Multiple Sclerosis: A Primer

Think today’s technology is complicated? Even the latest advances don’t measure up to what’s going on inside your body. Your central nervous system is an intricate network that allows the brain and spinal cord to communicate with other parts of your body. But like any complex system, any problems with it can have widespread and potentially devastating effects.

Multiple sclerosis — or MS for short — is one of the most common diseases of the central nervous system. It affects more than 2.5 million people worldwide, and Canada has the highest rate of incidence. The disease can be relatively mild for some patients and devastating for others. It’s difficult to diagnosis, often misunderstood and the subject of a lot of media attention in recent months.

Want to know more? Here’s a quick look at MS, including its symptoms and controversial new treatment.

What is MS?

While doctors aren’t sure exactly what causes MS, they do know there’s a strong immune system component. Experts classify MS as an autoimmune disease — a condition where the immune system turns on its own tissues, joints and organs — but experts are still at a loss as to what triggers this harmful response.

In the case of MS, the problem lies with the myelin sheath — a fatty material that protects and insulates nerve cells and allows them to communicate with each other quickly and easily. A smooth operating system is important because it takes countless communications (or nerve impulses) to make even the simplest of movements we take for granted.

With MS, inflammation and damage to the myelin sheath can slow down or stop these nerve impulses and cause a wide range of symptoms. Plaques or lesions appear on the brain and spinal cord where myelin is lost. This scarring give the disease its name: “multiple sclerosis” which means “many scars”.

So why can some MS patients lead a relatively normal life while others are confined to wheelchairs? There are four different kinds of MS. In Relapsing Remitting MS (RRMS), patients experience periods of remission punctuated by flare-ups or episodes where new symptoms appear or existing ones get worse. Patients experience plenty of “ups and downs”, but they usually don’t face increasing disability.

In contrast, Primary Progressive MS (PPMS) doesn’t have periods of relapse or remission — the course is more like a steady accumulation of disabilities. Secondary Progressive MS (SPMS) can start out with remissions and relapses, but then the disease starts to get worse. Finally, in Progressive Relapsing MS (PRMS), the rarest of all types of MS, patients experience a steady decline in health in addition to attacks.

What are the warning signs?

As you might expect from a central nervous system disorder, the effects can be widespread — and that makes for a long list of possible symptoms. Some common ones include:

Fatigue. Unpredictable, debilitating fatigue is the most common symptom of MS.

Eye and vision problems like double vision, blurred vision, loss of vision (usually in one eye) and uncontrollable eye movements.

Balance and coordination problems such as loss of balance, lack of coordination, vertigo, muscle tremors or spasms, muscle weakness and difficulty walking or standing.

Altered sensations or pain. People with MS can experience numbness, tingling, burning sensations or “pins and needles” feeling as well as various types of pain — including muscle pain, stabbing pains and facial pain.

Speech and swallowing symptoms like slurred speech, slow speech, difficulty speaking or problems chewing and swallowing.

Bowel and bladder symptoms including constipation, diarrhea, incontinence and sudden urges to urinate.

Brain and cognitive symptoms such as depression, dizziness, difficulty concentrating or making decisions, poor short-term memory and difficulty reasoning and solving problems.

Sexual issues like impotence, loss of interest and loss of sensation can also affect patients with MS.

Many people with MS are also sensitive to heat, which can make symptoms worse.

Not everyone who has MS experiences all of these symptoms. Different people experience different symptoms at different times — and some people have much more severe symptoms than others. MS usually shows up between the ages of 20-40, but it’s rarely seen in children or people over age 55.

Notice a trend? Many of these symptoms can be attributed to conditions such as other autoimmune disorders, migraines and certain types of cancer — making MS difficult to spot.

In addition, there isn’t a single test or scan for MS. Instead, doctors have to make a “clinical diagnosis” — that is, they watch patient’s symptoms and run tests to rule out other causes. Scans can show the presence of lesions, but doctors also rely on diagnostic criteria set out by the Multiple Sclerosis International Federation (MSIF). It can take months or years, not to mention trips to various specialists, before MS is officially diagnosed. People can be misdiagnosed initially and not get the right treatment.

