Multiple sclerosis (MS) is a disease in which the immune system mounts a response against the central nervous system (CNS). The resulting inflammation damages the myelin—the cholesterol-rich insulation that both surrounds nerves and forms the brain’s white matter-- the nerve fibers, and the cells that make myelin. Once this damage occurs, nerve messages within the CNS are altered or stopped completely. The damaged areas develop the multiple areas of scar tissue, or sclerosis, that give MS its name and that impair nervous system function.
A recent study funded by the National MS Society has confirmed that nearly one million people are living with MS in the United States, more than twice the original estimate from a previous study.
Common symptoms of MS include fatigue, gait disturbance, spasticity, numbness or tingling, weakness, vision problems, dizziness and vertigo, bladder and bowel problems, cognitive changes and depression. These nonspecific symptoms can often be confused with many other illnesses, making the diagnosis difficult.*
Criteria for the diagnosis of MS include:
Evidence of damage in at least two separate areas of the CNS AND
Evidence that the damage occurred at different points in time AND
That all other possible causes are ruled out.
The 2017 McDonald Criteria, which doctors use to help to definitively diagnose MS patients, include specific guidelines for using MRI and cerebrospinal fluid to speed the diagnostic process. Blood tests can rule out other conditions that resemble MS, including lupus, Sjogren’s, Lyme disease, syphilis, HIV, vasculitis, sarcoidosis as well as some hereditary diseases.
As CNS sclerosis progresses, one of four disease courses becomes manifest:
Clinically isolated syndrome (CIS)—A first episode of neurologic symptoms that must last at least 24 hours and is characteristic of MS but does not yet meet diagnostic criteria. People who experience CIS may or may not develop MS.
Relapsing-remitting MS (RRMS), the most common disease course, is characterized by clearly-defined attacks of new or increasing neurologic symptoms. These attacks, known variously as relapses, exacerbations and bouts, are followed by periods of partial or complete recovery (remissions). During remissions of RRMS, patient’s symptoms may disappear or some symptoms may become permanent. There is no apparent disease progression during remissions.
Secondary progressive MS (SPMS) follows an initial relapsing-remitting course followed by a transition to a progressive course in which neurologic steadily worsens over time.
Primary progressive MS (PPMS) patients experience worsening of neurologic function from the onset of symptoms without early relapses or remissions.
While the first documented case of MS was described in 1421, it was not until 1969 that the steroid compound ACTH became the first drug shown to speed recovery from MS relapses. In 1993, Betaseron was the first drug approved by the FDA that affected the underlying MS disease process.
Today, 22 drugs are effective in modifying the disease course of MS, and almost all of them are helpful in treating CIS, RRMS and SPMS. Patients whose MS is controlled by one of these drugs will likely continue it indefinitely. Only one medication—Ocrevus—has been approved by the FDA for the treatment of PPMS.
These disease-modifying therapies (DMT) primarily work by reducing inflammation and do not work as well in disease that is characterized by nerve degeneration. Thus, DMT drugs have not been shown to be helpful in treating most progressive forms of MS.
MS patients typically are under the care of a neurologist, but many common issues can and often are managed by their family physician.
Oklahoma patients and physicians have in the Oklahoma Medical Research Foundation a tremendous resource for helping to treat patients with MS. Dr. Gabriel Pardo leads the Oklahoma City-based MS Center of Excellence, which focuses on providing optimal medical care while advancing the understanding of MS through participation in multiple research protocols.
The National Multiple Sclerosis Society (NMSS) supports MS research worldwide, including that performed at OMRF. The Society also provides direct help to people living with MS through the MS Navigator program. MS navigators are highly skilled and compassionate professionals who connect MS patients and families to the information, resources and support they need to move their lives forward. The program’s benefits include providing information and education about MS, connecting those living with MS to emotional and support resources including support groups, helping MS patients understand the healthcare system, and offering wellness strategies and crisis intervention.
Thanks to decades of research into MS a critical platform of knowledge has become a springboard for progress. For example:
Researchers are learning how the body’s gut microbiome may influence MS severity. The microbiome is the normal combination of bacteria, yeasts, viruses and protozoa that reside in our gut and that help us to digest food.
Early human trials are investigating how to repair myelin.
Lifestyle factors that people can change—such as smoking, childhood obesity and vitamin D levels—have been identified that may reduce the risk of the next generation developing MS.
For more information about MS history, research, therapies, education and more, go to www.nationalmssociety.org.
*You rarely see MS patients during a relapse because they stay at home. In the past there was a stigma attached to MS, since it would be easy to think that MS patients instead were intoxicated by alcohol or other drugs.
