Multiple sclerosis

Summary about multiple sclerosis

Multiple sclerosis (MS) is an autoimmune neurological disease characterized, at the physiological and cellular level, by a progressive destruction of the structure of neurons, mainly the myelin sheaths. These, which surround the neurons, are essential for good nervous transmission of information through the nervous system. As these myelin sheaths are progressively destroyed, as the disease progresses, the symptoms worsen, such as vision disturbances, tingling, paralysis, etc.

It is called an autoimmune disease because the body’s own defense system cells, such as macrophages, attack nerve cells and destroy the myelin sheaths.

Multiple sclerosis affects more temperate countries (northern or southern) than tropical regions like India or Brazil. For example, in the United States, a country of just over 300 million inhabitants, there are about 400,000 people with multiple sclerosis, while in Brazil, where only a third of people live than in the United States, with just over 200 million of inhabitants, about 30 thousand Brazilians have the disease, or about 10 times less when we compare the number of inhabitants.

The disease affects women more than men and often manifests itself only between 20 and 30 years.

Causes A study published in January 2022 in Science (DOI: 10.1126/science.ada0119 ) came to the conclusion that multiple sclerosis is probably caused by the Epstein-Barr virus, at least in most cases (read more below in Causes) . The other causes of multiple sclerosis seem to be linked to genetic as well as environmental influences. The large differences observed between the United States (more cases) and Brazil (fewer cases) should encourage researchers to do more research, a hypothesis sometimes presented could be that vitamin D deficiency is more frequent in temperate countries than in tropical or subtropical. Food can also be a line of research.

There are 3 forms of multiple sclerosis, the most common is relapsing-remitting multiple sclerosis, that is, this disease manifests itself in outbreaks followed by long remission phases, this phase can last up to 25 years. Then, the relapsing-remitting form transforms into secondary progressive (SPMS).

Another form of MS is primary progressive multiple sclerosis (PPMS), which is exactly as its name implies: progressive, meaning without remission. This form affects 10 to 15% of patients and often develops after age 40.

Symptoms are numerous and often vary from one individual to another. Vision disturbances are frequently observed symptoms. Tingling, urinary or anal incontinence, strange sensations to the touch, paralysis of a limb, fatigue are other symptoms that often recur. Memory and reasoning disorders are sometimes observed.

The diagnosis is often made through an MRI scan and observation of clinical signs. Examination of cerebrospinal fluid (CSF) by lumbar puncture is often performed by physicians. Read diagnosis

Thanks to drugs, it is possible to alleviate many symptoms.

The main drugs against MS are corticosteroids, interferon-b and monoclonal antibodies. We can distinguish the treatment of crises. Currently, no treatment is able to cure the disease.

Physical therapy is a good way to alleviate some symptoms.

Taking vitamin D (asked, read more below), stress management and stress management, and meditation are other ways to lessen some symptoms.

Definition

Multiple sclerosis (or plaque sclerosis) is a chronic inflammatory disease of the central nervous system. It is characterized by the destruction of the myelin sheath (which protects the nerve) and by an abnormal deposit of connective tissue and its hardening (sclerosis), visible in the form of plaques. Myelin is a lipid (fatty) substance that surrounds nerve fibers. This destruction hinders nerve transmission and causes vision disorders, motor disorders, among others, in the patient.

Unfortunately the causes of the disease are unknown, however, certain factors favor its appearance.

There are several treatments against this disease, such as corticoids, interferons-b or baclofen.

Scientists continue to carry out research in order to determine the more specific causes of the disease, in order to find better treatments.

Multiple sclerosis is the most prevalent, so far incurable, inflammatory neurological disease, which mainly affects young adults aged 20 to 40 years and especially women.

In fact, multiple sclerosis strikes twice as many women as men.

Epidemiology

In fact, multiple sclerosis strikes twice as many women as men.

