Multiple Sclerosis (MS) is a chronic neurological disease that occurs in around 1 million individuals in the United States. It is most frequently diagnosed between the ages of 20 and 50 years and is much more common among females, who constitute about 76% of cases.

Dr. Ellen Mowry, a neurologist at Johns Hopkins University, points out that although multiple sclerosis (MS) cannot be entirely prevented, incorporating healthy lifestyle modifications—such as eating a balanced diet and exercising regularly—may decrease the risk of developing MS.

The I-PhiT program supports Multiple Sclerosis (MS) awareness through advocacy, community education, and support programs. Through the provision of resources and encouraging active healthcare participation, I-PhiT enables people living with MS to enhance their quality of life.

Multiple Sclerosis (MS) is a chronic neurological disease that attacks the central nervous system, interfering with the transmission of information in the brain, and between the brain and the rest of the body. It is caused when the immune system destroys the protective sheath that covers nerve fibers, resulting in inflammation and damage. The damage is able to cause a variety of symptoms, which can be different for each individual, so it sometimes proves challenging to diagnose and treat.

MS is a condition that does not discriminate, affecting people of all ages, backgrounds, and walks of life. Multiple sclerosis is striking nearly 1 million people in the United States, a number more than twice previous estimates. MS is roughly three times more common in females than in males. The disease is often diagnosed between 20 and 50 years old. Black populations identified to have 2nd highest MS prevalence in US.

Grasping MS is important because its reach goes beyond the person, affecting families, employers, and healthcare networks. With close to one million individuals suffering from MS in the United States alone, awareness of the disease is vital. It not only minimizes stigma but also encourages compassion, facilitates research breakthroughs, and ensures improved treatment and care. As medicine and science keep advancing, learning about symptoms, treatments, issues, and prevention becomes necessary to enhance quality of life in patients and work towards a brighter tomorrow.

Types of Multiple Sclerosis (MS)

1.    Relapsing-Remitting MS (RRMS)

It is the most prevalent type of multiple sclerosis, occurring in about 85% of those diagnosed. It is defined by relapses (exacerbations) of symptoms, followed by remission periods of partial or complete recovery. In relapses, symptoms can worsen, but they tend to improve or stabilize in remission. RRMS eventually progresses to Secondary Progressive MS (SPMS), where the symptoms progressively worsen with less or no remission periods.

2.    Secondary Progressive MS (SPMS)

It develops in individuals who previously had Relapsing-Remitting MS (RRMS). Over time, symptoms progressively worse, with or without relapses. Periods of remission become less frequent or may disappear entirely, leading to increased disability and neurological decline.

3.    Primary Progressive MS (PPMS)

Primary Progressive MS (PPMS) occurs in about 10-15% of multiple sclerosis patients. It involves a constant and continuous worsening of the symptoms since the disease started, with no clear-cut relapses or remissions. The course of the disease can be variable, with some periods of stability. PPMS is more often diagnosed in people above 40 years of age.

4.    Progressive-Relapsing MS (PRMS)

Progressive-Relapsing MS (PRMS) is the least common type of multiple sclerosis and was once considered separately. It involves ongoing disease worsening with occasional sudden relapses, but without well-defined periods of remission. In contemporary classifications, PRMS is usually included under Primary Progressive MS (PPMS).

Understanding Multiple Sclerosis: Causes and Symptoms

Our immune system may at times become hostile to our own body with catastrophic consequences. This is precisely what occurs in multiple sclerosis - a disease in which the immune system attacks the central nervous system (CNS) and induces inflammation that destroys essential neural structures.

The Autoimmune Nature of MS

Multiple sclerosis is an autoimmune disease in which our body's defense mechanisms identify healthy tissue as a threat. The immune system attacks the myelin sheath—a nerve fiber coating. It also attacks oligodendrocytes (myelin-making cells) and occasionally the nerve fibers (axons) themselves.

MS is not like other autoimmune diseases since scientists have not been able to find a particular antigen that causes the disease. Therefore, it's difficult to place the disease. Despite that, evidence indicates that an immune-mediated attack causes inflammation, destroys myelin, and are the pillars of typical lesions or scars within the CNS.

Multiple immune cell types contribute to the inflammatory response. CD8+ T cells predominate MS lesions and are associated with axonal damage, as opposed to CD4+ T cells that appear in experimental systems. This explains why some lab-effective treatments are not effective in human patients.

Common Signs of MS

MS symptoms may be different since lesions occur anywhere within the brain, spinal cord, or optic nerves. Symptoms flare and subside during remissions and relapses, particularly at the beginning of the disease.

