Contents
Multiple Sclerosis is a medical condition in which the patient’s brain and spinal cord show abnormal behavior. These two parts of your body make up the central nervous system. This system is responsible for taking messages from the brain and conveying them to the other parts of the body, and vice versa. MS causes communication issues within the brain and between the brain and other parts of the body. This miss-communication can lead to several complications, ranging from difficulty in moving to total disability.
The symptoms of Multiple Sclerosis vary with the severity of the illness. Sometimes this disease prevails in the body without showing any visible signs. There are many factors that may cause this disease but the exact causes are still unknown. Some of the potential causes are genetics, infections, deficiency of immunity, and environmental factors. Due to the lack of understanding of the exact causes of MS, no cure has yet been found. However, there are some treatments available which will reduce the symptoms of MS and lead to a better quality of life for patients.
This book will take you through the history of this disease and unravel some of the latest findings of this disease to help you understand and fight it.
Historical Perspective
Multiple Sclerosis is one of the most common disorders of the human central nervous system but it was not discovered until the early years of the nineteenth century. Historical documents reveal that even people in the Middle Ages faced the illness with symptoms similar to MS; but due to lack of scientific methods and modern technology this disease didn’t get proper attention. In 1868 the father of neurology, Jean-Martin Charcot, wrote about this disease. He was treating a young female with neurological problems. His examination of her brain after her death was the first time doctors were able to begin to understand MS and how it affects the nervous system.
In 1873, Dr. Walter Moxon officially recognized this disease in England and then in 1878, Dr. Edward Seguin recognized it in the United States. After that, several theories were established to explain the causes of this disease but none of them could be proved due to insufficient technology. The chances to study this disease in a much better way increased drastically when Dr. Santiago Ramon and Dr. Camillo Golgi perfected some chemicals to improve the nerve cells’ visibility under the microscope. They were awarded a Nobel Prize in 1906 for this achievement. After this discovery, many doctors including Dr. Louis Ranvier got the opportunity to study the nerve cells in detail, leading to the discovery of building block myelin. Myelin is one of the most important components of our nervous system and has a very strong link with MS. It wasn’t until the 1940s, however, that doctors succeeded in finding the exact composition of myelin. In 1943, Sylvis Lawry founded The National Multiple Sclerosis Society. Her brother was suffering from this diseases and it motivated her to create this society. The society’s initial aim was to find someone who had recovered from this illness. Although they failed this movement contributed a lot in creating awareness about this disease.
In the 1950s, the field of biology was revolutionised when James Watson and Francis Crick published their description of DNA – a discovery which earned them a Novel Prize in 1953 and paved the way for a far greater understanding of multiple sclerosis and many other diseases.
Over the course of last 100 years, physicians have come a long way in their understanding of Multiple Sclerosis, and today we know a huge amount about this disease that can help you to fight it.
Symptoms of MS
The symptoms of MS are as unpredictable as this disease itself. You can even have MS without showing any kind of sign. In some cases, patients experience mild issues like fatigue or numbness but in serious cases, vision loss or even paralysis may be sympomatic.
Numbness & Tingling
This disease disturbs the communication between brain and body as a result of which your body can receive conflicting messages from the brain which makes it difficult for the body to respond. Sometimes brain signals don’t reach the body and it causes numbness. Tingling & numbness are two of the most common warning signs of this disease. If you are having frequent numbness in your face, fingers, legs, and arms then you must visit your doctor.
Vision Issues
Your optic nerves are very close to the central nervous system and Multiple Sclerosis can also disrupt the communication between these nerves and result in double or blurred vision. There are lots of other factors that can cause this issue but in MS, you will also feel pain when you see from the top or corners of your eyes. This condition can also lead to vision loss.
Chronic Pain
According to studies by the National MS Society, almost 50% of patients with MS suffer from chronic pain. You may feel soreness in the torso which is known as ‘MS girdle’ or ‘MS hug’. You may also feel pain in your back, legs, and joints.
Weakness & Fatigue
80% of patients with MS feel weakness and fatigue without having any clear explanation. It is possible that you will feel fatigue or weakness even after resting for several hours.
Weak Coordination & Dizziness
The miss-communication between body and brain leads to poor physical coordination and can limit the mobility of patients. You may also feel dizziness. This feeling will not stay for long but its frequent occurrence suggests the presence of MS.