How is it treated?

Right now there isn’t a cure for MS, but many patients can control the disease through medications for:

Treating the flare-ups. Steroids like methyl-prednisolone are often prescribed for short-term use to reduce inflammation and help reduce exacerbation of the disease. However, this class of drugs doesn’t stop the progression of the disease.

Treating the disease itself. Disease-modifying medications can be used to reduce the number and severity of flare-ups, prevent new lesions from forming and even help slow the accumulation of disability.

Treating the symptoms. Some medications help ease specific symptoms rather than acting on the disease itself. (For instance, there are medications to help with pain.) However, experts have to be extremely careful in treating specific symptoms, and any medication has to fit into the overall treatment plan.

Unconventional therapies. While their use is still somewhat controversial, some patients are turning to complementary and alternative medicine (CAM) therapies for relief. For instance, some evidence suggests that tai chi and yoga can be beneficial for MS patients, and “non-traditional” therapies like reflexology, acupuncture, chiropractic medicine and massage may help some people. Some supplements like vitamin D, antioxidants and omega-3 and omega-6 fatty acids could also have benefits.

However, not a lot is known about the success of these therapies, and they may be more successful for some patients than others.

The controversial new treatment

CAM therapies and new drugs aren’t the only innovations in treating MS. By now you’ve likely heard of chronic cerebrospinal venous insufficiency (CCSVI) — a theory developed by Dr. Paolo Zamboni from the University of Ferrara, Italy. Essentially, the theory posits that veins in the neck and head of MS patients may be narrowed or blocked, and this can cause improper blood flow and drainage. New blood vessels can grow to compensate, only they aren’t as strong as their predecessors and can leak blood. Iron deposits from this leaked blood could be triggering an immune system and causing MS.

Enter the “Liberation Treatment” — a procedure where a surgical balloon is inserted and inflated to “open up” the narrowed or blocked veins. Following this procedure, some MS patients report experiencing a dramatic improvement in their symptoms. Some patients have even travelled outside of the country to receive the treatment.

However, both the theory and the procedure are mired in controversy. For instance, more recent studies have found that there is a link between CCSVI and MS, but there isn’t any proof that CCSVI actually causes the disease. A recent study published in the April 2011 edition of Neurology found that while there is an increased prevalence of CCSVI in MS patients, the rate isn’t as high as originally thought. Furthermore, CCSVI was also found in healthy patients (the control group) as well as in patients suffering from other neurological conditions. ( Read the abstract here.)

In short, the new treatment can’t be heralded as a success just yet — there are still too many questions. Still, experts agree that CCSVI can play a valuable role in treating MS even though no one is sure how. For instance, experts have to develop standards for imaging and diagnosis, and there needs to be a closer look into how CCSVI and lesions might be connected.

Furthermore, the treatment is so new that no one knows how safe or effective it is, how long the effects will last and what possible short- and long-term consequences could occur. While various governments and charitable organizations are setting aside money for clinical trials, when and where they will occur and who can participate is still unclear. Currently, testing for CCVSI isn’t available in Canada.

In other words, don’t expect to see widespread use of the Liberation Treatment any time soon. The process is going to take a lot of time. Right now the only option for patients not able to wait for the tests or procedure is to go outside the country — and bear the expenses themselves.

(For more information about CCVSI and ongoing research in Canada, visit the Multiple Sclerosis Society of Canada’s CCSVI and MS website.)

In the meantime, experts note not to get discouraged. A lot of exciting things are happening with MS research, and all the attention the disease has been getting is helping with awareness and understanding.

Where to find more information

We’ve provided a quick overview of MS, but there are many good resources online where you can find out more about the disease, support and current research.

Here are some places to start:

Multiple Sclerosis Association of America
Multiple Sclerosis International Federation
Multiple Sclerosis Society of Canada
National Institute of Neurological Disorders and Stroke
PubMed Health (from the U.S. National Center for Biotechnology Information)