The unexplained disease of Multiple Sclerosis

Dan Abshear has been a medic with the Navy and Marine Corps, a physician assistant, a sales and marketing rep for large pharmaceutical corporations, and is presently involved in efforts to improve regulatory compliance in the medical industry. He maintains a weblog at www.informaproject.blogspot.com.

Every October for over a decade I’ve been doing the MS-150, a two-day bike ride with thousands of other riders to raise money for multiple sclerosis (MS).

I didn’t know much about this disease until recently, and like millions of others, hope improved treatment options soon become available for MS patients.

First observed in Holland nearly 600 years ago, a French neurologist was first to recognized MS in the 1800s.

MS most often occurs with a sudden, unexpected onset to people in their early 30s but has been diagnosed in children as young as 2 years old and in seniors as old as 75. It occurs more often in females, and more often in whites than among other races. The disease is most prevalent in North America, Northern Europe, Australia, and New Zealand.

About 2.5 million people in the world have MS. In the United States, about 200 new cases of MS are diagnosed every week.

MS is a neurodegenerative disorder believed to be an autoimmune disease that at times results in serious physical and cognitive disabilities. MS symptoms can be relatively mild or progressive and brutal for some patients. Most MS patients have a fairly mild expression of the disease and live normal lives and enjoy a normal lifespan.

In MS, it is believed that the auto antibodies of the immune system attack the protective myelin sheath covering the nerve fibers. In time, the myelin sheath is destroyed, and replaced with scar tissue, a condition known as scoliosis. The process that occurs during this destruction is called demyelination. The nerve damage that occurs as a result is due mainly to inflammation from this process.

There are four classifications of MS, along with seven different forms of MS. The most common type is relapsing/remitting MS. It is believed remission occurs due to remyelination after the destruction of the myelin sheath by the immune system. It’s common for MS patients to alternate between episodes of remission, followed by relapses that can last from days to months.

About half of all MS patients develop increased disabilities within 10 years of the initial onset of the disease.

The cause of MS is still unknown. Suspected etiologies include viral infections, the Epstein-Barr virus in particular, as well as genetic dysfunction.

Smoking is believed to increase the risk of acquiring MS. Vitamin D deficiency has been suspected as the cause of MS as well. Damage to the blood/brain barrier in humans has also been suggested as a cause of MS.

The disease is often difficult to diagnose. In the past, MS was sometimes mistaken for a psychological disorder.

In addition to at least two separate MRIs to observe the possible presence of brain lesions, a lumbar puncture may be performed to obtain cerebral spinal fluid for analysis to confirm the diagnosis of MS. Similar diagnostic evidence can occur in what is known as “clinically isolated syndrome” as well.

Half of all patients with this syndrome progress to the disease state of MS. After about 10 years, MS patients may experience neurological damage that progresses more rapidly.

Optic neuritis, where the patient suddenly and temporarily loses their sight, is frequently an initial symptom of MS and the one that gets the MS patient to the clinic or hospital.  

Another early symptom is extreme fatigue. As the disease progresses, other symptoms may occur, such as affective disorders, cognitive dysfunction, muscle spasms, bowel dysfunction and voiding abnormalities resulting from the damage to the nervous system. Depression is present with most patients with MS. Patients with the disease have higher suicide rates than the general population.

Overall, costs of treating MS are high, particularly when biologic agents are prescribed.

Pharmacological treatment regimens may be intuitive or empirical. Experts recommend initiating treatment as early as possible to delay the disease progression. Often, multiple medications are needed to control the symptoms.

Treatment with corticosteroids is the standard for newly diagnosed patients. Interferons are also commonly prescribed for some, and are effective in 50 percent of people with MS. Immunomodulary or immunosuppressive agents are also prescribed.

Other treatments coming into use include an antibiotic called doxycycline, which has been shown to slow MS progression. Remarkably, parasitic hookworms, which can be damaging to humans when they reside in the human intestines by causing anemia, actually may be beneficial for the MS patient as well. These parasites have been shown to decrease the damaging activity of the MS patient’s immune system.

Daily niacin injections have been shown to be advantageous by offering protection from the damage and pain incurred by inflammation. Some biologic agents, such as Compath, an agent used to treat Leukemia patients, have been shown to decrease and delay the progression of MS as well as relapse episodes. Tysabri is another beneficial biologic agent given intravenously once a month to decrease the frequency of the MS symptoms.

SSRI antidepressants and statin drugs have also been shown to decrease the progression of MS. Testosterone therapy for men with MS has been linked with decreased brain degeneration in this population.

There are other promising treatments for MS in research and development stages, including bone marrow stem cell transplantation which has been proven to reset the immune system of the MS patient to within normal limits.

Related: Living with the unpredictable: Women and MS