Problems with Bladder and Bowel
MS also affects the bowel, bladder, and reproductive systems of patients. You may experience:
Frequent urination
Difficulty in holding urine
Diarrhea
Constipation
Difficulty in sexual arousal
Loss of bowel control
Cognitive Issues
Since MS is directly linked to the brain, it also causes several cognitive problems. Some of those problems include:
- Difficulty in concentrating
- Loss of memory
- Issues with speech and language
Other Symptoms
Some other signs of Multiple Sclerosis include:
- Seizures
- Trouble swallowing
- Mood swings
- Depression
- Out of control shaking
- Hearing loss
- Garbled speech
- Breathing problem
All these symptoms may occur to a greater or lesser extent – however, with advances in modern medicine they can also be controlled in the majority of cases.
Types of Multiple Sclerosis
On the basis of its pattern, there are four basic types of Multiple Sclerosis.
Relapsing-Remitting MS (RRMS)
In this kind of MS, symptoms start to appear periodically after regular intervals. This period of symptomatic activity is also known as relapse, flare, or attack. After these active periods you may experience quiet periods known as remission. In this remission period symptoms become less noticeable or may disappear entirely. The length of remission period varies from months to years. This is the most common type of MS and according to estimates almost 80 to 90% patients of MS suffer from RRMS.
Primary-Progressive MS (PPMS)
In PPMS the severity of symptoms increases gradually over time. In this type, you will not experience any remission period but the intensity of some symptoms may decrease to some extent. Johns Hopkins Medicine claims that PPMS affects approximately 10 to 15% of patients.
Secondary-Progressive MS (SPMS)
This type is closely associated with RRMS and many people with RRMS ultimately develop SPMS. In this type, the severity of symptoms gradually increases, leading to what is known as ‘acute attack’. More than 50% patients with RRMS develop SPMS within 10 years and 90% of RRMS patients develop this type within 25 years.
Progressive-Relapsing MS (PRMS)
This is the most severe type of MS. In PRMS, symptoms start to aggravate gradually and severity increases to an extreme level. In medical terms this phenomenon is known as ‘acute exacerbation’. This is rare type of MS and less than 10% of patients with MS experience this disease.
Pathogenesis of MS
Pathogenesis is the manner by which any disease progresses. The pathogenesis of MS covers the whole lifespan of the patient. The type of MS determines what path this disease will follow and it is also important to study the pathogenesis of this disease to diagnose the right type and to make efforts in treating the disease. The diagram below shows how different types of MS progress.
Causes
The causes of multiple sclerosis are largely a matter of theory and hypothesis, as physicians simply don’t have enough conclusive evidence to claim that certain factors are known to cause the disease. Here you will find out how this disease prevails in your body, which factors are most likely to cause this disease and which factors aggravate this condition.
Deterioration of Myelin
In the history section, you found that myelin is closely linked to MS. Myelin is a unique substance in your body which is designed to protect the central nervous system. It is an insulating material composed of phospholipids and protein. It covers the nerve fibres (as shown in the figure below) and electrically insulates them which increases the speed of signal flow and facilitates communication between neurons.
Your body has the natural tendency to recover any deterioration of myelin but a significant reduction in myelin may be a cause of multiple sclerosis. The damage to the myelin disturbs the communication between the brain and the body and symptoms of MS start to appear.
Possible Factors of Multiple Sclerosis
Immunologic Factors
As described earlier, a deficiency in myelin can cause MS but the question is which factors can reduce your natural immunity. This is the one of the biggest questions for researchers as they seek better treatments and even a cure for MS.
Genetics
Diseases like MS usually pass through from parents to children, so scientists are also working in this direction. Statistics and research results do suggest a genetic connection.
Environmental factors
Scientists have discovered that Vitamin D plays a very important roll in protecting against the deterioration of myelin. The human body processes Vitamin D from sunlight, and consequently people who live nearer to the equator are enriched in Vitamin D and their ability to protect myelin is much higher, leading to a far lower occurrence of MS in equatorial populations.
Infections
There is a virus, demyelination, which causes the inflammation and breakdown of myelin. It has opened the gates to study the infectious factors that can cause MS. Some bacteria and viruses that have potential to cause this medical condition are
- Human herpes virus-6 (HHV-6)
- Epstein-Barr virus (EBV)
- Measles virus
Common Trends
Though the causes are not well known, over the past few decades experts have gathered enough information to identify some trends associated with this disease. These trends include:
Age: People between the ages of 15 and 60 are more likely to experience this disease.
Gender: Women are 2 times more likely to have this illness.
