Multiple Sclerosis is a disease affecting the central nervous system in young adults at the prime of their lives. The peak age of onset is 20-40 years. It involves demyelination (rubber coming off the wire) of the central nervous system. The myelin is produced by Oligodendrocytes which are supportive cells in the central nervous system. Myelin is produced by Schwann cells in the peripheral nervous system and hence it is not affected by this disease. Multiple sclerosis can be familial and first degree relatives are at an increased risk. Where a person spends the first 15 years of the life can have a bearing for the risk of acquiring Multiple Sclerosis. Higher latitudes confer an increased risk but whether this is solely due to low levels of Vitamin D seen in the higher latitudes in not entirely proven. Human brain is laid out in a fashion that the cell bodies (soma) are located close to the surface of the brain and the cell arms (dendrites) and tail (axons) are located internally. Since Multiple Sclerosis affects the dendrites and axons, the disease is primarily seen in the white matter of the brain, deep inside. It shows up as lesions of demyelination in the white matter. Some of them can enhance or light up with a contrast dye.
Multiple Sclerosis can present with a myriad of symptoms. In some patients the disease heralds its onset with Optic Neuritis, an inflammation of the second nerve head located in the center of retina, the screen where we see images in our eyes. It is often painful. The characteristic phrase for this condition is “the patient sees nothing and the doctor sees nothing”. This implies that the patient has a blurry vision and the doctor may find no abnormalities in many cases as the inflammation may be just behind the optic nerve head. Red color vision may be affected disproportionately. The condition is treated with high dose steroid and the vision usually improves with time but some deficit may persist.
MRI of the brain is then done to see if other areas of the brain are also affected. If there is evidence of multiple lesions in the brain then the diagnosis of Multiple Sclerosis is made.
In other patients multiple sclerosis may start with an attack resembling a stroke like picture but happening not as quickly as a stroke. So, there can be numbness, tingling, tremors, weakness or paralysis, double vision, pain and incoordination. Gait may change. Even incontinence is possible. Main treatment of repeated attacks or relapses like this is intravenous steroid for a few days followed by an oral taper.
MRI, Spinal tap to check for specific abnormalities indicating MS and evoked potentials showing slowed impulse transmission are the usual tests to confirm the diagnosis.
The disease is treated with medicines to control the immune system in the central nervous system. Starting with self-injectable Interferons in the 1990s and to current treatments with infusion of monoclonal antibodies, the treatment choices have exploded in the past 30 years. Monoclonal antibodies such as Natalizumab (Tysabri) and Ocrelizumab (Ocrevus) are powerful treatment to stop the disease progression in many patients. 4-Aminopyridine or Ampyra is approved by FDA for improving gait in Multiple Scelrosis. Oral medicines like Fingolimod (Gilenya), Dimethyl Fumarate (Tecfidera) and Teriflunomide (Aubagio) provides for convenient intake.
A large number of patients of Multiple Sclerosis use marijuana to treat pain, spasticity and emotional distress. Both CBD and THC have a role here.
Physical therapy and occupational therapy are frequently needed. Depression may require regular anti-depressants or medical marijuana can help.
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