Multiple Sclerosis

*The information on this website is not intended to diagnose, treat, cure or prevent any disease.

What is multiple sclerosis (MS)?

Multiple sclerosis is an immune-mediated disease which attacks the nervous system in the brain and spinal cord. In this disease, the immune system recognizes the outer sheath around nerves (called myelin) as foreign material and destroys it. This myelin sheath is important for maintaining the health of the nervous system and plays a critical role in transmission of through the neurons. Of the immune-mediated conditions which affect the nervous system, multiple sclerosis is the most common. Across the world, over 2 million people are believed to be affected. Over time, this disease can result in severe disability including the loss of ability to walk, speak, or see.

The severity and symptoms of multiple sclerosis vary widely between individuals, and the disease can sometimes have a “relapsing and remitting” course, which means that there are periods in which the disease is not progressing and an individual may be symptom-free for periods of time.
Interestingly, this disease has several factors which influence individual risk. It is geographically-influenced condition; people who live further away from the equator (both north and south) have a higher risk of developing this disease. There are exceptions to this, however, with many groups of indigenous people having a low risk despite living far from the equator, and other groups having a higher risk closer to the equator. It is, however, most common in people of northern European descent. There also appears to be a relationship between the time of a year a person is born and life-time risk, with those being born in the winter months in northern hemispheres having higher risks than those born in summer months. It is also more common in women than in men.

Prognosis for multiple sclerosis varies widely, however some factors can be predictive of a better prognosis. Women, those who experience “relapsing and remitting,” and experience more vision-related symptoms at the beginning of the disease course tend to have better outcomes. Overall, once the disease begins, the average life expectancy is 30 years. As this disease often begins in adulthood, this results in a decrease in life-expectancy by about 10 years compared to the average population. Suicide and complications related to disability are major factors in death and life-expectancy.

Common Symptoms

The symptoms of multiple sclerosis can vary widely and range in severity, as different nerve fibers may be affected. Commonly reported symptoms may include:

Numbness that is localized to one side of the body
Facial numbness
Vision loss (complete or partial), often affecting only one eye
Ocular pain
Colors appearing faded or dull
Incoordination, difficulty walking
Tremors
Dizziness
Electric shock-like sensations, particularly when bending the neck forward
Slurring of speech
Constipation
Bladder control issues or frequent urination
Fatigue or tiring easily
Tingling and pain in the arms/hands
Emotional disturbances and depression
Muscle spasms
Sexual problems
- Difficult achieving climax
- Decreased libido
- Vaginal dryness
Hearing loss
Difficulty eating or swallowing
Difficulty breathing

Diagnosis

Multiple sclerosis is a diagnosis of exclusion, meaning that there is no single test for MS and other causes of neurologic signs need to be ruled out first. In order to make a diagnosis, physicians may rely on physical examinations, a good history, and a series of diagnostic tests which may include advanced imaging such as an MRI, and laboratory tests such as a cerebrospinal fluid (CSF) analysis (also known as a spinal tap), and bloodwork to rule out other possible causes of symptoms including Lyme disease, HIV, Guillain-Barre, hereditary diseases, and other conditions.

The 2017 McDonald Criteria for the Diagnosis of Multiple Sclerosis are considered the gold standard in diagnosing this condition.
An MRI is a usually the diagnostic test of choice for evaluation the nervous system due to its non-invasive nature and ability to detect abnormalities. Myelin damage can be observed with an MRI, and the progression of the disease can be tracked. It also allows exclusion of other diseases which may appear similar to MS. Lab work like CSF analysis and bloodwork can help identify potential infectious causes of neurologic damage, and can again be helped to rule out other disease processes.

Another test which may be performed is called “evoked potentials”, which measures electrical activity of the nervous system following stimulation of different neuronal pathways. Evoked potentials are no longer included as part of the McDonald Criteria; however, they can provide useful information. The test is essentially measuring how rapidly an impulse is conducted along the sensory nerve fibers up to the brain. With healthy, normal myelin, this conduction occurs rapidly. As myelin begins to degenerate, the conduction will slow down. This test can measure conduction dysfunction well before it becomes apparent on an examination. In order for a diagnosis of MS to be made, the physician must document two areas of the nervous system which are affected, and then rule out other diseases which can cause damage to myelin

Treatment Options

Unfortunately, there is no definitive cure for MS at this time, however different approaches to treatment can help prolong lives as well improve the quality of life MS sufferers have. For people with mild symptoms or who are in a remission-phase, no treatment may be necessary.