– In Brazil, in 2017 about 35 thousand people suffer from multiple sclerosis. The prevalence of multiple sclerosis in Brazil is 15/100,000 inhabitants (in the world it is 33/100,000).
Note that Brazil, with its more than 200 million inhabitants, is little affected by this disease, in relation to the number of inhabitants compared to the United States, which has just over 300 million inhabitants. We know that tropical and therefore sunnier countries are less affected by multiple sclerosis than temperate countries (Europe, North America). A lack of vitamin D may be the cause in countries with a colder and less sunny climate, but an even more advanced hypothesis (also read below in Causes and Tips) by scientists is that vitamin D would not play an important role. Vitamin D would be a consequence and not a cause. On the other hand, the sun with its UV rays could play a positive role in preventing multiple sclerosis and in the origin of these differences between the regions of the world.

– In Europe, multiple sclerosis affects 350,000 people.

– In the USA, about 400,000 people are affected by this disease.

– Multiple sclerosis affects about 2.8 million people worldwide1.

Causes

As we saw in the section “Definition of multiple sclerosis”, the causes of the disease are not very well known. It is believed that several factors influence the appearance of the disease, such as immunity, where the person lives and heredity. But a study published in January 2022 in Science (DOI: 0.1126/science.ada0119 ) came to the conclusion that multiple sclerosis is likely caused by the Epstein-Barr virus, at least in most cases.

Immune factor
The immune system of people suffering from multiple sclerosis does not recognize myelin as being the person’s own tissue, but as a foreign body, so the immune system attacks and destroys it, in the same way it would with any bacteria or cancer cell.

Environmental factor
There are more reports of the disease in temperate countries, but people living outside this zone can also be affected. Studies show that most patients spent their childhood in these regions, so we believe that the environmental factor should be considered, although there is still no evidence to prove this information.

Hereditary factor

If a person’s father or mother has multiple sclerosis, the risk of their child developing the disease will be multiplied by 20 to 50.
Regardless of its triggering factors, the disease results in destruction of the myelin sheath and by an abnormal deposit of connective tissue. This, in turn, hardens and forms plaques visible by MRI (Magnetic Resonance Imaging).

In August 2011 French researchers from Inserm/CNRS in Paris published very interesting results confirming 23 already known genetic variants and identified 29 other factors as genetic predisposition to multiple sclerosis.

Vitamin D
deficiency – The lack, or deficiency, of vitamin D can be one cause, among others, of the appearance of multiple sclerosis.
– The level of vitamin D (partly synthesized by the sun) is very important, due to the higher incidence of MS in countries or regions with little sun, such as Scandinavia, than in other countries with a more tropical climate, such as India or Brazil (read also in epidemiology).
– However, researchers increasingly believe that vitamin D may be more a consequence than a cause of the disease, as suggested by an Australian study published in July 2018 in the scientific journal Nutritional Neuroscience(DOI: 10.1080/1028415X.2018.1493807). The sun can have a positive impact on preventing multiple sclerosis, but the exact causes are not yet known.

Viruses
Some viruses, such as Epstein Barr and others that cause mononucleosis , have been associated with multiple sclerosis. According to our information, the causal relationship is not clear. Currently it’s more of a correlation.

Above all, and as seen above, a study published in January 2022 in Science (DOI: 10.1126/science.ada0119 ) came to the conclusion that multiple sclerosis is probably caused by the Epstein-Barr virus. The January 2022 US study from Science , published this week in the prestigious journal Science, showed that this virus is necessary for the development of multiple sclerosis, even if all infected people do not develop this disease. The hypothesis had already been studied for several years, but difficult to prove, mainly because this virus is very common and the symptoms of the disease only start about ten years after the infection. This is “the first study to provide convincing evidence of causality,” said Alberto Ascherio, lead author and professor of epidemiology at the Harvard School of Public Health. “This is an important step forward as it suggests that most cases of multiple sclerosis can be prevented by stopping the Epstein-Barr virus infection,” he added. “Research for this virus could lead to the discovery of a cure.” Researchers followed more than 10 million young men enlisted in the US military for 20 years, of whom 955 were diagnosed with multiple sclerosis while in service. According to this work, the risk of contracting multiple sclerosis increased 32 times after being infected with the Epstein-Barr virus, but remained unchanged after infection with other viruses. According to researchers at Stanford University, who published a commentary on the study in the journalScience , other factors, for example genetics, may play a role in the development or not of the disease.