Some of the initial warning signs of multiple sclerosis are:

ü  Vision difficulties (partial loss of vision, one-sided pain in an eye, blurred vision, double vision)

ü  Numbness or tingling in extremities, trunk, or face

ü  Weakness or clumsiness of limbs

ü  Fatigue (not routine tiredness, but total exhaustion)

ü  Balance issues and dizziness

How MS Impacts the Central Nervous System

The CNS damage occurs through a chain of events. The inflammation initially injures the insulating myelin sheath that covers nerve fibers—like frayed insulation around electrical wires. Myelin damage will slow down nerve impulses or stop them altogether.

Demyelination forms lesions or scars over time (that's why it's "sclerosis"). These occur primarily in the periventricular and juxtacortical areas, brainstem, cerebellum, spinal cord, and optic nerve. The body can restore some myelin, but this restoration isn't clean and causes constant nerve damage.

The actual nerve fibers themselves will finally break or become damaged. This axonal damage is permanent and progressively disabling, especially as MS worsens.

What Triggers MS in Women Compared to Men

MS reveals an impressive sex difference. MS strikes women three times as frequently as men—numbers that continue to increase. This wasn't always the case - in the early 1900s, MS struck both sexes with the same frequency.

Scientists are not yet clear on these gender differences, but hormones probably have a lot to do with it. Studies indicate that estrogen may help shield nerves, which would account for men experiencing more nerve damage even though they have lower rates of MS. In addition, women generally present with more inflammatory lesions on MRI scans, while men lose more gray matter and experience greater spinal cord damage.

Aside from hormones, there are other causes that can initiate MS in both men and women:

ü  Genetic predisposition (although there is no MS gene)

ü  Environmental factors such as infection with Epstein-Barr virus

ü  Low levels of vitamin D (more impactful on women's immune systems)

ü  Obesity (influencing inflammation differently in women)

ü  Geographical location (more prevalent away from the equator)

Male patients develop primary progressive MS more frequently and experience poorer outcomes based on gender alone. Women tend to experience changing symptoms in harmony with their hormone cycles during menstruation, pregnancy, and menopause.

Diagnosis & Testing of Multiple Sclerosis

Diagnosis of Multiple Sclerosis (MS) is often difficult, since its symptoms may resemble other neurological conditions. There is no test for MS, and therefore doctors apply a combination of clinical examination, imaging, and laboratory investigations to make the diagnosis.

1.    Medical History & Neurological Examination

A physician examines the patient's history, symptoms, and possible risk factors to determine the probability of Multiple Sclerosis (MS). A neurological exam is also performed to check coordination, balance, vision, and reflexes to determine if there are any abnormalities related to MS.

2.    Magnetic Resonance Imaging (MRI)

MRI scans are the definitive tests for Multiple Sclerosis (MS) diagnosis. They identify lesions (plaques) on the brain and spinal cord, which are primary signs of nerve damage from MS.

3.    Lumbar Puncture (Spinal Tap)

A cerebrospinal fluid (CSF) analysis aids in detecting immune system abnormalities, which may point to Multiple Sclerosis (MS). The detection of oligoclonal bands (OCBs) in CSF indicates long-standing central nervous system inflammation, a typical feature of MS.

4.    Evoked Potential Tests

Evoked potential tests evaluate how the brain reacts to visual, auditory, or electrical stimulation. Slowed responses on these tests could be evidence of nerve damage due to Multiple Sclerosis (MS).

5.    Blood Tests

No blood test is able to definitively diagnose MS, but they are useful in eliminating other conditions causing similar symptoms, such as infection or autoimmune disease.

Current Treatment Landscape for Multiple Sclerosis

MS treatment options have dramatically increased over the past three decades. There are more choices for patients and clinicians than ever. The primary objectives of modern management strategies involve treating acute attacks, alleviating symptoms, and lowering disease activity with specialized drugs.

Traditional Disease-Modifying Therapies

Disease-modifying drugs (DMTs) are the lifeblood of MS management. They inhibit or modulate immune activity. These drugs suppress inflammation—particularly during the relapsing stage. This minimizes relapse rate, curbs new lesion formation, and stabilizes or slows disability worsening.

The investigators discovered the first breakthrough with interferons and glatiramer acetate. These drugs were fortunate serendipitous finds in early treatment. They decrease relapse frequency modestly and became popular scripts soon. Interferons achieve this by:

ü  Downregulation of MHC molecules from antigen-presenting cells

ü  Reducing proinflammatory cytokines but augmenting anti-inflammatory ones

ü  Suppressing T-cell growth

ü  Prevention of inflammatory cell migration to the CNS

Shortcomings of the Available Treatments

We have far to go, but we can build on this progress with existing therapies. DMTs work well for relapsing forms of MS, but their impact on progressive MS is an unmet need. A meta-analysis revealed DMTs offer no discernible benefit beyond median age 53.

