Multiple sclerosis (MS) is such a puzzling disease that our ancestors looked to the heavens for explanations. In the 13th century, a young Icelandic woman, apparently suffering from MS, suddenly lost her vision and her ability to walk. When she prayed to the saints, her sight and mobility returned — at least for a time.
Scientists still are searching for answers about MS — particularly regarding what specifically causes the disorder and what can be done to manage the troubling symptoms and effects.
Multiple sclerosis is an autoimmune disease that frequently strikes young adults in their 20s and 30s. For some reason, the body’s immune system turns inward and causes damage to the protective myelin sheath that covers nerves throughout the body. Without this protective coating, what happens might be compared to a short in the electrical system of your car. Messages that travel along nerves become slowed or blocked, usually in an unpredictable pattern.
Symptoms and even the course of the disease vary so widely that doctors are not always certain of the diagnosis. At first, the patient may notice only numbness, weakness or tingling in the legs that come and go with no ready explanation. Or he or she may suddenly feel so weak in the legs that it’s hard to walk.
Other possible symptoms include tremor, pain, electric shock sensations, slurred speech and dizziness.
In only about 10 to 15 percent of patients do symptoms get gradually and progressively worse. This is known as primary-progressive, the most common type in people who develop the disease after age 40.
The usual course is for symptoms to come and go in a relapsing-remitting pattern. The patient suffers unpredictable attacks when symptoms get worse over a period of several days to several weeks. This is followed by a period of full or partial recovery of some function. The disease does not worsen and the patient may not even have symptoms during this period of remission, which can last a year or longer.
During relapse periods, one area of a nerve in the brain and spinal cord becomes inflamed, as the fatty myelin sheath around the nerve is being destroyed. A plaque is formed that interferes with normal nerve impulses and produces the MS symptoms.
Early, aggressive treatment is needed when symptoms occur to limit long-term damage. Over 10 to 25 years, nerves begin to deteriorate, and relapse periods become less frequent or stop altogether. At this point, there is no known way of recovering nerve function, and some patients eventually lose the ability to walk or speak clearly.
Treatment generally involves reducing the inflammation, ordinarily with corticosteroids. Over the past decade or so, new drugs have been introduced and six have been approved by the Food and Drug Administration for the treatment of multiple sclerosis.
Known as disease-modifying drugs, these agents work directly against the immune system, weakening the response that causes the inflammation. They have been shown to be effective in reducing the frequency and severity of attacks. When the immune system is blunted, of course, the body is left vulnerable to outside attacks.
While reducing inflammation has long been a major goal of treatment, doctors now are targeting the degeneration of nerves that takes place in many patients after 10 to 20 years.
This neurodegeneration has long been believed to be a consequence of the long-term inflammation. Some experts now believe it may be the other way around; the disease process involves a gradual deterioration of nerve fibers that causes an inflammatory response from time to time.
These theories have led to consideration of another treatment strategy — neuroprotection, as used for treatment of Alzheimer’s, Parkinson’s and other neurodegenerative diseases. Many of the drugs currently used offer protection of nerves by reducing inflammation and increasing levels of growth factors, which are neuroprotective.
One area deserving of further investigation is the possible role of exercise as an MS disease-modifier. Animal studies have found exercise associated with an increase in production of growth factor.
Although the disease works its way out in varied ways, multiple sclerosis can lead to substantial disability and suffering. With so many new treatments available and others on the way, the future looks good.
Rupp is a certified information and referral specialist on aging for NODA Area Agency on Aging. Contact her at 237-2236.