Heredity: There is evidence to suggest that multiple sclerosis may be an inherited disease.
Infections: Some viruses are known to have a link with MS. One of them is the Epstein virus, which causes infectious mononucleosis.
Race: Descendants of Northern European people are at higher risk while Asian, Native American, and African races demonstrate a lower likelihood of contracting the disease.
Smoking: Patients who experience one occurrence of MS symptoms are more likely to experience a second ‘event’ if they also smoke. There is an increased chance for smokers that RRMS will develop.
Associated diseases: If you have bowel inflammatory disease, type1 diabetes, or thyroid problems then the chances of developing MS are higher than those who don’t have this disease.
Epidemiology of MS
Epidemiology is the study of different aspects of a disease within a certain population. The epidemiology of Multiple Sclerosis is very important to understand because the statistics indicate that people in some regions and people of certain races are more likely to experience the symptoms of MS. In 2008, the World Health Organization (WHO) and the MS International Federation published a worldwide study on the epidemiology of MS, under the name of Atlas. According to Atlas, 2.3 million people all over the world are fighting with MS. This disease is found in almost every part of the world but Europe and North America have the highest number of patients with MS. Almost 10% of MS patients live in America. On the other hand, East Asia and sub-Saharan Africa has the lowest number of such patients. This varying possibility of people in different regions to have this disease is referred as the prevalence factor. You already know that Vitamin D is one of the reasons why people at the equator are less likely to have this disease. The following diagram shows which parts of the world have the highest prevalence factor.
Diagnosing MS
Many factors contribute to the cause this illness and several other factors increase its severity. There is therefore no single test which will provide enough evidence to diagnose this disease with 100% certainty. Moreover, most of the symptoms of this disease are similar to those of other neural diseases due to which its diagnosis in early stages is very difficult.
Modern technology has allowed us to use several hi-tech tests to diagnose such diseases, but it is potentially dangerous and expensive to use a large number of tests that utilize radiation. All these complications in the diagnosis of this disease lead doctors to follow a ‘step by step’ approach so that the risk of an incorrect diagnosis can be reduced. Before administering any test doctors will ask about symptoms and family history of diseases. Sometimes the condition of the patient indicates the nature of the disease. After the preliminary checkup, doctors can ask you to go through one or all of the following tests.
Magnetic Resonance Imaging (MRI)
In the 19th century, doctors discovered that MS causes inflammation of the brain. With the help of MRI, doctors can observe this inflammation. If they find inflammation of the brain and/or spinal cord then there is very high possibility of MS. This kind of diagnosis cannot confirm MS in older people and patients with diabetes and high blood pressure as these two diseases and aging can also cause inflammation of the brain and spinal cord. Equally, the absence of inflammation does not completely rule out MS because 5% patients with MS don’t show any physical abnormality of the central nervous system. However, it can be used as a good indication.
Spinal Taps
Spinal tap, also known as lumbar puncture, is the testing of cerebrospinal fluid. This fluid resides in the spinal cord and high expertise is required to remove the right quantity of this fluid. Doctors examine the protein level and current composition of this fluid. The composition of cerebrospinal fluid can indicate whether the myelin is damaged or not. This fluid is extremely important therefore doctors will suggest only in the case of extreme necessity. The procedure to acquire this fluid from spinal cord is shown in the figure below.
Treatment
The treatment method for diseases of the nervous system has improved a lot over the past few decades. There was a time when doctors used to inject gold and silver in order to treat neural diseases. Now technology has helped us to treat several diseases, but currently, there is no treatment method that can completely cure multiple sclerosis; therefore doctors try instead to cure the symptoms to reduce the severity of the disease.
Deep Brain Stimulation
Deep brain stimulation (DBS) is a modification of the surgery used for the treatment of tremors in patients with diseases like essential tremor, Parkinson’s disease, and multiple sclerosis. In this surgery, the surgeon tries to destroy two parts in the brain. These two small parts are the thalamus and globus pallidus. These parts reside deep in the brain therefore this surgery is known as deep brain stimulation. This surgery is considered high-risk, because the destruction of wrong cells in the brain can cause several complications like loss of vision and paralysis.
Usually, 4 electrodes are used in this surgery and the surgeon adjusts the position of electrodes by testing the reaction of the patient during the surgery. In this way doctors can find the right spot without causing any damage to other parts of the brain. This treatment method does not cure MS but it can relieve the signs of those tremors that are related to MS. This treatment method is not yet approved in the USA by the FDA.