Herpes virus HHV-6
A study published in the journal Scientific Reports in 2017 showed that the human herpes virus 6 (HHV-6) could play a key role in preventing the brain from repairing itself in multiple sclerosis. This study carried out by researchers at the University of Rochester in the United States could help explain the differences in severity in the symptoms of multiple sclerosis.

One hypothesis put forward by the researchers is that the HHV-6 virus produces a protein that has the potential to impede the natural ability of nerve cells to repair the myelin sheath. HHV-6 is the most common human herpes virus and infections during childhood often go unnoticed, but the virus can cause a sudden rash (infantile roseola) that is characterized by fever and rash in infants. It is estimated that over 80% of people have been exposed to the HHV6 virus at some point in childhood. While the immune system fights most active forms of infection, the virus never actually leaves the body and can reactivate later in life.

At present, there is no confirmation of the causal relationship between the HHV6 herpes virus and multiple sclerosis, but it is possible that the HHV6 virus may play a detrimental role in the development of the disease.

Intestinal flora (microbiota)
Intestinal flora, also called microbiota, can trigger multiple sclerosis (MS) as shown in several studies. One of them was published in August 2017 and was performed on 35 pairs of identical (human) twins and genetically modified mice. For each set of twins, one had MS and the other did not. Scientists transplanted intestinal bacteria from twins suffering from MS into genetically engineered mice. In almost 100% of cases, these developed symptoms close to multiple sclerosis (a form of encephalitis, in English, experimental autoimmune encephalitis ). This study was published (in English, approved ) on August 7, 2017, in the scientific journal PNAS (Proceedings of the National Academy of Sciences) . Scientists from the Max-Planck Institute of Neurology in Munich, Germany, as well as the University of California San Francisco in the United States participated in this study.

Groups of risk

Multiple sclerosis affects people of both sexes, but with a female predominance (60%).

People who have a relative with multiple sclerosis have a much higher risk of developing it.

Patients are between 20 and 40 years old.

People who live in countries with a temperate climate such as Europe (especially in the north), North America, Argentina, South Africa or Australia are at greater risk than people who live in countries with a tropical climate or subtropical. Vitamin D (see also Tips and Prevention below) could be the source of these differences.

Symptoms

The symptoms of multiple sclerosis result from the destruction of myelin and the appearance of plaques (sclerosis). As we saw in the “Multiple sclerosis definition” section, the myelin sheath covers the nerve fibers, this system makes it possible to protect the nerves, and improves nerve transmission.

After the myelin has been destroyed, nerve transmission is impaired, causing disorders:

– sensitive (tingling, pins and needles). These are the first signs of the disease.

– motor (spasms, transient paralysis of a limb such as the arm or leg)

– visual (brutal decrease in visual acuity, blurred vision)

– urinary (control of urine and urinary incontinence)

– balance and motor coordination

Frequency of the most common symptoms
According to the Swiss Society of Multiple Sclerosis who asked people with the disease to describe the symptoms most frequently, they are:
– Numbness (61%)
– Visual disturbances (36%)
– Fatigue (32%)
– Trouble walking (31%)
– Weakness (30%)

Important note: The intensity of multiple sclerosis symptoms can vary from one person to another. Some people have milder symptoms (numbness in one leg) and others have more severe symptoms (disturbed vision).

We also emphasize that plaque sclerosis would be more active in spring and summer. According to an American study published in August 2010, during these periods, new brain lesions resulting from this disease occur two to three times more frequently than in the rest of the year.

The 3 forms of multiple sclerosis

We can distinguish three forms of multiple sclerosis, the most common is the relapsing-remitting form of multiple sclerosis, that is, the disease is characterized by relapses followed by long phases of remission, this phase can last up to 25 years. Then the relapsing-remitting form turns into the secondary progressive. In this second phase, there are no more remission phases.

Another form of MS is primary progressive multiple sclerosis which is actually as the name implies: progressive, which means without remission. This form is related to 10 to 15% of patients and often develops after age 40.

Notes on MS

– In some cases (less than 15% of cases), the remission phase can be very long or even definitive.

– During pregnancy, women experience fewer MS relapses. This difference is due to hormonal reasons (higher concentration of estriol during pregnancy). That’s why US researchers administered estriol to women with MS and observed 47% fewer MS attacks than those who received placebo or glatiramer acetate.

