How Much Do You Know About Multiple Sclerosis?

Overview of Multiple Sclerosis

• Multiple Sclerosis (MS) is a demyelinating disease, which damages the insulating covers of nerve cells in the brain and spinal cord, disrupting the ability to transmit signals.

• Symptoms of MS can range from physical to mental and psychiatric problems, such as double vision, muscle weakness, and trouble with sensation or coordination.

• MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms).

• The underlying cause of MS is thought to be either destruction by the immune system or failure of the myelin-producing cells, with proposed causes including genetics and environmental factors.

• There is no cure for MS, but treatments attempt to improve function after an attack and prevent new attacks, with physical therapy and occupational therapy helping with people's ability to function.

• MS is the most common immune-mediated disorder affecting the central nervous system, with nearly one million people having MS in the United States in 2022, and about 2.8 million people affected globally in 2020.

• MS is more common in women than men, and usually begins between the ages of 20 and 50.

• A person with MS can have almost any neurological symptom or sign, with autonomic, visual, motor, and sensory problems being the most common.

• The cause of MS is unknown, but it is believed to occur as a result of some combination of genetic and environmental factors, such as infectious agents.

• Smoking may be an independent risk factor for MS, and stress may also be a risk factor.

• The three main characteristics of MS are the formation of lesions in the central nervous system, inflammation, and the destruction of myelin sheaths of neurons.

• The attack on myelin starts inflammatory processes, which trigger other immune cells and the release of soluble factors like cytokines and antibodies.Overview of Multiple Sclerosis

• Multiple sclerosis (MS) is a chronic inflammatory disease that affects the central nervous system (CNS) causing demyelination, axonal damage, and neurodegeneration.

• The blood-brain barrier (BBB) is a part of the capillary system that prevents the entry of T cells into the central nervous system.

• Gadolinium-enhanced MRI is used to show BBB breakdowns, and central vein signs (CVSs) have been proposed as a good indicator of MS.

• MS is typically diagnosed based on the presenting signs and symptoms, in combination with supporting medical imaging and laboratory testing.

• The McDonald criteria are the most commonly used method of diagnosis.

• Several diseases present similarly to MS, and red flags are findings that suggest an alternate diagnosis.

• Several phenotypes (commonly termed "types"), or patterns of progression, have been described.

• The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability.

• Medications used in the management of MS have several adverse effects.

• During symptomatic attacks, administration of high doses of intravenous corticosteroids is the usual therapy.

• Multiple disease-modifying medications were approved by regulatory agencies for relapsing-remitting MS.

• In 2011, mitoxantrone was the first medication approved for secondary progressive MS.

• Several new medications have been approved for the treatment of MS, including ocrelizumab, siponimod, cladribine, ozanimod, and ponesimod.

• Both medications and neurorehabilitation have been shown to improve some symptoms, though neither changes the course of the disease.Overview of Multiple Sclerosis: Non-pharmaceutical interventions, alternative treatments, prognosis, epidemiology, history, research and medications

Non-pharmaceutical:

• Aquatic therapy is a beneficial intervention for MS.
• PT interventions including vibration interventions, electrical stimulation, exercise therapy, standing therapy, and radial shock wave therapy (RSWT) can be beneficial for limiting spasticity.

Alternative treatments:

• Over 50% of people with MS may use complementary and alternative medicine.
• Evidence suggests vitamin D supplementation provides no benefit for people with MS.
• There is insufficient evidence supporting high-dose biotin and some evidence for increased disease activity and higher risk of relapse with its use.

Prognosis:

• Disease-modifying therapies (DMTs) can reduce relapses and slow progression, but as of 2022 there is no cure.
• The prognosis of MS depends on the subtype of the disease and there is considerable individual variation in the progression of the disease.
• In relapsing MS, after a median of 16.8 years from onset, one in ten needed a walking aid, and almost two in ten transitioned to secondary progressive MS.
• In untreated primary progressive MS, the median time from onset to requiring a walking aid is estimated as seven years.

Epidemiology:

• The total number of people with MS was 2.8 million globally, with a prevalence of 36 per 100,000 people.
• Prevalence varies widely in different regions around the world.
• MS usually appears in adults in their late twenties or early thirties but can rarely start in childhood and after 50 years of age.

History:

• The French neurologist Jean-Martin Charcot was the first person to recognize multiple sclerosis as a distinct disease in 1868.
• Diagnosis was based on Charcot triad and clinical observation until Schumacher made the first attempt to standardize criteria in 1965.
• Refinements of the concepts have taken place since the beginning of the 21st century.

Research:

• The pathogenesis of MS as it relates to EBV is actively investigated, as are disease-modifying therapies.

• Anti-AQP4 autoantibodies were found in neuromyelitis optica (NMO), which was previously considered an MS variant.

• Medications that influence voltage-gated sodium ion channels are under investigation as a potential neuroprotective strategy.Multiple Sclerosis: Current Understanding and Emerging Theories

• Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system, characterized by inflammation, demyelination, and axonal injury.

• MS is a heterogenous disease, with four different patterns of demyelination reported, and atypical presentations such as neuromyelitis optica spectrum disorder (NMOSD).

• Auto-antibodies play a significant role in MS, and their detection can aid in diagnosis and treatment.

• Proteins showing loss of nerve tissue such as neurofilaments, tau, and N-acetylaspartate are under investigation as biomarkers for disease progression.

• Neuroimaging techniques such as PET and MRI carry promise for better diagnosis and prognosis predictions, but still lack standardization of acquisition protocols and the creation of normative values.

• COVID-19 infection in individuals with MS is associated with a higher hospitalization rate (10%) compared to the pooled infection rate (4%), with a pooled prevalence of death in hospitalized individuals with MS estimated at 4%.

• The hygiene hypothesis proposes that early-life exposure to infectious agents reduces susceptibility to allergies and autoimmune disorders such as MS, while certain gut bacteria and lower levels of vitamin D have also been correlated with MS.

• MS mechanisms begin when peripheral autoreactive effector CD4+ T cells get activated and move into the CNS, attracting more T cells and macrophages to form the inflammatory lesion.

• In MS patients, macrophages and microglia assemble at locations where demyelination and neurodegeneration are actively occurring, and astrocytes generate neurotoxic chemicals and are responsible for astrogliosis.

• Treatments for MS include disease-modifying therapies, symptom management, and rehabilitation.

• Research is ongoing to understand the underlying mechanisms of MS and develop new treatments.

• MS can have significant physical, cognitive, and emotional impacts on individuals, highlighting the importance of comprehensive care and support.