Multiple sclerosis

Summary

Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS. They can include visual disturbances, muscle weakness, trouble with coordination and balance, sensations such as numbness, prickling, or “pins and needles”, and thinking and memory problems. No one knows what causes MS. It may be an autoimmune disease, which happens when your immune system attacks healthy cells in your body by mistake. Multiple sclerosis affects women more than men. It often begins between the ages of 20 and 40. Usually, the disease is mild, but some people lose the ability to write, speak, or walk. There is no single test for MS. Doctors use a medical history, physical exam, neurological exam, MRI, and other tests to diagnose it. There is no cure for MS, but medicines may slow it down and help control symptoms. Physical and occupational therapy may also help.

(2022, Autoimmune Association)

A neurological disease that is thought to be triggered by environmental factors in individuals with genetic susceptibility. MS causes immune attacks on the axons and myelin in the CNS that cover nerve fibers, which causes permanent communication problems between your brain and the rest of your body.
MS can be divided into 5 different disease subtypes: 

• Radiologically isolated syndromes

• Clinically isolated syndromes

• Relapsing-remitting MS

• Secondary progressive MS

• Primary progressive MS

(2022, Global Autoimmune Institute)

Symptoms

Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. Symptoms often affect movement, such as:

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or your legs and trunk

• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)

• Tremor, lack of coordination or unsteady gait

Vision problems are also common, including:

• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement

• Prolonged double vision

• Blurry vision

Multiple sclerosis symptoms may also include:

• Slurred speech

• Fatigue

• Dizziness

• Tingling or pain in parts of your body

• Problems with sexual, bowel and bladder function

(2022, Autoimmune Association)

Muscle weakness or numbness, difficulties with balance, paralysis, paresthesia, pain, Lhermitte’s sign (electric-shock sensations that occur when bending the neck forward), sexual dysfunction, migraines, blurred or complete loss of vision, red-green color distortion, speech impediments, dizziness, hearing loss, cognitive impairments, and depression. 

Individuals with MS can experience a broad range of symptoms that are dependent on the amount and type of nerve damage that occurs. In fact, most people with MS will likely only experience a few of the known symptoms. Relapsing-remitting cycles of MS progression are not uncommon with relapses developing over days or weeks and remission that last months or years.  

(2022, Global Autoimmune Institute)

Diagnostic Criteria

(Multiple Sclerosis Centers of Excellence, 2022)

Study Classification Criteria

Under Investigation

Diagnostic Tests

Under Investigation

Organized Autoimmunity

(Alternative Autoimmune Disease Classification: FIEM, MIEM or BIEM, or FEM, MEM or BEM)

1. sex predominance (is an autoimmune disease primarily found in genetic Females, Males, or equally in Both?)

   1. Under Investigation

2. Inherited and acquired gene variations that cause increased susceptibility

   1. Human Leukocyte Antigen (HLA) Associations

      1. HLA-DRB1*15:01, acts as a co-receptor for Epstein-Barr virus to enter B cells (Menegatti et. al, 2021)

   2. Other Gene Variations (mutations)

      1. Under Investigation

3. Gene Triggering Environmental Exposures

   1. Infections

      1. Epstein Barr Virus (2022, Bjornevik) (Menegatti et. al, 2021)

      2. H. pylori (Deretzi et al, 2015).

   2. Toxins

      1. Under Investigation

   3. Stress

      1. Needs to be assessed for each patient

4. Multiple interactive and destructive immune system pathologies

   1. Under Investigation

Tissue-Type or Cell-Type Attacked

Under Investigation

Treatment(s)

• Clemastine, an antihistamine studied for its role in myelin repair (myelin is the fatty coating on neurons that expedite messages in the brain) (Caverzasi et. al, 2023)

• Tyruko (natalizumab-sztn), a biosimilar to Tysabri (natalizumab) for the treatment of adults with relapsing forms (FDA Approved)

• Tysabri (natalizumab) injection (FDA Approved)

Managing Specialist(s)

• Neurologist

Research Authors

Under Investigation

Research Institutions

Under Investigation

Average Time from Symptom Onset to Diagnosis

Under Investigation

Last Updated

August 29, 2023

References

2017 McDonald Criteria. Multiple Sclerosis Centers of Excellence, U.S. Department of Veterans Affairs. (2022, July 06). Retrieved December 06, 2022, from https://www.va.gov/MS/Professionals/diagnosis/Updated_McDonald_Criteria_2017.pdf

Bjornevik K, Cortese M, Healy BC, Kuhle J, Mina MJ, Leng Y, Elledge SJ, Niebuhr DW, Scher AI, Munger KL, Ascherio A. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science. 2022 Jan 21;375(6578):296-301. doi: 10.1126/science.abj8222. Epub 2022 Jan 13. PMID: 35025605.

Caverzasi E, Papinutto N, Cordano C, Kirkish G, Gundel TJ, Zhu A, Akula AV, Boscardin WJ, Neeb H, Henry RG, Chan JR, Green AJ. MWF of the corpus callosum is a robust measure of remyelination: Results from the ReBUILD trial. Proc Natl Acad Sci U S A. 2023 May 16;120(20):e2217635120. doi: 10.1073/pnas.2217635120. Epub 2023 May 8. PMID: 37155847; PMCID: PMC10193980.

G. Deretzi, J. Kountouras, S. A. Polyzos, E. Koutlas, S.-H. Pelidou, G. Xeromerisiou, C. Zavos, I. Tsiptsios. Polyautoimmunity in a Greek cohort of multiple sclerosis. Acta Neurologica Scandinavica. 2015 April: 131: 225–230. https://doi.org/10.1111/ane.12308

Menegatti J, Schub D, Schäfer M, Grässer FA, Ruprecht K. HLA-DRB1*15:01 is a co-receptor for Epstein-Barr virus, linking genetic and environmental risk factors for multiple sclerosis. Eur J Immunol. 2021 Sep;51(9):2348-2350. doi: 10.1002/eji.202149179. Epub 2021 Jun 3. PMID: 34019695.

Multiple Sclerosis. Autoimmune Association. (2022, April 30). Retrieved November 26, 2022, from https://autoimmune.org/disease-information/multiple-sclerosis-ms/

Multiple Sclerosis. Global Autoimmune Institute. (2022). Retrieved November 26, 2022, from https://www.autoimmuneinstitute.org/multiple-sclerosis/