Multiple Sclerosis – Extra Credit

What is it? Multiple sclerosis also known as MS is an inflammatory disease in which primary
target is myelin sheath of nerve cells of brain and spinal cord. This is actually an autoimmune
disorder in which our own immune cells started to attack the protective covering of myelin
sheath of brain and spinal cord. An autoimmune disorder is defined as when our immune system
which mostly attack foreign bodies like bacteria, viruses starts to attack out own body cells. In
the multiple sclerosis our immune system attacks the myelin sheath of nerve fibers. This will
leads to the destruction of myelin sheath and remove it from the nerve fibers completely. This
results into wounds which are called as lesion, plaque or sclerosis. When myelin sheath is
damaged it will result into the disruption in the message transfer in the direction of nervous
system. Message can be transfer slow or in inaccurate way, or it can be transferred from one to
other strand or can be rejected altogether. This will lead to the interruption with the parts of
nervous system which are responsible or needed for communication which results into high level
of physical symptoms. With the advancement of disease permanent neurological problems start
to appear continuously in the next stages of disease.
Multiple sclerosis is a progressive autoimmune disorder in which protective coverings of nerve
cells are damaged which ultimately leads to reduction in the function of brain and spinal which
are pillars of every body function. Even though multiple sclerosis is discovered in 1808 but its
causes were uncertain. Approximately, almost 40,000 people in the United State and 2.5 million
people in whole world are suffering from multiple sclerosis.
Research shows that inflammation is the main cause of damage to nerve cells but cause of
inflammation is unknown. There are quite unpredictable and various symptoms of multiple
sclerosis. People suffering from multiple sclerosis usually have different types of symptoms and
these symptoms changes with the course of disease. Some individuals may have one or more
symptoms but other can have one of those symptoms and some different symptoms.
Types of multiple sclerosis: there are four major types of multiple sclerosis disease courses as
explained by International Advisory committee on multiple sclerosis clinical trials in 2013 which
are Clinical isolated syndrome, relapsing remitting, secondary progressive and progressive.
Clinical isolated syndrome: this is one of the major MS disease courses and this is first part of
neurological signs and symptoms which remains for at least 24 hours and is caused by central
nervous system because of inflammation or demyelination.
It further has two types which are

 Mono focal area: In this type individual will experience a one neurological sign or
symptoms for example, an optic neuritis attack which is due to a single lesion.
 Polygon area: In this type individual will have more than one neurological signs and
symptoms. For example an optic neuritis with numbness or legs burning due to lesions in
one or more locations in the brain.

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Relapsing remitting Multiple sclerosis: This is very common course which is mainly
characterized by the clear attacks of new and enhancing neurological signs and symptoms and
these symptoms may also show enhancement as well. This can also lead to permanent or partial
recovery. During the remission of the disease some signs may disappear and some may become
permanent and in recovery there is clear increase in the disease.
Relapsing remitting multiple sclerosis is an inflammatory condition in which myelin sheath
which is a membrane layer which is insulated around neural fibers in the central nervous system
as well as nerve fibers. During these inflammatory attacks our own active immune cells cause
injury in small local area which leads to symptoms of multiple sclerosis. As site of lesions
usually different in individual so there can be different symptoms in different individuals.
Most common symptoms in the Relapsing remitting multiple sclerosis includes fatigue,
numbness, vision problems, learning and memory problems, problems in information processing,
spasticity, stiffness, problems of bowl and bladder. Usually individual who is suffering from
multiple sclerosis show behavioral and mobility problems.
Secondary progressive Multiple sclerosis: this form of multiple sclerosis and it follows an
initial remitting course. All people mostly which are diagnosed with Relapsing remitting
multiple sclerosis leads to this secondary progressive Multiple sclerosis and it increases with the
progression of neurological function. This form can be active at several points or inactive as
well. Each person who suffered Secondary progressive Multiple sclerosis will experience new
type of symptoms. Multiple sclerosis experts think that medication actually affects the
progression of the disease.
Primary progressive multiple sclerosis:
Primary progressive multiple sclerosis is an intensification of the nerve function which is
accumulation of disability from the start of the disease without any early relapse or remissions.
This can be active at several points. Approximately 15 % of multiple sclerosis are diagnosed
with Primary progressive multiple sclerosis. Every individual will experience new type of sign
and symptoms in this Primary progressive multiple sclerosis as well. This can occur in short
period in the sustained disease.

