Multiple sclerosis: Two forms of the autoimmune disorder

5/10/2010

This is one of a series of columns about health issues written by staff members of ProMedica and Mercy Health Partners and the Toledo Clinic.

Multiple sclerosis is a potentially disabling disease of the brain and spinal cord that progresses over many years.

Symptoms usually start in young adults (ages 20-40) but, on occasion, can begin later in life. Women are affected about twice as often as men. The first symptom may be optic neuritis that results in a change or loss of vision, most often in one eye. Other typical symptoms include vertigo, pins-and-needles sensations in the arms and legs, a wobbly, unsteady gait, or weakness of the arms or legs.

MS can occur slightly more often (1 to 2 percent) when either the father or mother had the disease. It can be the result of a previous viral infection; is seen more often in Caucasians, and, for unknown reasons, with greater frequency in people who live further from the equator, such as North America, Europe, Australia and New Zealand.

Multiple sclerosis is an autoimmune disorder, which is a disease where the immune system actually attacks the body it was designed to protect. Think of the brain and spinal cord as a huge electrical system with billions of small batteries (nerve cells) and many billions of interconnecting wires (axons and dendrites) some covered with insulation (myelin).

MS attacks and destroys that insulation, causing the nerves to “short circuit” and disrupt the signals. As the disease progresses, more nerve cells are lost and the symptoms become worse. Complications can include stiffness in walking, loss of bladder control and infections, forgetfulness, and problems with concentration. Other complications include depression, headache and, rarely, seizures.

There are two distinct forms of MS. About 90 percent of patients have remitting and relapsing MS with attacks of disabling symptoms usually lasting four to six weeks unless quickly treated with steroid medications. The other 10 percent have primary progressive MS. These patients start with similar symptoms that progressively cause disability. This smaller group does not respond to current modulating therapy, and may indeed be a totally different disease state which science has yet to understand.

Making a diagnosis of MS can be difficult because other disorders may mimic the disease. As the name implies, the diagnosis requires identifying multiple lesions in the brain or spinal cord over time. This is usually accomplished through a thorough neurologic exam, MRI procedures, spinal fluid analysis and other electro-physiologic testing.

MS medications have vastly improved over the last 20 years. At one time steroid medication treatment was limited to controlling only acute symptoms. However, since the mid-1990s, a new group of disease-modifying medications such as interferon and glatiramer have been used that (interferon, glatiramer) slow down the progression of the disease and reduce disability.

Other nonmedical treatments include physical and occupational therapy, strategic use of bracing to assist walking, and social support. Lifestyle also plays an important role. MS patients often benefit from moderate exercise combined with sufficient rest. Smoking cessation is also beneficial.

For complicated reasons, MS symptoms are worsened by the heat including hot showers or spas; and patients, therefore, may benefit from avoiding these situations. While no clinical trials have ever proved that MS is improved by a specific diet, a healthy diet improves overall well-being and therefore is recommended. Each case of MS is unique. Only a physician with knowledge of this disease, working with the patient, can sort through the decision making steps to choose which treatment will be best.

Medical research is ongoing and always looking for new approaches and new thoughts. On the horizon are newer medications, including Cladribine and Fingolimod. These drugs are classed as chemotherapeutic agents that affect T-cells, a specific class of immune regulator cells; and, while these medications may reduce the frequency of relapses, there may also be a risk for serious side effects. Another new oral medication (Fampridine) has been shown to improve walking speed.

Those with specific questions and concerns about multiple sclerosis are encouraged to consult their physician for more information. Just as the last 25 to 30 years has greatly improved the outlook for MS, the next few decades will do the same. New ideas for causes are being investigated, new medications are being released, and the light at the end of the tunnel continues to get brighter.

Dr. James E. Sander is a member of the Neurology Department of the Toledo Clinic.