Pharmaceuticals:

Corticosteroids: These are sometimes prescribed during MS attacks in which there is severe inflammation of the nerves. Although they are powerful anti-inflammatories, they have a broad range of side effects including effects on mood, weight gain, high blood pressure, and insomnia.
Ocrelizumab (Ocrevus): This is a medication based on human antibodies which is considered a “disease modifying therapy”. It has use in both relapsing-remitting and progressive types of MS. Although it is effective in slowing progression of the disease, it may be associated with higher risks of cancer due to its immunosuppressive effects.
Beta interferons: This is a group of medications which can help alleviate some of the symptoms associated with attacks. They also work by inhibiting the immune system, which may result in increased susceptibility to infections. Over time, the body may actually work against these drugs by developing anti-bodies, and they may become less effective.
Fingoliod: This is an immune-modulating drug which can reduce the frequency of relapses. It impacts the immune system by preventing the transit of lymphocytes (a type of white blood cell) out of lymph nodes, impeding auto-immune reactions.
Glatiramer: An immunomodulating medication, glatiramer can reduce relapses, but it does not slow progression of MS. This drug is composed of amino acids which resemble myelin, and is thought to work by acting as a “decoy” and drawing immunologic reactions towards it rather than myelin.
Teriflunomide: Another drug which impacts the immune system. Teriflunomide inhibits replication of rapidly dividing cells (like white blood cells).
Alemtuzumab: This is a chemotherapeutic antibody which targets lymphocytes, when are then removed from circulation by the body. This medication likely targets lymphocytes involved in the destruction of myelin.
Natalizumab: This medication works by targeting the transportation molecules of the immune system, making it harder for them to reach their destinations. It is associated with a rare condition called progressive multifocal leukoencephalopathy, which temporarily led to its withdrawal from the market, though it has since been re-approved.
Dimethyl fumarate: This is another immunomodulatory drug. It is primarily used for psoriasis, however has found some use in MS as well. It’s mechanism of action are not well-understood.
Mitoxantrone: This is a chemotherapeutic agent which is effective against white blood cells. It can potentially be toxic to the heart, and doctors may recommend cardiac evaluation before, during, and after treatment with mitoxantrone.
Antibiotics: Antibiotic therapy may be beneficial in some MS patients, particularly those in whom Lyme disease is suspected. Tetracycline antibiotics such as doxycycline and minocycline are the standard treatments for Lyme disease, and some MS sufferers may see improvements in their clinical signs following treatment. These treatments may be IV or oral, and may take months to achieve effects.

Non-Pharmaceutical Treatments

There are a large number of non-pharmaceutic options for MS, which may be used in conjunction with the pharmaceutic approaches listed above.

Physical therapy: This can play a strong role in maintaining muscle strength and slowing loss of function associated with MS.
Cannabis: Medical marijuana may be effective in relieving pain associated with MS.
Acupuncture
Massage
Supplements
- Vitamin D: Low levels of Vitamin D may be associated with increased risk of MS.
- Evening Primrose Oil
- Omega-3 fatty acids
- Alpha lipoic acid
- Co-enzyme Q10
- Curcumin
- Pycnogenol
- Glutathione
- Sulforaphane
- Probiotics
- Ginkgo biloba
Procedures
- Chronic cerebrospinal venous insufficiency (CCSVI) procedure: This is a procedure aimed to improve venous drainage from the brain. This is a controversial procedure which has not been supported by controlled clinical trials, however there are anecdotal reports of improvements in MS signs.
- Plasmapheresis: This is a medical procedure in plasma is “exchanged.” This allows the removal of harmful substances from the blood, such as antibodies directed against myelin.
Bee venom therapy
Hyperbaric oxygen therapy
Chelation therapy: This involves administering compounds which bind to heavy metals and remove them from the body. This particular approach may be useful for MS sufferers who may be at risk of heavy metal or mercury toxicity, such as from amalgam fillings. Chelation typically involves either injections of ethylene diamine tetra-acetic acid (EDTA) or oral agents such as dimercaptosuccinic acid (Succimer).
Stem Cell Therapy: Regenerative medicine approaches are an exciting new avenue for many people. Transplantation of stem cells into the central nervous system may facilitate repair of myelin and damaged neurons. This therapy is in its infancy, but clinical trials are being developed. Stem cell therapy may be available in some other countries such as Mexico or Russia.

