There's a spring in his step again



Alex Normandin was super-fit and super busy as a medical student - until multiple sclerosis struck. Now, thanks to an experimental stem cell treatment, he's on the road to recovery.



By CHARLIE FIDELMAN, The GazetteApril 28, 2009




As an avid athlete and medical student putting in more than 100 hours in-hospital a week, it was easy for Alex Normandin to dismiss a spot on his temple that grew numb.
But he remembered the moment when he realized that half his face felt frozen. It was during surgical rounds at the Jewish General Hospital.
He panicked.
He knew the paralysis was a sign of something more serious than stress or fatigue.
Normandin, now 26, was diagnosed with multiple sclerosis nearly two years ago.
He had learned in medical school that MS is an unpredictable, often disabling illness of the central nervous system. The autoimmune disease mistakenly attacks the insulation, or protective myelin, covering nerves.
Symptoms vary but can include blurred vision, fatigue, problems with coordination, speech and muscles, loss of balance, and paralysis.
But Normandin also figured time was on his side because normally MS progresses very slowly.
So he continued with a planned two-month rotation in family medicine in the Bahamas where he worked and exercised fully.
"Jogging on the beach, snorkeling, swimming with dolphins," he recalled.
But then his energy and coordination started to fail. Thirty minutes on the treadmill became 20, then 10.
"And then I couldn't run anymore," he recalled.
Back at the Montreal Neurological Institute, Normandin learned that he had an extremely aggressive form of MS. He was told he would likely be using a wheelchair within months.
The news came as a shock; Normandin moved back into his parents' home.
He was also fast-tracked for a cutting edge, experimental treatment: a bone marrow stem cell transplant.
The procedure is not without risk - one patient died in Ottawa in the first phase of the treatment in 2002.
The procedure is fatal in five per cent (or one in 20 patients) because of the toxic chemotherapy drugs used to prepare a patient to receive a stem cell transplant.
Here's how the treatment works:
First, powerful chemotherapy drugs are used to erase patients' existing immune cells, leaving them temporarily open to infection.
Then, a stem cell transplant "reboots" the body's ravaged immune system with a fresh one, minus the disease.
The experimental treatment trial had been run since 2000 by Ottawa bone marrow transplant expert Harold Atkins and MS neurologist Mark Freedman.
People don't necessarily die of MS because it progresses so slowly, explained Freedman, lead investigator, professor of medicine at the University of Ottawa and director of the Ottawa Hospital Multiple Sclerosis Research Unit.
So a transplant with a five-per-cent mortality rate isn't for everyone, Freedman said: "The alternative has to be so bad that death is on the table as an option."
Twenty four people took part in the trial. It was open only to those with rapidly progressing MS who failed to respond to routine therapy and who were also likely to become severely disabled.
Normandin became patient 19. His transplant took place in December 2008.
It worked. Not only does the disease appear to have stopped its progression, but Normandin says he feels his coordination and strength improving.
In fact he has returned to the gym every day and will be resuming fourth-year medical studies at McGill University in July.
Normandin is buoyed by the treatment's eight-year track record - none of the 24 patients have suffered a relapse or a brain lesion.
Freedman stops short of calling it a cure, but this treatment seems to arrest the illness and allows some people to recover faculties they had lost.
"We're hopeful for Alex but it's too soon to say," Freedman said. The best improvements showed up 18 months after treatment and in patients with the least disabilities, he said.
In people with significant disabilities, "there's ... no way of reversing it," Freedman said.
Just when is it too late?
"We don't know where the critical stage is," he said.
Freedman's team is now looking at why some patients get better and others don't.
One theory is that the stem cells are doing more then "rebooting" the immune system, he said. Perhaps the cells are migrating to the brain or to damaged site and directing the repairs, he said

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