As a common condition, Dr. Alireza Minagar, a neurologist from Shreveport, Louisiana, sees patients with multiple sclerosis (MS) often, and understands that those who have been diagnosed, or those who may think they have the illness, can be very concerned. Dr. Alireza Minagar took the time to explain what multiple sclerosis is, the symptoms, the diagnosis process, and the management of MS.
Multiple Sclerosis is presumed to be an immune-mediated disorder in which the body’s immune system attacks the central nervous system (brain, spinal cord, and optic nerves). Our brain is made up of both white and grey matter, the differentiation being that white matter is made up of nerves that are covered in a sheath of fat called myelin, the primary target of the immune system in MS. Dr. Minagar explains that myelin is a coating that helps insulate nerve fibers and helps increase the speed of electrical impulses significantly.
In patients with MS, myelin is damaged causing a disruption in the impulses and leading to decreased cellular activity. Overtime, the damaged cell or area can become scarred and hence the name multiple sclerosis, or multiple areas of scarring. As the immune system attacks the myelin, this insulating layer becomes inflamed and can cause damage to the nerve itself as well. There is no one particular known cause for MS, and can be either genetic, environmental or a combination of both.
Due to the vastness of the brain matter and the uncertainty of immune response, there are a variety of neurological symptoms that a patient may experience, and in some cases, the disease may go undiagnosed for years. Relapsing-remitting neurological symptoms in various parts of the central nervous system are often clues to physicians of the diagnosis itself, as symptoms may occur and disappear with no significant issue. The patient may feel fine and be completely fine for months or even a few years before experiencing neurological symptoms again. MS is generally diagnosed in those in their 20s and 30s, but can often be diagnosed much later on in life for patients who do not experience as many symptoms, or not as often.
As Dr. Minagar mentioned, MS may occur sporadically in different parts of the white matter, and at very unpredictable times, and can be hard for patients to fully understand what is going on. Constellation of signs includes numbness or weakness of one side of the body, electrical shock sensations when moving the neck in certain positions, unsteady gait, falls, memory loss, or tremor. As a neurological disease, some patients may also experience incontinence or loss of bladder and bowel control. As the optic nerves are also part of the central nervous system, patients may also experience loss of vision in normally one eye at a time associated with eye pain on movement, blurry or double vision, flashes of light, or decreased color acuity. In patients with MS, optic neuritis is of grave concern as it can often lead to permanent blindness. MS also affects the gray matter of the brain and such process leads to loss of nerve cells (neurons) and their axons. Loss of gray matter, clinically, shows itself by dementia, memory loss, and general loss of cognitive faculties.
Dr. Minagar explains that initially diagnosis can be difficult in patients who have only experienced one episode of isolated neurological symptoms (a condition known as clinically isolated syndrome), but as the disease course goes on and patients begin to follow a relapsing-remitting pattern with new symptoms or re-occurrence of old ones, physicians should have a high index of suspicion for MS, and should send the patient for an MRI of brain/spinal cord immediately. Through MRI, physicians will be able to see areas of damage, also called lesions, in the white matter, and many times there will be multiple present as many patients will have had a few different flare ups of their MS. MR images also enable physician to diagnose and assess the gray matter loss and destruction of the nerve cells (neurons) and their extensions.
While there is no cure for MS unfortunately, Dr. Alireza Minagar points out there are many medications that can help slow the disease course as well as prevent or treat flare ups, and most of these medications are aimed at decreasing immune response as well as inflammation. The good news is that many neurologists and neuron-immunologists around the globe is doing extensive research to find a cure for MS, and we hope that one day not far from today, they will hit the target.