What Is Multiple Sclerosis and Who Gets It?

Recently while visiting a friend of mine, I noticed an article he had cut out of a widely recognized newspaper and asked what he had read. My friend has a daughter who was diagnosed with MS several years ago, and when he stumbled upon the article about a new drug therapy for MS patients he wanted her to know about it. As someone who also has a chronic neurological malady ( I have adult-onset epilepsy) that is still not all that well understood by the medical community (and most definitely not by the general public), I am most interested in neurological diseases that have been around since Julius Caesar, but for which modern medicine still has few answers and no cures. Along with epilepsy, MS is another disease that can strike without prior notice or warning, has individual characteristics that can and often do affect a patient physically and emotionally, and depending upon the attack, it can also affect a person’s mental acuity.

The good news for MS patients is that in the last decade and a half, researchers have discovered more medicinal therapies for MS than for any other neurological diseases. One that has very recently been approved is a drug therapy called AUBAGIO. Unlike other drugs that are delivered by injection on a daily or weekly basis, Aubagio is taken in a pill form once a day. And unlike other MS drug therapies, Aubagio has shown fewer side effects with “equal or better effectiveness.” Considering that twenty years ago there were no drugs for MS patients – to say that modern medical researchers have developed something of a “minor” miracle for all who suffer such a debilitating disease would be a gross understatement.

WHAT MS IS, AND ITS EFFECTS

Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.

MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop. The nerve damage is caused by inflammation. Inflammation occurs when the body’s own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord. It is unknown what exactly causes this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may play a role.

BAD LUCK OR BAD GENES?

Several years ago during a routine check-up with my doctor, we were discussing the brain and how certain neurological diseases affect certain areas of the brain. During that conversation my doctor mentioned MS and said that here in the Red River Valley there is a very high portion of the population with different variations of MS. When I asked why, my doctor said at that point they really didn’t know, but that MS seemingly hits Scandinavian populations more than others. Obviously, that might explain why collectively, there is a large segment of the Red River Valley population which has MS. According to the information I found on MS, it is generally accepted that you are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.

Approximately 400,000 individuals have been diagnosed with MS in the United States and as many as two and a half million worldwide, with an estimated 10,000 new cases diagnosed in the United States annually. Most people with MS experience their first symptoms and are diagnosed between the ages of 15 and 50.

The distribution of this disease is not totally random. On average, women are three times as likely as men to develop MS. Additionally, the occurrence of this disorder is positively correlated with latitude. People living beyond the 40-degree mark north or south of the equator are far more likely to develop MS than those living in the warmer climates near the equator. This is especially true for people in North America, Europe, and southern Australia, while Asia continues to have a low incidence of MS. More prevalent among those of northern European or Scandinavian ancestry, Caucasians are far more likely than those of African heritage to develop this disease.

While MS is not contagious or hereditary, MS susceptibility is increased if a family member has MS. The average risk of developing MS in the United States is one in 1,000, or one-tenth of one percent. For first-degree relatives (such as a child or sibling), the risk increases to three or four percent. This is not true for adopted children, or half siblings who do not share the parent who has MS, whose risk is the same as unrelated individuals. In instances where one identical twin has been diagnosed with MS, the other twin has a 31 percent risk of developing the disease. The risk for twins who are not identical is five percent – similar to that of other siblings.

One other factor linked to MS is cigarette smoking. Women who smoke are 1.6 times more likely to develop MS than women who are non-smokers. Additionally, individuals with MS who smoke appear to be at a much greater risk of experiencing a quicker progression of their disease.

DIAGNOSIS — HOW TO CONFIRM THAT YOU HAVE MS

In the beginning, symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions. People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms. Your health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times. A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. Symptoms may include: abnormal nerve reflexes, a decreased ability to move a part of the body, or a decreased abnormal sensation. Some people may show a loss of nervous system functions in other areas. Eye exams are important and may present abnormal pupil responses, changes in the visual fields or eye movements, decreased visual acuity, problems with the inside parts of the eye, or rapid eye movements triggered when the eye moves.

SPECIFIC TESTING CAN CONFIRM MS

Specific, albeit not pleasant tests to diagnose multiple sclerosis include:

Lumbar puncture (spinal tap) for cerebrospinal fluid tests, including CSF oligoclonal banding; an MRI scan of the brain and MRI scan of the spine are important to help diagnose and follow MS, and a nerve function study can usually conclude whether a person does in fact have Multiple Sclerosis. Once the diagnosis is confirmed, the next expectation is the prognosis and treatment plan.

The outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.

TREATMENT

Unfortunately, there is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.

Medications used to slow the progression of multiple sclerosis are taken on a long-term basis. Some may include: Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri), Fingolimod (Gilenya ), Methotrexate, and azathioprine (Imuran). Intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the above drugs are not working well. Steroids may be used to decrease the severity of attacks.

Medications to control symptoms may include: medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine. Other medicines are for reducing urinary problems, antidepressants for mood or behavior symptoms, and Amantadine to combat continual fatigue.

The good news is that there are medical therapies and new medicines now available for people diagnosed with MS today, when only twenty-five years ago there were not. Like many other neurological diseases, the medical community is finally focusing on how to treat the disease so that each patient is given a fighting chance of continuing as normal a life as possible.

For more information regarding MS, and the new treatment drug AUBAGIO, the following are websites for each: http://msassociation.org/ and for Aubagio: https://www.aubagio.com/

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