Summary:
Multiple sclerosis is a chronic neurological condition that affects the central nervous system, which includes the entirety of the brain, spinal cord and nerves. The primary insult starts in the central nervous system wherein the body’s immune system mistakenly attacks its own nerve fibers, leading to disruption of communication between the brain and the rest of the body. Hence, symptoms vary widely and affect multiple organ systems. While there is no cure for MS, various treatments are available that manage symptoms, slow disease and help in improving the quality of life of individuals. Early diagnosis and medical intervention play a crucial role in improving the overall well-being of those affected. [1]
Keywords: multiple sclerosis, neurological disorders, autoimmune disease, chronic diesease, immunomodulatory agents
Introduction:
If you say that someone is eccentric, you mean that they behave strangely, and have habits and opinions that are different from those of most people. Analogous to this eccentricity is the diagnosis of multiple sclerosis (MS). MS is a neurological disorder that is distinctive in its patterns and manifests with a range of unpredictable symptoms. Due to the multifaceted nature of its presentation, MS poses a challenge to the medical community and understanding its unpredictability is important in the diagnosis and treatment of patients presenting with this condition. Every individual has a unique MS journey. It is important to keep in mind that this scary, terrifying diagnosis is not a death sentence, but can be debilitating if not taken care of.
What is multiple sclerosis?
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease characterized by central nervous system (CNS) lesions that can lead to severe physical or cognitive disability as well as neurological defects. [1]
According to the latest prevalence studies, there are now an estimated 2.9 million people who are living with MS around the world, and it continues to increase in many countries. [3]
Why does MS occur?
● MS is characterized by an autoimmune response, where the immune system mistakenly targets and damages the myelin sheath of nerve fibres that form our brain and spinal cord. This attack causes inflammation of the affected tissues and causes demyelination which disrupts the transmission of electrical impulses along the nerves.
● The cause of MS is multifactorial and is not fully understood. Various genetic as well as environmental factors are linked to immune system malfunction that causes MS. [1]
A. Environmental risk factors:
1. Exposure to EBV, HHV6, Mycoplasma pneumoniae
2. Smoking
3. UV radiation
4. Vitamin B12 and Vitamin D deficiency
B. Genetic risk factors: the presence of the HLA-DR2 gene is strongly associated.
Symptoms of MS:
Since this disease can affect any part of the CNS, symptoms are usually unpredictable. It mostly follows a relapsing-remitting pattern. This pattern can be compared to a rollercoaster form of symptoms, with ups and downs in the person’s health over time. Individuals experience periods of new or worsening symptoms (relapsing), followed by periods of partial or complete recovery (remissions).
The most commonly reported symptoms are:
● Sensory disturbances (numbness, tingling, itching, burning)
● Walking difficulties (due to fatigue, weakness, spasticity, loss of balance and tremors)
● Vision problems (diplopia, blurred, and pain in eye movement)
● Intestinal and urinary system dysfunction (constipation and bladder dysfunction)
● Cognitive and emotional impairment (inability to learn and depression)
● Dizziness and vertigo.
Hence a thorough history and physical examination is necessary, and every system must be reviewed.[5]
Diagnosis of MS
Early detection is important in MS. Various diagnostic modalities such as those given below can be used:
MRI: hyperintense white matter lesions are seen in the periventricular area which is characteristic of MS.
CSF analysis: shows oligoclonal bands
Abnormal visual evoked potential
Blood sample analysis: Immunoglobulin G in serum. [4-5]
Treatment of MS
Currently, there is no definitive cure for MS.
Treatment aims to stop the progression of the disease and to provide symptomatic relief.
Immunomodulating agents such as Interferon-beta and glatiramer acetate are used. They inhibit immune cell activation, thereby lessening some of the MS symptoms.
However, the current treatment regimens do not halt the ongoing progression of neurodegeneration, and hence adipose-derived stem cell based therapy (ADSC) has been proposed as a potential treatment regimen. However, further studies have to be done to prove the efficacy of such treatment. [2]
Prognosis of MS
The prognosis of the disease is poor. In approximately half of the affected individuals, they will no longer be independently ambulatory after 20 years, with overall life expectancy being reduced by 7-14 years. Patients may have to adapt in their daily lives, but with the right care and support people can lead long, active and healthy lives. [6]
REFERENCES:
Tafti D, Ehsan M, Xixis KL. Multiple Sclerosis. 2022 Sep 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29763024.
Ghasemi N, Razavi S, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell J. 2017 Apr-Jun;19(1):1-10. doi: 10.22074/cellj.2016.4867. Epub 2016 Dec 21. PMID: 28367411; PMCID: PMC5241505.
https://www.nhs.uk/conditions/multiple-sclerosis/living-with
Writer- Sruti Regalla
Editor- Anusree Ashit