What are the symptoms?

Multiple sclerosis symptoms are variable in each individual and these symptoms depend on the
lesions. Two persons may not have same type of symptoms and these symptoms may alter with
the course of disease progress. One person may feel one or two symptoms and other individual
may have other two symptoms. Many of these symptoms can be controlled by the use of
medication, rehabilitation and other strategies for the disease management. Management of the
effective factors by an interdisciplinary team of healthcare professionals is one of very important
part of multiple sclerosis care.
Some of the common symptoms are:
Fatigue, walking difficulties, numbness, spasticity, weakness, vision problems,

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Dizziness, vertigo, bladder problems, Sexual problems, Bowl problems, Depression,
Pain and itching, cognitive change, emotional changes, speech problems,
Swallowing problems, tremors, seizures, breathing problems, Hearing loss
Molestation, severe pain, muscles cramps, Dysphagia, weakness of muscles.

Risk Factors:
These factors enhance the chances of Multiple sclerosis which includes
Age: Multiple sclerosis can occur at any age but mostly occur at the age of 16 to 55
Sex: Women have more chances of developing multiple sclerosis the men
Family history: If your parents have multiple sclerosis you are on high risk of it
Some infections: Some viruses also cause this disease like Epstein-Barr a virus which causes
infectious mononucleosis.
Race: White people are on high risk to develop multiple sclerosis
Weather: Canada, New Zealand, South Australia have many cases of multiple sclerosis as these
are temperate countries.
Vitamin D: If you are having low levels of vitamin D and less exposure to sunlight then you
have high risk to have multiple sclerosis.
Some autoimmune diseases: if any individual is suffering from thyroid cancer, inflammatory
bowel disease the he is on high risk of multiple sclerosis
Smoking: smokers are also on high risk of developing multiple sclerosis.
Treatment: A drug which is developed by US Food and Drug administration for the treatment
of primary progressive multiple sclerosis, as well as for clinically isolated syndrome, relapsing
remitting disease and active secondary progressive disease known as Ocrevus (Ocrelizumab) in
infusion form. We can also go for the symptomatic treatment.
Injectable treatment includes

 Interferon beta medications

 Glatiramer acetate
Oral treatment includes

 Fingolimod
 Dimethyl fumarate
 Teriflunomide

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 References:

1. Hammond, S. R. (2000). The age-range of risk of developing multiple sclerosis:

Evidence from a migrant population in Australia. Brain, 123(5), 968–974.

https://doi.org/10.1093/brain/123.5.968

2. Mayo Clinic. (2020). Multiple sclerosis - Symptoms and causes. Retrieved from Mayo

Clinic website: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/

symptoms-causes/syc-20350269

3. National Center for Complementary and Integrative Health. (2019, November). Multiple

Sclerosis. Retrieved from NCCIH website: https://www.nccih.nih.gov/health/multiple-

sclerosis

4. Orton, S.-M., Herrera, B. M., Yee, I. M., Valdar, W., Ramagopalan, S. V., Sadovnick, A.

D., & Ebers, G. C. (2006). Sex ratio of multiple sclerosis in Canada: a longitudinal

study. The Lancet Neurology, 5(11), 932–936. https://doi.org/10.1016/s1474-

4422(06)70581-6

5. Ventura, R. E., Antezana, A. O., Bacon, T., & Kister, I. (2016). Hispanic Americans and

African Americans with multiple sclerosis have more severe disease course than

Caucasian Americans. Multiple Sclerosis Journal, 23(11), 1554–1557.

https://doi.org/10.1177/1352458516679894

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