Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
Like lupus, psoriasis, and rheumatoid arthritis, multiple sclerosis (MS) is one of more than 100 autoimmune diseases. In autoimmune diseases, the body’s immune system misfires. Instead of attacking foreign invaders such as viruses and bacteria, the immune system sends in its armies of inflammatory substances to attack the body’s own healthy tissues. Normally, when our immune systems encounter an intruder, they “memorize” its features and put certain cells on permanent lookout for it. In people with autoimmune disorders, this tricky process of identifying and memorizing enemies has gone awry, and a friend gets permanently mistaken for a foe. In the case of multiple sclerosis, that unfortunate friend is the central nervous system—the spine, brain and nerve cells that carry electrical signals throughout the body.
It’s not yet clear why some people get MS. We know that people with MS appear susceptible to other autoimmune diseases, and we know that such conditions run in families and are more prevalent in certain ethnic groups. In fact, prevalence of MS among children or siblings of affected people is 20 to 40 times higher than that among the general population, and having an identical twin with the disease puts one at up to 300 times greater risk. But genes are not the whole story. If they were, then the sibling of each and every identical twin who had MS would also get the disease, since their genes are identical. Instead, many scientists believe that a genetic predisposition for MS means the body will lie in “wait mode” until some environmental factor triggers the disease. This theory also applies to other autoimmune diseases such as lupus and rheumatoid arthritis, but with MS, scientists have zeroed in on a likely culprit…the Epstein-Barr virus.
Unfortunately, EBV, as it’s known, is among the most common and contagious viruses transmitted between humans. A type of herpes, it’s spread from person to person through saliva, and is therefore often transmitted through kissing and sexual contact, although it’s also possible to get it from being sneezed or coughed on, eating or drinking after someone with the virus, or from putting an object (such as a toothbrush, pacifier, or toy) in your mouth after it’s been used by someone else.
EBV infections usually aren’t serious. It’s the virus that causes mononucleosis, which is sometimes called “mono” or “the kissing disease,” common among teenagers. Its symptoms can include fever, sore throat, fatigue, loss of appetite, muscle soreness, and a rash. Its most famous symptom, fatigue, can sometimes last for months, after the other symptoms have resolved. Many people become infected with EBV without knowing it because they never experience any symptoms at all.
The Epstein-Barr virus never really goes away after infection. Instead, it lies dormant, and sometimes later in life it can become reactivated, with a similar set of symptoms to those associated with the initial infection.
While the link between EBV and MS is intriguing, it has not been definitively established. Certainly we know that people who have been infected with EBV are at considerably higher risk of MS than those who haven’t. In fact, in one study, the MS risk of people who’d been infected with EBV infection was 32 times higher than that of people who’d never been infected. Still, more study is needed to determine whether EBV directly causes MS and, if so, how. One thing is clear…having had EBV is not cause for alarm. Some 95% of adults have been infected, yet less than one half of 1% develop MS.
A competing theory is that MS is triggered by traumatic brain injury. In one study, having a concussion early in life was associated with a 30% greater risk of developing MS. This, too, requires more research.
In MS, the immune system attacks a specific component of the central nervous system, a kind of protective covering surrounding nerve fibers known as the myelin sheath, which is a bit like the rubber that encases the wire in an electrical cord. Given that analogy, it’s not hard to imagine what happens when that protective coating is destroyed by inflammatory substances released by the immune system. The “wire” inside—the nerve itself—then becomes susceptible to damage, and the transmission of signals gets disrupted. Over time, parts of the brain and spinal cord develop areas of scarring known as “sclerosis.”
Because nearly everything we do is controlled by the nervous system, damage to it can have a devastating effect on everyday life. Depending on where in the body the nerve damage occurs, and depending upon the severity of that damage, people with MS may lose the ability to walk, to see properly, and to control their bladders, and they often experience unpleasant symptoms such as numbness, tingling, weakness, and spasming.
The progression of MS can follow any of three patterns:
There is no cure for MS, but there are treatment options for various aspects of the disease.
For acute attacks…physicians may use corticosteroids including oral prednisone to calm the inflammation that is causing the flare-up. Another treatment for attacks is known as plasmapheresis or plasma exchange. First, blood is taken from your body. Then the blood cells are separated from the plasma (the liquid portion of the blood) and combined with albumin. The mixture is then reinjected into the body.
To modify the disease’s progression…doctors and patients have several therapies from which to choose. Unfortunately, these often come with serious health risks. They include monoclonal antibodies, oral medications, and injections. Examples are glatiramer acetate, interferon beta drugs, monomethyl fumarate, dimethyl fumarate, teriflunomide, fingolimod, ozanimod, siponimod, ponesimod, cladribine, ocrelizumab, alemtuzumab, and natalizumab.
For treatment of symptoms…doctors may prescribe or recommend muscle relaxants, anti-fatigue medications, physical or occupational therapy, drugs to increase walking speed, or drugs to combat insomnia, sexual problems, urinary or bowel incontinence, pain, and depression.
