Multiple sclerosis is a chronic disease that affects many people in different ways. Its cause, symptoms, diagnosis, and treatment are all complicated. Scientists believe the disease is caused by a variety of factors. To understand the best diagnosis and treatment is important to understand the cause and symptoms of the disease.
What is Multiple Sclerosis and what causes it?
Multiple sclerosis, otherwise known as MS, is a chronic, degenerative immune-mediated inflammatory disease of the central nervous system. Scientists are not entirely sure of the exact cause. It is characterized by the inflammation, demyelination, and axonal degeneration of the central nervous system. The prevailing theory is that some trigger activates T-lymphocytes, an important cell type in the immune system. This then activates inflammatory processes, causing demyelination of some axons. This then results in the loss of axons, scarring, and inadequate
healing of the central nervous system. While they are not certain of the trigger, they believe it is somewhat genetic and somewhat related to environmental triggers. These environmental triggers include ultraviolet radiation, insufficient vitamin D consumption, cigarette smoking, and a virus that often causes mononucleosis.
What are the symptoms?
The symptoms are different for each person, but there are certain commonalities between all patients. Women are twice as commonly affected as men. The most common age of onset is 20-40 years old. Interestingly, people in warmer climates are also more affected. Because the central nervous system is affected, sensation and movement deficits are the most common symptoms. A common symptom is optic neuritis, which describes an impaired vision and colored blindness, often in one eye, and often only lasting for a few weeks to months. Other common symptoms include shooting electric sensations traveling down the spine with neck flexion, spastic upper extremities, loss of vibration and fine touch sensation, numbness, difficulty walking, difficulty with speech, tremors, bowel and bladder dysfunction, and possibly even changes in mentation.
What are the different types of MS?
MS is a particularly notable disease because it can come in different forms. There are three specific types: relapsing-remitting, secondary progressive, and primary progressive. Relapsing-remitting makes up 90% of MS cases when patients first present. It describes a course in which symptoms wax and wane with almost no symptoms in between episodes. Secondary progressive MS describes exacerbations with worsening of symptoms in between exacerbations. Some patients who were first diagnosed with relapsing-remitting MS eventually get diagnosed with secondary progressive MS. Lastly, primary progressive MS is when the symptoms get continuously worse with no exacerbations. This makes up 10% of cases.
How is it diagnosed?
MS is a diagnosis made on the patient’s history and imaging. Generally, people who exhibit signs and symptoms of MS will go to their doctor. Their doctor will often order labs to rule out other diseases and might refer them to a neurologist, a doctor who specializes in the brain and nervous system. The neurologist will often order imaging based on their suspicions. The diagnostic imaging of MS is called a Magnetic Resonance Imaging (MRI). The MRI of a person with MS will show multiple sclerotic plaques in the periventricular white matter with an enhancement of active lesions. Another way to diagnose MS is through a lumbar puncture. This is only useful if the MRI is inconclusive. The lumbar puncture will show lymphocytic pleocytosis and oligoclonal bands.
What is the treatment?
Treatment is generally approached in a step-by-step fashion. For acute exacerbations, patients are given high-dose glucocorticoids like methylprednisolone. If those do not relieve symptoms, doctors turn to a treatment called plasmapheresis. This process is when physicians essentially filter the plasma of individuals with immune-mediated diseases.
To prevent exacerbations, each type of MS has its own specific treatment. For relapsing-remitting MS, the first-line therapies are immunomodulators, specifically glatiramer acetate and interferon therapy. The second line is another immunosuppressant, natalizumab. Secondary progressive MS also uses interferon therapy, but these patients also use IV glucocorticoid or cyclophosphamide pulses in addition to methotrexate. All of these are different immunosuppressants, but they differ slightly in the mechanism of action from the immunosuppressants used in relapsing-remitting MS. Primary progressive MS often requires an expert. It has no established therapy because there are technically no exacerbations. Rather, physicians rely on supportive therapy to help patients overcome or manage some of their symptoms.
Summary
MS is a complicated, immune-mediated disease. Scientists are still not completely certain of its causes, and therefore are still trying to perfect its treatment. To learn more about MS, its treatment, and the best options to meet your health goals, contact the Stem Cell Transplant Institute today.
