Multiple Sclerosis: An Unpredictable Disease

Multiple Sclerosis is an autoimmune disease in which the body’s immune system mistakenly attacks myelin sheath in the central nervous system. Myelin sheath is the protective coating around the nerve fibre in the CNS, which is the primary target in MS. Further, the messages within the CNS are altered or stopped completely and lead to the production of a variety of neurological symptoms which may vary in severity and type.

MS is identified in four types or stages. First is relapsing-remitting MS, in which the patient may show initial signs of the disease in their early 20’s. After that, they may have relapses from time to time in the form of symptoms. This could happen within weeks, months, or years. The second type is , primary progressive MS, which is defined by no well-defined symptoms and there is little or no recovery. Due to which treatments do not work well with this type of MS. The thirdly is secondary-progressive MS, which occurs once the patient has had relapsing-remitting MS for many years; symptoms begin in a way that are similar to primary progressive MS. Finally, progressive relapsing MS is one of the least common types. Relapses occur often, though symptoms may worsen in between relapses.

Usually, the onset of MS is between 15 and 60 years of age. Women are twice as likely as men to develop MS. Furthermore, the cause of MS still remains unidentified, though it is believed to be triggered by a combination of factors. Researchers have identified factors such as immunologic, genetic, infectious, and environmental, which might help us understand MS better.

Immunologic factors suggest that there exist inflammation and damage to the myelin coating as well as an abnormality in the immune cells that target the CNS in people with MS.  It has been reflected in studies that the disease is not passed on from generation to generation in the general population. However, the risk of developing MS in identical twins is 1 in 4, and is increased in first degree relatives (siblings, parents, and children). Apart from genetic factors, the Epstein-Barr virus (EBV) that causes mononucleosis contributes to the risk of developing MS. Furthermore, understanding MS geographically, the risk differs according to countries, with nations farther from the equator having larger populations of MS-diagnosed persons (also has to do with Vitamin D being a protective factor for MS). Furthermore, lifestyle factors, such as smoking and obesity, may contribute to causing MS.

Diagnosing  MS is sometimes difficult, as the symptoms vary and are unpredictable. It may differ from individual to individual, and fluctuates over a period of time. However, it is essential to identify the symptoms that may manifest in form of fatigue, spasticity, weakness, tingling sensation, bladder problems, bowel problems, sexual problems, pain and weakness and emotional problems.

Tests such as the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) are used for diagnosing MS. One of the stark differences between the two tests is that EDSS does not measure cognition, whereas, MSFC includes tests on cognition.

Furthermore, looking at the prevalence of psychiatric issues in MS, a study found that major depressive disorder and anxiety disorders are highly prevalent in patients with MS. Most often, people being diagnosed with MS find it difficult to cope, due to the magnitude of the disease. In some cases MS patients may also experience affective disorder, perhaps manifesting in form of pathological crying or laughing or pseudobulbar affect (PBA). PBA is characterised by episodes of uncontrollable, sudden and inappropriate laughing or crying. In the case of MS, due to the damage in the messages within the CNS, it occurs approximately 10% in patients diagnosed with MS.

Looking at the treatment of MS, in most cases, the approach that is taken is pharmacological. medicines help in inhibiting the enzymes that lead to damage of myelin. Drugs such as aubagio, a teriflunomide, is prescribed most often in the relapsing form of MS. It helps in reducing the number of overactive immune cells that are thought to cause MS flare-ups, while allowing normal immune cell activity to occur. Yet, one must undergo supervision from the physician before beginning the course. Furthermore, it needs to be understood that the patient undergoing MS needs to be provided biopsychosocial support, in the sense that medicine and psychological aid is provided in conjunction. It will not only facilitate stabilization but also aid in the efficient management of an individual’s emotional state. Also, it is necessary to help the couple or family deal effectively with the patient’s disease. A review of 16 studies showed that Cognitive Behavioural Therapy (CBT) has been found to be useful in helping patients and families with MS as it addresses thoughts and behaviours.

It is essential to keep in mind that MS holds a range of symptoms and manifestations that makes it difficult for one to identify the disease. Alongside, understand that the treatment of the disease requires attention that is multimodal for coping and effectively managing the symptoms such as - pain and fatigue, to name a few. Additionally, more research in the area of MS will help in better understanding and awareness of the disease.

Anjali Kanojia