Multiple Sclerosis is a complicated disease. As a head of a Multiple Sclerosis Center, I have seen thousands of MS Patients. In each one of them, the disease looks different. This variance from patient to patient makes it a difficult disease to understand as well difficult to diagnose.
Despite the complexity, through years of treating my patients as well as conducting basic laboratory research, I’ve made a lot of progress in understanding MS and developing a particular approach to the care of MS patients. We still have many questions and we still don’t know what really causes MS, but we are getting closer. So, whether you have MS, know someone who does, think you may have it or you just want to better understand it, here is an overview what I know about multiple sclerosis.
A Chronic Disease of the Brain and Spinal Cord
Multiple Sclerosis (MS) is a disease that affects your central nervous system (brain and spinal cord) by disrupting communication between the brain and the body. It is caused by the destruction of the myelin sheath, produced by a wrapping of cells with insulation that coats nerve fibers. When this myelin sheath is destroyed, the brain can no longer send messages to the body successfully.
Initially, the disease may not have a big effect. But, over time it may severely disable a person. It is not contagious nor fatal, though in severe cases it can lower life expectancy.
One of the Most Prevalent Disabling Neurological Diseases Amongst Young People
MS is usually diagnosed when patients are between 20 and 40 years old, although researchers believe its impact may start earlier than changes in the brain can be seen. Women are affected at almost twice the rate of men, but of those who are diagnosed at later ages, men and women are affected in about equal numbers.
Multiple Sclerosis (MS) affects more than 2.3 million people worldwide, though it is is five times more prevalent in temperate climates, such as United States, Canada and Europe, than in tropical regions. The concentration of MS in certain geographic areas has led to a variety of theories amongst researchers. One is that patients are exposed to a virus around puberty, and its effects are only seen as they mature. Another theory is that genetic, racial or ethnic predisposition causes the disease to appear in specific locations.
An Evolution of Understanding The Cause of Multiple Sclerosis
We used to think that MS was a simple degeneration of the nervous system. Then we thought it was caused by a virus. Then, we thought it was caused strictly by an attack by the body on the cells that insulate the nerve cell processes in the brain and spinal cord. Then we found out what we thought was just a different type of MS is actually caused by specific antibodies to a water channel in cell membranes. And now we’re finding out that some type of toxin seems to be generated by immune cells setting up little nests in the covering membranes of the brain and spinal cord. And so it goes.
We still don’t know what really causes MS in humans, though we have made tremendous progress and we think we may be honing in on the cause. We know it’s not just about the myelin, or insulating cells of the central nervous system, that keep the nerve processes healthy. Even though we know some of the molecules of inflammation can cut the delicate processes of nerve cells just like a knife, it’s also about those nerve cell bodies too.
Beginning to Recognize MS – The Common Symptoms of Multiple Sclerosis
As I mentioned before, MS looks differently in every patient. But, it does seem to have some things in common amongst most people who get it. Symptoms manifest when an inflammation starts, followed by the forming of a scar (or plaque) in the central nervous system. This plaque, or lesion, can permanently disrupt your motor and sensory control. The plaque may form in various places of the central nervous system, and its placement will affect the symptoms you experience.
Some of the most common symptoms include:
- Numbness
- Weakness and/or fatigue
- Lack of coordination
- Visual problems
- Loss of balance
- Loss of bladder or bowel control
- Mood swings
- Cognitive problems
- Difficulty speaking
Of course, identifying MS by its symptoms isn’t quite so simple. There many other diseases that mimic Multiple Sclerosis, affecting people in the same age group with similar symptoms. These similarities amongst diseases highlight the importance of an accurate diagnosis.
How is the Diagnosis of MS Made Anyway?
For a long time MS has had a diagnosis by exclusion, ruling out other potential diseases and causes. And while we still don’t have a specific blood test for diagnosing MS, the MRI of the central nervous system has made the diagnosis a lot easier. However, the mainstay of the diagnosis is symptoms and signs, in a part of the central nervous system that MS usually affects, that are separated in time and space. Assessing these against accepted diagnostic criteria such as the MacDonald 2010 criteria, allows us to diagnose MS with more certainty.
The Amazing Ride of MS Treatments, From Interferon Beta to Now
In the 1990’s, Interferon beta was first approved for the treatment of MS. Since then, many new drugs have been approved for treatment and many more are on the way. These drugs are largely derived from our knowledge of the immune processes involved in MS, though we don’t have a cure for the MS disease process itself. The approved drugs modulate the disease, and decrease relapse rate and to some extent progression to disability.
Each of the drugs vary in what they do, how they are taken and what side effects they cause. So how does one choose among these therapies? Doctors usually try to stratify therapy, trying to get the best control of your MS, with the lowest risk to you, and with the fewest side effects. While it sounds simple on paper, it requires a lot of open dialogue with your doctor.
If you have MS, or care for someone who does, the most important thing is do not be afraid, and don’t stick your head in the sand! There are things we can do now we couldn’t do before. And those therapies are improving every day.