Accessibility issues complicate the treatment scenario further. Fewer than 35% of MS patients in Latin America have access to treatment. Even areas that have improved accessibility are confronted with complex treatment dilemmas because of:

ü  Differential safety profiles across patient age

ü  Higher risks of infections with worsening disability

ü  Declining vaccine responses with some DMTs

ü  High costs being a financial constraint

Recent Developments in Multiple Sclerosis Treatment

MS treatments have made tremendous advancements over the past few years. Ocrelizumab, a humanized monoclonal antibody against CD20 molecules of B cells, was approved in 2017. It is highly effective in preventing relapses and silent progression in relapsing MS patients. It was also the first DMT to be approved for primary progressive MS.

Our knowledge about MS has also changed. Now we realize it's not only T-cell-mediated but we acknowledge B cells have a key role in pathogenesis. This shift helped us create targeted treatments such as:

ü  Ofatumumab (Kesimpta) - Self-injecting therapy for relapsing kinds of MS

ü  Siponimod (Mayzent) - Oral therapy for relapsing and secondary-progressive MS

ü  Cladribine (Mavenclad) - Oral treatment that demonstrates less progression of disability

Next-generation sphingosine-1-phosphate receptor modulators with selective receptor affinity have fewer side effects compared to earlier generations. To mention an example, siponimod demonstrated lower confirmed disability progression at 3 and 6 months in secondary progressive MS in the EXPAND clinical trial.

Stem cell transplantation therapy and Bruton's tyrosine kinase (BTK) inhibitors are still under research. These could provide new avenues for treatment in patients who are not responsive to the available treatments.

Management of Multiple Sclerosis (MS) by New Approach

Apart from medicines, some of the rehabilitation treatments and lifestyle management can be effective in managing symptoms of MS as well as the quality of life.

Rehabilitation Therapies

1.    Physical Therapy (PT):

Physical therapy helps maintain mobility, strength, and balance, making daily activities easier for individuals with Multiple Sclerosis (MS). It also reduces muscle stiffness and improves coordination, enhancing overall movement. Therapy sessions may include stretching, strength training, and the use of assistive devices when necessary.

2.    Occupational Therapy (OT):

Occupational therapy aims to enhance daily activities of living, including dressing, cooking, and writing, in order to improve independence in MS patients. Occupational therapy also addresses energy conservation strategies to minimize fatigue and suggests assistive devices for better functionality in daily activities.

3.    Speech and Cognitive Therapy

Speech and cognitive therapy helps those with speech, swallowing, or cognitive impairments of Multiple Sclerosis (MS). It enhances memory, problem-solving, and communication, all leading to improved quality of life.

Lifestyle Approaches

1.    Diet & Nutrition:

A well-balanced diet comprising fruits, vegetables, whole grains, and healthy fats can contribute to overall health and well-being in Multiple Sclerosis (MS) patients. Some diets also indicate that anti-inflammatory diets can help control symptoms by minimizing inflammation and enhancing neurological functions.

N-6 Fatty acids

N-3 Fatty acids

Linoleic acid

Dietary sources: sunflower, sesame, safflower, oils, seeds, nuts, lean meat, eggs.

Alpha-linolenic acid

Dietary sources: green leafy vegetables, legumes, soybean oil.

Gamma-linolenic acid

Dietary sources: evening primrose oil, borage oil

Eicosapentaenoic acid (EPS)

Dietary sources: fish, seafood, cod, liver oil, fish oil.

Arachidonic acid (AA)

Dietary sources: Dietary sources: liver, kidney, lean meat, eggs.

Docosahexaenoic acid (DHA)

Dietary sources: Dietary sources: fish, seafood, liver, egg, cod liver oil, fish oil.

Prostaglandin E2

(Immunosuppressive)

Prostaglandin E3

(anti-inflammatory)

 

2.    Exercise & Movement:

Consistent low-impact physical activities like walking, yoga, or swimming may reduce muscle weakness, flexibility, and fatigue in patients with Multiple Sclerosis (MS). Moreover, individualized exercise programs may prevent muscle weakness and joint stiffness and help to enhance mobility and overall well-being.

3.    Stress Management & Mental Health

Practices like meditation, mindfulness, and deep breathing can be used to lower stress levels, which are well known to initiate MS flare-ups. Support from therapists, counselors, or MS support groups can also offer emotional counseling and aid individuals in managing the psychological effect of the disease.

I-PhiT: Empowering Communities Through Multiple Sclerosis Awareness and Support

Although there is no cure for MS at present, the implementation of overall maintenance and prevention measures can greatly improve quality of life and even halt disease progression. I-PhiT (Implementing Public Health Initiatives Throughout) is committed to the promotion of health and wellness through education and community outreach, consistent with the multi-faceted strategies that are helpful for people with MS.