Plasmapheresis
Plasma is the liquid component of your blood. In MS some viruses and bacteria in the blood damage the myelin and it is important to clean the blood to eliminate the chances of attack on myelin. In a process similar to a blood transfer or dialysis, this is done using the healthy plasma of a donor. This treatment can help to manage severe flares. This method can reduce your blood pressure significantly and you may feel dizziness or weakness. If you are allergic then this procedure can cause an allergic reaction. This treatment method is very promising because 40% of people who display sudden and sever attacks show improvement after this treatment. Moreover, this treatment method is relatively simple and inexpensive, but unfortunately it is only a short term option.
Therapies to Modify Progress
You can use different therapies to reduce the duration, frequency and severity of relapses. These therapies are also known as disease-modifying therapies (DMTs). These therapies cannot cure the disease but they can certainly improve a patient’s standard of living.
Alemtuzumab (Lemtrada)
You can use this DMT if you are suffering from RRMS and you have gone through one relapse. It is used as the first therapy for most patients. Usually, doctors recommend 2 courses of this DMT with a gap of one year. Each requires 5 drips for 5 days (one drip for each day).
Avonex (interferon beta-1b)
If you have RRMS and after the first attack your MRI shows that your MS is still active then you can use this therapy. If you have SPMS and experience severe relapses then this DMT may also be prescribed.
Betaferon (interferon beta-1b)
This is the most popular therapy to treat MS. You will need to inject it under your skin or into the muscle and it can reduce the severity and rate of relapses. Flu and irritation at the injection site are the side effects of this therapy.
Dimethyl Fumarate (Tecfidera)
Doctors recommend to take this medicine twice in a day and it can also help you to increase the period of remission time. Its side effects are nausea, diarrhea, the decrease in white blood cells, and flushing.
Extavia (beta interferon-1b)
This therapy is predominantly used for RRMS and SPMS and you have to inject it under your skin. You will need to use it every other day.
Fingolimod (Gilenya)
This DMT is also used to decrease the rate of relapses. It is important to check the heartbeat before taking this medicine for the first time because it slows down the heart rate. Side effects of this medicine are high blood pressure, blurred vision, and headache.
Glatiramer acetate (Copaxone)
This DMT protects the myelin from the attacks of different viruses. You have to inject it under your skin. You will feel some irritation at the site of injection.
Natalizumab (Tysabri)
This medication blocks those movements in the bloodstream that can damage your immune cells. In this way it can prevent further deterioration of your myelin. Some people use it as their primary medicine. The side effect of this disease is that it can increase the risk of viral infection.
Plegridy (peginterferon beta 1a)
This injection is used to increase the gap between relapses. Usually this is prescribed fortnightly.
Rebif (beta interferon-1a)
Rebif is similar to Plegridy and used for exactly the same reason. The main difference is that you will need to use it once in a weak.
Teriflunomide (Aubagio)
This DMT is used to reduce the number of relapses. Women who want to have babies in future, should avoid this therapy as it can have an impact on the female reproductive system. Other side effects of this DMT are hair loss and liver damage.
Alternative Treatment
The number of treatment methods for MS is increasing with time. Modern medicine involves several chemical and can cause serious side effects. Some holistic treatment methods such as acupuncture may also help you. Acupuncture cannot cure MS but it can help reduce symptoms like pain and muscle spasm. Some patients even experience better bladder control with this treatment method.
Exercises like yoga and tai chi can also help to fight the pain and emotional problems. These exercises provide you flexibility, energy, and balance which can help you to improve your physical activities. Concentration through yoga can help you to overcome depression and anxiety.
Some people recommend medical marijuana because it reduces the pain. Marijuana disables that part of the brain which is responsible to interpret the feelings of pain. When this part disables it automatically reduces the feeling of pain, but it is not recommended.
Other methods to treat this disease are:
- Baclofen Pump
- Botox
- Imuran
- Novantrone
- IV Steroid
- Tysabri Therapy
- Physical Therapy
To some degree, the effectiveness of treatment of multiple sclerosis depends on the patient’s mental attitude. You have to remain positive and encourage yourself to live the life to its full. A positive mental attitude will not treat this disease but it will give you the strength to keep on trying.
Sources
WebMD Multiple Sclerosis
National MS society introduction
http://www.msif.org/research/epidemiology-of-ms/
http://www.who.int/mental_health/neurology/Atlas_MS_WEB.pdf
MS Society licensed disease modifying drugs