Diagnosis

Be aware that the diagnosis of Multiple Sclerosis is not always easy and that the disease must be reassessed over time in order to avoid a false diagnosis (in fact, there may be a risk of confusing Multiple Sclerosis with other
diseases).
Different methods make it possible to diagnose multiple sclerosis:

1. Observation of clinical signs

2. A IRM

3. Examination of CSF (Cerebrospinal Fluid) by lumbar puncture

1. Observation of clinical signs

The diagnosis of multiple sclerosis is essentially made by observing certain signs. Symptoms appear very suddenly and in multiple locations (multifocal damage). This occurs due to the destruction of myelin and the deposit of plaques (sclerosis) and therefore the decrease in nerve transmission.

2. A IRM

Then the diagnosis will be confirmed through MRI (Magnetic Resonance Imaging). This method makes it possible to highlight the demyelinated plaques on the nerve fibers.

3. Examination of CSF by lumbar puncture

Lumbar puncture makes it possible to collect cerebrospinal fluid (CSF). The examination of this can highlight the presence of white blood cells and the elevation of the percentage of antibodies. All these elements are part of the human body’s immune system. As we saw in the sections “Definition of multiple sclerosis” and “Causes of multiple sclerosis”, the disease can appear after a deficiency in the immune system, which attacks the tissues of the human body, considering them to be foreign bodies.

Complications

The course of the disease varies greatly from one person to another. In general, it evolves over 25 years, but it can be faster in certain people.

The evolution of multiple sclerosis is characterized by phases of relapse (disorders) and remission; Remission phases are relatively long at first (lasting several months or years). Then the bursts occur at more regular and shorter intervals.

With nerve transmission becoming more and more difficult, the patient may suffer from:

– paraplegia

– coordination disorders

– psychic disorders.

Therefore, the patient is led to suffer from progressive disability. However, treatments are becoming more and more effective and help to reduce the speed of disability.

Treatments

The treatment of multiple sclerosis (MS) aims to decrease the activity of the immune system and prevent it from further destroying the myelin. That is why corticoids and immunomodulators (interferon-b) are used. In addition, the treatment will improve the patient’s quality of life by reducing disturbances (motors, urinary incontinence, re-education through kinesiotherapy).

– Corticosteroids: Corticosteroids are usually given by infusion in a hospital setting. But they can also be taken by intramuscular injection and orally.
– Interferon-b : Interferon-b is a protein that has antiviral and immunomodulatory properties. Its action is important in multiple sclerosis, an autoimmune disease. Patients must inject the drug subcutaneously. The drug is indicated to reduce the phases of outbreaks.
– Glatiramer acetate. It is an immunomodulator.

Reeducation by kinesiotherapy: the patient often suffers from motor disorders. Re-education is usually necessary and can improve your quality of life. In addition, the doctor may prescribe baclofen to reduce spastic episodes.

Of course, this type of medication requires strict medical supervision.

New Medicines (2012-2019)

– There is a new medicine against multiple sclerosis: Gilenya (molecule: fingolimod). This drug developed by the Swiss pharmaceutical company Novartis, according to them, would be up to 52% more effective than drugs classified as interferon.

The drug’s mechanism of action is very different from treatments already on the market, such as interferon. Fingolimod, simply put, prevents the release of immune cells that attack myelin sheaths (read multiple sclerosis definition).

However, this medication can also cause serious adverse effects, especially on the heart. With the use of this drug there should be enhanced cardiac monitoring within 24 hours after the first dose, according to the French drug agency (Afssaps).

It is clear that this type of medication involves strict medical monitoring.

– The active ingredient teriflunomide (Aubagio) is available in some markets. It is an oral treatment for multiple sclerosis (MS) in adults, available with a prescription. This medication acts on MS relapses. It is strictly contraindicated for pregnant women.

– There are also monoclonal antibodies in the markets of some countries (mainly in Europe) such as alemtuzumab (at first developed against leukemia), capable of attacking cells that attack neurons in multiple sclerosis.

– A study published in 2014 showed that statins can reduce damage to the nervous system. These drugs also act on physical disturbances in the case of secondary progressive multiple sclerosis.

