What is Multiple Sclerosis?

Multiple Sclerosis, or MS, is a chronic auto-immune demyelinating condition of the central nervous system.

• Chronic – MS often begins around the age of 30 but can be diagnosed at any age.  Since it begins at a relatively young age, it can span decades.
• Autoimmune – In addition to fighting off foreign pathogens like bacteria and viruses, the immune system also mistakenly attacks one’s self.
• Demyelinating – In MS, the immune system targets the coating surrounding nerve cells, called “myelin”. Much like a wire needs insulation to conduct efficiently, so does a nerve cell. If myelin is attacked and damaged by the immune system, signals from the brain don’t travel efficiently, and this causes the symptoms of MS.

What Causes Multiple Sclerosis?

No one knows exactly what leads to MS but, like many conditions, MS is likely caused by a combination of environmental and hereditary factors. There are over a hundred genes that are associated with risk for MS. Environmental factors that may play a role include vitamin D level, sun exposure, geography, diet, and certain viruses.

How Common Is Multiple Sclerosis?

The most recent estimate is that nearly 1 million people are living with MS in the US. That number has grown substantially since the last estimate from the 1970s.

What Are The Sub-types of Multiple Sclerosis?

The sub-types of MS refer to the different ways MS can lead to symptoms, but these can be confusing to learn. It is simpler to think of MS as causing symptoms in 2 potentially-overlapping ways.

1. Most commonly, MS causes relatively sudden symptoms, called “relapses“, typically accompanied by changes on MRI, and often followed by at least some recovery, hence the term “relapsing-remitting“.
2. The other way MS causes symptoms is by a gradual worsening of function over months to years, often without clear changes on MRI. This is what is called “progression“. However, even people who experience “progression” may still have “relapses“, as the two are not mutually exclusive.

What Treatment Options Are Available?

The field of MS has grown immensely over the past decade, and there are now over 10 different medications available, each one of them proven to reduce the risk of new relapses and changes on MRI. Some of the medications are injected under the skin, others are pills, and others are infused through an IV. Each medication comes with its own pros and cons, and a thorough discussion is necessary in order to choose the right medication for a given individual. A list of all the treatment options can be found on the National MS Society Website.

Is Stem Cell Therapy An Option for Me?

Use of stem cells for the treatment of MS is an exciting prospect, but there is not enough information to recommend stem cell treatment for most people with MS at this time. There are typically two types of therapies that people refer to when they talk about stem cells for MS.

1. During “Hematopoietic stem-cell transplantation“, stem-cells are first harvested from an individual, strong chemotherapy medications are then administered to kill immune cells throughout the body, and the stored stem cells are then given back to the individual in order to re-populate the immune system. In this way, the immune system is “re-set”. While there is some evidence that this may be a very effective treatment at preventing relapses, it is still an extremely risky procedure and is only reserved for those who have not responded well to other therapies. There is no evidence for this therapy in the treatment of “progression”.
2. “Mesenchymal stem cell” therapy involves harvesting of stem cells from blood or bone marrow and re-introducing them into the body. There are several ongoing clinical trials studying this, though the studies have different methodologies. Time will tell whether there is any benefit from this type of treatment, but as of this point, there is no clear evidence to argue for it.

Besides Taking Medication, What Else Should I Be Doing?

There is evidence that a healthy lifestyle is essential, not just for general health, but in order to decrease MS severity.

• Regular exercise tends to improve energy, cognition, and overall muscle strength.
• A healthy diet is likely beneficial for people with MS, but more research needs to be done to determine if one particular diet is better than another. At this time, there is some evidence to recommend a Mediterranean-style diet. While there are several other “fad” diets that have been proposed to be beneficial, there isn’t much evidence to recommend them. Given the lack of clear benefit, people with MS should avoid going on a diet that is too restrictive since that could limit one’s quality of life.
• Smoking tobacco is not only harmful for general health, but has been shown to worsen severity of MS. Quitting smoking is clearly beneficial.

Finally, low vitamin D levels are associated with MS and with disease severity, so someone with MS should take vitamin D supplementation to ensure that the level is within the normal range, in consultation with a doctor.

What Will The Future Bring for Me?

While the field of MS has advanced substantially over the past decade, the ability of doctors to predict long-term outcome for a given individual is still lacking. That being said, there is reassuring evidence from clinical trials suggesting that people who are diagnosed with MS early often do very well over the long term.  In addition, there are numerous promising new therapies currently being studied that offer hope for the future.