammation and limit scarring. But steroids have many unpleasant side effects, including gastro-intestinal upset and bone loss.

More recently, doctors -- and insurance companies -- have recognized the added value of physical therapy. While nothing yet can repair the myelin damage, Dr. Johnson said, repetitive exercise "helps the nerve fibers get back into conducting impulses, and also strengthens the muscles."

For some patients, he said, "with rehabilitation and steroid therapy we can get them walking again."

The next best hope for MS patients is something called beta-interferon, a natural protein that limits the body's immune response.

After years of research, much of it at University of Maryland Medical Center, Dr. Johnson and other scientists have shown that beta-interferon can reduce by half the number of MS attacks a patient may suffer.

The Food and Drug Administration is expected within the next 12 to 18 months to license beta-interferon for use in treating MS, the first new MS drug to be licensed in 25 years.

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