Understanding Multiple Sclerosis

Dear Dr. Deena,

I am 26 years old, and was just diagnosed with Multiple Sclerosis. What is this disease? 

AG

AG, I am so sorry to hear about your diagnosis. Luckily modern medicine has many treatment options for you that can slow down progression of this disease!

Multiple Sclerosis, commonly known as “MS”, is a disease that effects the central nervous system (which consists of the brain and spinal cord). MS effects  90 in 100,000 individuals. These individuals are mostly young women, with the usual age of onset between 24 and 30 years of age.

To better understand MS, let us look at the structure of a nerve cell (see image the below). The nerve cell is composed of 2 distinct parts: the cell body (outlined by the red square) and the axon (circled in blue). The cell body receives information and nerve signals from other nerves. The axon transmits information to other nerves, muscles and glands.  

Axons are coated by myelin.  Myelin is a fatty substance that protects the nerve cell and allows for proper nerve signal transmission and functioning.   In fact the more myelin that coats the axon, the faster that a nerve signal can be transmitted to other nerves, muscles, and glands.

The CNS is composed of 2 types of matter: white matter and gray matter. Gray matter consists of the cell body and dendrite portion of the nerve cell. White matter consists of the axons of the nerve cell and appears white because of the myelin sheaths covering the axons.

MS is a “demyelinating” disease which means that it damages “myelin” and thus mostly effects the “white matter” of the CNS.

The actual cause of MS is unknown.  Many researchers believe that it is an autoimmune disease (where the body’s immune system attacks itself); however, the true cause for MS is still uncertain. What we do understand is the pathogenesis of this disease- meaning how the disease injures nerves and how the disease might progress overtime if untreated.

The main mechanisms of disease in MS are quite complex. To break it down simply for all of you, the disease begins with inflammation surrounding the nerve cell which leads to demyelination (damage and destruction of myelin)  which then leads ultimately to “sclerosis” (or scarring) of the nerve cell which can ultimately lead to loss of function of that nerve.  

As the myelin is damaged by inflammation, the axon can no longer transmit nerve signals properly, leading to a variety of symptoms that can occur. These symptoms depend on the location of the nerve affected and the degree of damage to that nerve.  

Remember, every MS patient has different symptoms!

Sensory symptoms are very common among MS patients, and symptoms may be described as numbness, tingling, pins-and-needles, coldness, or swelling of the limbs or trunk. 

Motor symptoms can include difficulty with walking, balance and motor coordination. Muscle weakness, tremor, and spasms may also be seen.

Bowel, bladder, and sexual dysfunction can also been seen in patients with MS. The extent of bowel and sexual dysfunction often parallels the degree of motor impairment in the lower extremities. Constipation is quite common among people with MS.

When MS effects the nerves supplying the eye (known as the optic nerve), one might develop “optic neuritis” which can cause eye pain and partial blindness. Luckily this condition can easily be reversed with high dose steroids.

Fatigue is a characteristic finding in MS, usually described as physical exhaustion that is unrelated to the amount of activity performed. MS patients are at risk for development  of depression and changes in cognition (i.e. the brain's ability to process and understand information).

If you are concerned that you might have symptoms similar to MS, contact your MD. Luckily there are many medications available that can slow down the progression of disease, though there still remains no definitive treatment. Depending on the type of MS you have, there is always the possibility to go into remission for years with no substantial change to your quality of life.

I hope this information helps, AG. Thanks for visiting my blog. Once again if you have any new comments or questions, please email them to DoctorDeenaMD@gmail.com.

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