Multiple Sclerosis

Anyone may develop MS but there are some patterns. Women are at least two to three times more likely than men to develop MS. Most people are diagnosed between the ages of 20 and 50, although an estimated 8,000–10,000 children under the age of 18 also live with MS, and although rare but people as old as 75 have developed it. Studies suggest that genetic factors may make certain individuals more susceptible than others, but there is no evidence that MS is directly inherited. MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is more common in Caucasians of northern European ancestry. Finally, those further away from the equator are at higher risk because they lack sunlight/vitamin D exposure. Whereas those closer to the equator naturally have more vitamin D which supports the immune function and protects against immune mediates diseases like MS.

An estimated 2.3 million people live with MS worldwide. These numbers can only be estimated, in the absence of formally reported data, because MS activity can occur without a person being aware of it and symptoms may be completely invisible. At the present time, MS incidence and prevalence are not consistently tracked and reported in the U.S. as there is no government requirement to do so.

MS can cause extreme fatigue, impaired vision, problems with balance and walking, numbness/tingling or pain and other sensory changes. It can also cause bladder and bowel symptoms, tremors, problems with memory and concentration, mood changes, difficulty speaking, difficulty swallowing, and loss of coordination. Symptoms may worsen due to heat, alcohol, and smoking.

Symptoms of MS are unpredictable; they can vary from person to person, and from time to time in the same person. These problems may be permanent or may come and go. Major symptoms sometimes disappear completely, and the person regains lost function. In severe MS, people have permanent symptoms that might include partial or complete paralysis and difficulties with vision, cognition, speech, or bowel and bladder function.

MS symptoms result when an immune system attack affects myelin, and the protective insulation surrounding nerve fibers of the central nervous system. Myelin is often compared to insulating material around an electrical wire; loss of myelin interferes with the transmission of nerve signals. Myelin is destroyed and replaced by scars of hardened “sclerotic” tissue. Some underlying nerve fibers are permanently damaged or severed as well. The scars (or lesions) appear in multiple places within the central nervous system, giving the disease its name. When any part of the myelin sheath or nerve fiber is damaged, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur.

MS symptoms result when an immune system attack affects myelin, and the protective insulation surrounding nerve fibers of the central nervous system. Myelin is often compared to insulating material around an electrical wire; loss of myelin interferes with the transmission of nerve signals. Myelin is destroyed and replaced by scars of hardened “sclerotic” tissue. Some underlying nerve fibers are permanently damaged or severed as well. The scars (or lesions) appear in multiple places within the central nervous system, giving the disease its name. When any part of the myelin sheath or nerve fiber is damaged, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur.

There is much one can do to manage the disease and the symptoms it can cause. A number of medications that have been shown to “modify” or slow the course of MS have been approved by the U.S. Food and Drug Administration (FDA) for people with relapsing forms of MS. Relapsing forms include relapsing-remitting MS as well as progressive forms of MS in people who are experiencing relapses.

While there is no way to predict with any certainty how a person’s MS will progress, four basic disease courses have been defined:

• Clinically isolated syndrome is a first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system. A person who experiences clinically isolated syndrome may or may not go on to develop MS, with the chances being higher in someone who has lesions on MRI that are similar to those seen in MS.
• Relapsing-remitting MS is characterized by clearly defined relapses (also called attacks or exacerbations) that last from days to weeks and then subside, with full or partial recovery and no apparent disease progression between attacks. Approximately 85% of people begin with this disease course.
• Primary progressive MS is characterized by a gradual but steady progression of disability from the onset of symptoms, with few or no relapses or remissions. Approximately 15% of people are diagnosed with this disease course.
• Secondary progressive MS begins initially with a relapsing-remitting course that later evolves into a more consistently progressive course, with or without relapses.

Unfortunately, there is no cure for MS, however, medications can alter the course of MS. Treatment options include:

• Injectable: Avonex, Betaseron, Copaxone, Extavia, Glatopa, Plegridy
• Oral: Aubagio, Gilenya, Tecfidera, Ampyra
• Infusion: Lemtrada (alemtuzumab), Novantrone (mitoxantrone), Ocrevus (ocrelizumab), Tysabri (natalizumab)

There is no definitive diagnostic test. Diagnostic tools include medical history, neurologic exam, MRI (gold standard), CSF, “Spinal Tap” findings, and Visual Evoked Potential (VEP). Based on these diagnostic tools, clinically definite MS require documentation of two or more episodes of symptoms and 2 or more signs that reflect pathology in anatomically noncontiguous white matter tracts of the CNS. At least one of the 2 required signs must be present on neurologic examination. Symptoms must also last for more than 24 hours and occur as distinct episodes that are separated by a month or more.