– Some experts believe that cannabinoids (from marijuana) could help rebuild the myelin sheath of neurons and thus become a drug in case of MS.

– Estriol, a female hormone, is sometimes indicated in MS. Also read on symptoms

– The pharmaceutical industry continues to work to find new drugs. Monoclonal antibodies look particularly promising, some have the ability to rebuild the myelin sheath.

– Plasma exchange ( plasmapheresis ) is a method often used in multiple sclerosis in case of severe symptoms or unresponsiveness to corticosteroids.

– A phase 2 clinical trial published on August 30, 2018 in the journal of The New England Journal of Medicine (DOI: 10.1056/NEJMoa1803583) showed that ibidulast, a medicine available mainly in Japan against stroke or asthma, can help to reduce brain damage in 255 patients suffering from progressive multiple sclerosis. The researchers concluded that ibidulast was associated with a slower progression of brain atrophy than placebo, but was associated with higher rates of gastrointestinal side effects, headache, and depression. Currently, there are no medications for the progressive form of the disease.

Alternative

Unfortunately, there are no truly effective alternative methods against multiple sclerosis. However, a homeopath may eventually monitor the treatment to improve the patient’s quality of life. After carrying out an anamnesis and identifying the triggering factors, he can prescribe homeopathic remedies in order to reduce the disturbances triggered by the disease.

In herbal medicine, you can try donkey weed oil (rich in omega-3) which can reduce inflammation. This in no way replaces a classic treatment and should only be used as a complementary measure.

We recommend that people interested in alternative medicine never discontinue classic medication without medical approval.

therapy tips

– The treatment of MS is done by administering corticoids in large amounts, therefore it is essential to scrupulously follow the dosage prescribed by the doctor.

– Mindfulness meditation improves the quality of life of MS patients. Depressions, anguish and states of exhaustion clearly decrease, according to Swiss researchers in 2010.

– Betaferon: The administration of interferon-b is done through injections, therefore, if the patient injects the drug himself, it is essential that he is very well instructed to do it correctly. A training certificate will be issued to patients who take the course to inject the medication. The patient must present this certificate at the pharmacy to withdraw the medicine.

– Try to reduce stress (especially violent ones). According to a study, stress can increase the number of nerve injuries in the brain region.

– Vitamin D , in high doses, can have a positive effect on multiple sclerosis. Currently (2017), serious studies are still needed to determine whether or not vitamin D is useful in multiple sclerosis therapy.
However, in 2018, an Australian study was critical of the impact of vitamin D on multiple sclerosis. According to researchers at the University of Adelaide, who published the study in July 2018 in the scientific journal Nutritional Neuroscience(DOI: 10.1080/1028415X.2018.1493807), a low level of vitamin D would be the consequence and not the cause of multiple sclerosis. In other words, taking vitamin D as a food supplement would be useless. Scientists note, however, that exposure to the sun can be beneficial in preventing the disease, but the exact causes are not yet known.

– Healthy eating, consume omega-3.

– When you are suffering from the symptoms of MS, it is important to rest well.

Prevention

As the causes of MS are unclear, it is difficult to effectively prevent the disease. However, there are useful measures that can be taken in the treatment of MS (see above). Some tips may be helpful, such as:

– Not smoking is a way to prevent the disease. Smoking also seems to favor MS flare-ups.

– A regular consumption of vitamin D can prevent the appearance of the disease.

Vitamin D and multiple sclerosis

– Vitamin D, particularly in high doses (some sources speak of 10,000 IU of vitamin D per day), can have a positive effect on multiple sclerosis. Talk to your doctor, he may prescribe vitamin D therapy.

You should know that the use of vitamin D is controversial in the world medical community, some doctors believe that it is almost a miracle cure for multiple sclerosis, others are more skeptical about the effect of vitamin D for this indication.

This use of vitamin D (partly synthesized by the sun) has arisen because the incidence of multiple sclerosis is higher in countries or regions with little sun, such as Scandinavia, than in other countries with a tropical climate, such as India.

Currently (2018), serious studies are still needed to determine whether or not vitamin D is useful in multiple sclerosis therapy. However, as discussed in Tips above, this recommendation was called into question by an Australian study published in 2018 (DOI: 10.1080/1028415X.2018.1493807).

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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