MULTIPLE SCLEROSIS

About the disease:

Multiple sclerosis is a condition that can affect both the brain and spinal cord, affecting vision, leg movement, sensation, or balance. The state is lifelong; however, often, the impact of the disease is mild. 

Types of multiple sclerosis:

MS is of two types

Relapsing-remitting MS: This is the most common type of MS. Relapsing multiple sclerosis is a condition where the patients will have relapses and a period of stability. Relapsing/remitting MS is more common in younger patients.Primary progressive MS: In this MS, relapses rarely occur. However, the symptoms gradually increase with the progression of the disease.

Symptoms:

• Fatigue

• Difficulty in walking

• Vision problems

• Numbness and tingling

• Muscle stiffness

• Impairment in thinking, learning, and planning

Etiology:

MS is an autoimmune disease. Immune cells attack the myelin sheath (the layer that protects the nerves). Myelin sheath is an insulating layer around the neurons. When the insulating sheet is damaged, messages traveling along the neurons may be slowed or blocked. This results in the impairment of neural transmission. 

Diagnosis:

• Blood tests: Specific biomarkers to diagnose MS are under development. However, blood tests rule out other diseases having similar symptoms.

• Liver function tests

• Renal function tests

• Spinal tap: Spinal fluid is removed from the spinal cord and is tested for antibodies associated with MS

• MRI helps to identify the lesions on the brain and spinal cord. The diagnosis is straight forward and is usually confirmed with MRI. It is tough when there are unusual symptoms or progressive disease. However, NICE guidelines recommend not to diagnose MS on MRI alone. 

Mortality:

Life expectancy is slightly reduced in patients suffering from MS.

Treatment options:

• Aubagio: The drug acts by blocking the enzymes that activate the white blood cells.

• Fampyra: Fampyra is a potassium channel blocker. It reduces the level of potassium transmission, enabling the signals to pass down usually. 

• Gilenya: This is the first drug approved for MS. The drug acts by binding to white blood cells and retaining them within the lymph nodes. This prevents WBC from damaging the nerve cells.

• Lemtrada: This is a monoclonal antibody that targets immune cells that are involved in damaging the nerve cells.

• Mavenclad: It works by reducing the number of B cells and T cells that are involved in the destruction of the myelin sheath. 

• Ocrevus: The drug targets the B cells, which are involved in damaging the nerve cells. 

• Tysabri: The drug acts by binding to T cells, preventing the cells from reaching the brain and spinal cord, thereby protecting the myelin sheath. 

Other measures: 

NICE guidelines recommend avoiding smoking in patients suffering from MS