Multiple Sclerosis 101

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During the second and third season, The West Wing’s fictional president is diagnosed with a debilitating and difficult disease that ultimately leads to a scandal in Washington. His relapsing-remitting multiple sclerosis (MS) is portrayed with relative accuracy and was commended by The National MS Society—the president continues on to have a productive life, keeping most of his symptoms out of the public eye.

MS is an autoimmune disease where the body’s immune system attacks the myelin– a protective layer around the nerves fibers of the spine made of proteins and fats. The cause of MS is unknown. The resulting injuries to the myelin cause communication issues between the brain and the body. It manifests in symptoms like lack of bodily coordination, numbness or weakness in limbs on a single side of the body, and vision loss.

The majority of identified cases of MS are originally diagnosed as the relapsing-remitting type; progressive MS is far less common. Patients with relapsing-remitting MS demonstrate periods of remission and stability between relapses rather than consistent MS attacks. Around half of those diagnosed with relapsing-remitting MS develop progressive symptoms within 10 to 20 years of the onset of the disease. These symptoms progress with varied periods of remission, and the progression is identified as secondary-progressive MS.

There is not a test for diagnosing MS but rather a differential diagnosis (ruling out other conditions). The process will focus around finding evidence of damage in at least two separate areas of the central nervous system and that the damage occurred at different points in time. The tools used could include patient history, blood tests, spinal tap, MRIs, and evoked potential tests.  MRIs and cerebrospinal fluid analysis can be used to identify damage caused during a potential MS attack. Someone may be more likely to get MS if they have autoimmune conditions such as inflammatory bowel disease, thyroid disease, or type 1 diabetes. If you are from certain ethnic groups such as northern Europe, or you’re a smoker, or female. Women are two to three times as likely to be diagnosed with MS compared to men.

Current MS treatments–known as “disease-modifying therapies”(DMTs)–are immunomodulatory or immunosuppressive drugs that reduce the frequency of attacks of the relapsing-remitting form of the disease. These drugs can help prevent permanent damage to the central nervous system but do not cure the disease. They have varying levels of success but have no significant benefit for patients with progressive MS. There is an extensive list of potential side effects associated with taking the available DMTs. Some of these include myelotoxicity–a decrease in the production of immunity-providing leukocyte cells, skin necrosis–the death of cells in body tissue due to lack of blood supply, and several infections of varying severity. Preliminary research is being done to understand the effects of specific DMTs on the level of danger presented by coronavirus for patients with MS.

The unpredictability of MS can make getting the best from healthcare services difficult. Patients are encouraged to understand their local resources–including their touchpoint physicians, access to mobility aids, and community support groups. This can be important for maintaining a high quality of life. Additionally, there are a plethora of online resources—like the National MS Society—that outline the best ways to aid physical, spiritual, emotional, and cognitive health that contribute to high life quality. These include suggestions about mindful diet choices, modified exercise, stress management techniques, and finding solace in self-defined spirituality. The goal of these techniques, in conjunction with DMTs, is to modify the course of the disease, treat relapses, manage symptoms, and rehabilitate to improve function.