We all have a god gifted defense mechanism in our body, our immune system. When it feels something wrong entered in our body it directly attacks them, but sometimes it also makes some wrong judgment and attacks our own healthy cells and organs. This results in autoimmune diseases. 

This blog is all about one of those rare autoimmune diseases, Multiple Sclerosis.

Where our very own immune system attacks our brain and spinal cord…

What is Multiple Sclerosis??

Multiple Sclerosis is a neuro-immunological condition where our immune system attacks the protecting cover of our nerve cells, myelin sheath and causes scars or sclerosis in multiple places. The degeneration of myelin sheath makes it a progressive disease by causing permanent nerve damage and disruption of neural signaling and communication. The severity of the disease depends upon the amount of damage in the nerve cells of the central nervous system. Sometimes in-between the attack, symptoms may disappear completely though the permanent damages stay as it is.

Types of Multiple Sclerosis:

In the year 2013, the International Advisory Committee on Clinical Trials in Multiple Sclerosis have defined four types of Multiple Sclerosis disease,

Clinically Isolated Syndrome (CIS): This is considered as the first type/episode of Multiple Sclerosis. CIS is usually caused by inflammation and demyelination of nerve cells in the central nervous system. As per the diagnostic rules, these symptoms must last for at least 24hrs to be considered as Clinically Isolated Syndrome. Sometimes people with CIS do not show any progress for Multiple Sclerosis. Although if the MRI shows MS-like lesions with CIS then the individual could be at a high risk of developing Multiple Sclerosis. Early diagnosis and treatment of Clinically Isolated Syndrome have been shown to delay the onset of Multiple Sclerosis.

Relapsing-Remitting MS (RRMS): This is the most common type or form of Multiple Sclerosis. Around 80-85 percent of people with MS are diagnosed with RRMS. This type of MS is characterized by some clearly defined attack with a progressive/relapsing stage followed by a partial or complete recovery with a remitting stage. The most critical part of RRMS is the relapsing stage as the symptoms get worse at that time, but during remission, the symptoms may disappear completely or partially. Although a few symptoms can stay and become permanent. Early diagnosis and effective treatment can stop RRMS from developing Secondary Progressive Multiple Sclerosis.

Secondary Progressive MS (SPMS): This is the second stage of the disease that develops from RRMS. The symptoms of SPMS gradually change from an inflammatory phase to a more progressive phase by causing nerve damage or loss. Studies have found that 50 percent of the individuals with RRMS would further develop SPMS within 10 years. Occasional relapses may occur which gradually increases the disabilities, so it's important to treat SPMS as early as possible.

Primary Progressive MS (PPMS): This is the rarest type of Multiple Sclerosis. Focusing on surveys only 10-15 percent of people with MS develop PPMS. It is a progressive form of Multiple Sclerosis which leads to the loss of neurological functions. Individuals with PPMS also tend to have more lesions in the spinal cord than in the brain. PPMS gets worse over time and it is very difficult to predict that how much damage it will cause. Unlike other types of MS, PPMS does not have any relapsing or remitting stage. Treating PPMS on its early onset can reduce nerve damages and can increase one’s lifespan.

Symptoms & Diagnosis:

Multiple Sclerosis affects the nerves of the CNS, so the disabilities can occur at any part of the body. The symptoms may differ from a person to person. Numbness and muscle weakness in one side of the body can be an early sign of Multiple Sclerosis. Although fatigue is considered as one of the main symptoms of MS, according to the National Multiple Sclerosis Society (NMSS) 80 percent of people with MS experiences fatigue. The secondary stage of MS has a more diverse range of symptoms such as vision problems, speech problems, dizziness, and cognitive issues. If left untreated MS shows an adverse range of symptoms starting with Lhermitte’s sign, where a person experiences a short electrical shock-like sensation passing down the spinal cord and radiating through the limbs. 

These above-mentioned symptoms are most common in the case of MS. There are no such specific tests that can confirm the diagnosis of MS. A complete neurological exam with full medical history can be helpful to confirm it. Some tests such as blood tests, Gadolinium MRI, CSF analysis, evoked potential tests can confirm the symptoms or presence of lesions on the brain and spinal cord. If the finding meets the criteria for the diagnosis of MS then a doctor can confirm it and proceed with the treatment planning.

Treatment Options:

Till now there is no cure for Multiple Sclerosis, but treating it symptomatically can decrease its severity. There are many treatment options available that can slow down the progression of this disease.

Disease-Modifying Therapies (DMTs) is one of the effective ways to treat MS, it can slow down the relapses and the damages caused by MS. They have also been shown effective to reduce lesions on the brain and spinal cord. Apart from DMTs, symptomatic medication and treatment can also reduce the further progress of this disease. Cognitive Behavioral Therapy (CBT), Rehabilitation and physical therapy, alternative, and complementary therapies are also very much effective to reduce the severity of MS.

Scientists are working for making some more effective treatments to cure MS. Nowadays an FDA-approved drug named Ocrevus has become a very famous medication for relapsing forms of multiple sclerosis in adults. Also, researchers have found that stem cell therapy and plasma therapy could become a good treatment options to cure MS in near future.

Conclusion:

We need to remember that Multiple Sclerosis is not fatal, there are many treatment options available to reduce the severity of this disease. Good knowledge about MS is very important to catch the disease in its earlier stage. Most people diagnosed with MS learn to manage their symptoms and they lead full and active lives. In recent years scientists have made excellent progress in developing many drugs and medications for MS. Hope that in near future researchers will find some more effective treatment options to cure MS completely.

Reference and Resources:

1)Multiple Sclerosis (MS): Early Signs and Common Symptoms, Medically Reviewed by Carol DerSarkissian, MD

2) National Multiple Sclerosis Society 

3) Multiple Sclerosis Review, NHS UK

4) Medical Encyclopedia, Multiple Sclerosis, NIH U.S. National Library of Medicine

5) Multiple Sclerosis: Pathogenesis, Symptoms, Diagnosis and Cell-Based Therapy

Nazem Ghasemi, Ph.D,1 Shahnaz Razavi, Ph.D,1 and Elham Nikzad, B.Sc2

6) Multiple sclerosis: New insights and trends

This blog of mine has also been published in Vision Science Academy's monthly journal, and it secured the 6th position worldwide in their November 2021 Blog Competition.

Here is the link to the blog published on Vision Science Academy:

Multiple Sclerosis, The Details You Need to Know | Scientific Blog by Arijit Bhattacharya | Vision Science Academy