Prevention

There is no surefire way to prevent MS, however there are certain risk factors which have been identified, such as living far from the equator and being born at certain times of the year. These risk factors have raised concerns about a possible link between vitamin D and the development of MS. Supplementing vitamin D may reduce the risk of developing the condition. For those who suffer from MS, vitamin D may play role in reducing the risk of relapse. Smoking is very strongly associated with an increased risk of developing MS in life, and offers up a potential behavior that can be modified.

Being overweight is also associated with an increased risk of MS. Maintaining a healthy body weight via a healthy diet and exercise may reduce the risk of MS by up to 50%. Incorporating more omega-3 and omega-6 fatty acids may also play a role in reducing the risk of MS, as studies have shown lower rates of MS in countries which consume large amounts of fish.

Dietary habits beyond weight control may also play a role. Caffeine consumption is associated with a lower risk, as is resveratrol, the compound found in red wine often speculated to play a part in preserving cardiovascular health and prolonging life.

For those who have been diagnosed with MS, preventing relapses becomes paramount. Vitamin D and omega-3 supplementation may be helpful in reducing the frequency and severity of relapses. Avoiding certain triggers such as tobacco, alcohol, caffeine, and stress are important factors for decreasing the risk of relapse. Additionally, there are studies which suggest that use of tobacco products can accelerate the progression of MS. Practicing fasting also appears helpful in reducing the severity and progression of MS and may be helpful in reducing flare-ups.

Other infectious agents possibly associated with the development of MS include Chlamydia pneumoniae, herpes viruses, and the measles virus. The exact method by which these diseases result in MS is unclear, however they may result in an over-active response of the immune system, resulting in inappropriate attacking of myelin within the central nervous system.

Causes

There are a number of potential causes for MS, but overall the disease process is not well-understood. Most evidence points to the condition being auto-immune in nature, which is supported by the fact that the most effective medications for managing the disease tend to be immunosuppressive or immune-modulating in nature. There is not complete agreement on this point, however; an Italian scientist by the name of Dr. Paolo Zamboni has hypothesized that the condition is due to inadequate drainage of blood from the brain, resulting in iron accumulation. Dr. Zamboni has recommended procedures designed to improve drainage of blood from the brain, with some people reporting marked improvement in their conditions following the procedure. These findings have not been backed by controlled clinical trials, however, and the procedure remains controversial.

Vitamin D deficiency is a popular theory as a cause of MS, especially due to the apparent increased risk of people who live far from the equator and have less sun exposure. Vitamin D is an important factor in the body, and is critical for normal immune system function and development.
Other researchers have pointed to amalgam (silver) fillings as being linked to the development of MS. These older fillings contained mercury, which can leach into the blood stream. A study on patients with MS who had metal fillings found higher levels of mercury in their hair compared to a control group which did not have MS. It is possible, then, that MS is actually a heavy metal toxicity.

Infectious diseases have also been postulated to be responsible for the development of MS. Epstein-Barr virus is a common viral infection which has been implicated in a large number of disorders, including chronic fatigue syndrome and mononucleosis. It is present in over 90% of the population, most of whom exhibit no obvious symptoms, however a minority of people may experience overt disease. Epstein-Barr may ultimately result in MS by activating a different virus which is embedded in the DNA called HERV-W/MSRV, which is associated with MS.

Other viruses that have been suspected of causing MS include the measles virus and human herpes virus-6 (HHV-6). Research has shown that relapses of MS have correlated with increased circulating antibodies of HHV-6 in the body, and that these titers can be predictive of impending relapse. The same has not been found to be true of Epstein-Barr virus antibody titers. There are also animal models which have shown MS-like signs following infection with HHV-6.

Bacterial infections, specifically Lyme disease, have also been thought to contribute to MS, that Lyme disease is often misdiagnosed as MS, or that they may even be the same disease. Around the world, the distribution of Lyme disease and MS closely mirror each other, as does the age of those are affected. Lyme disease can be exceedingly difficult to diagnose, as some patients may never show an immune response to the bacteria.

Chlamydia pneumoniae has also been associated with MS. An unusually high number of patients with MS have had positive cultures of Chlamydia pneumoniae in cerebrospinal fluid samples, however this link has been controversial, with other studies unable to replicate these results. It may be that there is a subset of MS patients who have chronic Chlamydia pneumoniae infections resulting in MS signs, while other sufferers of MS have other causes.

Genetics almost certainly play a role in MS as well, although it is not considered an inherited disease. Studies in identical twins have shown that if one twin develops MS, the risk of the other twin developing MS is approximately 25%, which significantly higher than the general population. It must also be considered within the context that twins very likely spent the majority of their lives in very similar environments, and were likely exposed to similar risk factors.