What is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disorder of the central nervous system, is characterized by myelin loss (damage of protective covering of nerve cells) and neuronal damage. The damage means the brain cannot send signals through body correctly. As a result, MS patients experience symptoms. MS is a long-lasting disease that can affect brain, spinal cord, and the optic nerves.

What causes Multiple Sclerosis?

Although the exact cause/etiology is unknown, it is considered to be of multifactorial. That means, when an individual with genetic susceptibility encounters environmental factors, a cascade of immune responses is triggered, which then leads to nerve demyelination, neuronal dysfunction, and neuronal cell death.

The environmental factors include:

Vitamin deficiency
Exposure to viral and bacterial agents such as Epstein Barr virus (EBV), Human Herpes virus type 6, and Mycoplasma pneumonia
Tobacco smoking / passive smoke exposure
Obesity in childhood and adolescence
Other potential associations including altered Microbiome and Hygiene hypothesis

“1966 Leibowitz et al. first suggested that the prevalence of MS was correlated with a childhood environment characterized by a high level of sanitation. Similar observations have led to the formulation of the hygiene hypothesis, which holds that a relative lack of “evolutionarily normal” childhood infectious exposures may predispose susceptible individuals to allergic and autoimmune diseases later in life. Recent findings that are consistent with the hygiene hypothesis have come from studies in epidemiology, immunology, and animal models, as well as successful clinical trials of probiotic treatment for allergic and autoimmune diseases. In this regard, many observers have noted that the prevalence of MS in the developed world far exceeds that of regions characterized by widespread childhood infection or poor sanitation.”

The MS subtypes and clinical course:

Radiologically isolated syndrome (RIS) (not officially recognized)
Relapsing Remitting MS (RRMS) – Symptomatic bouts with no apparent clinical worsening between bouts, and variable recovery over weeks to months.

Clinically isolated syndrome (CIS) (categorized as high/low risk for MS based on brain MRI) – first symptomatic relapse not meeting criteria for relapsing remitting MS.
Relapsing MS: recurrent MS inflammatory activity with at least one clinically symptomatic bout; recurrence may be defined by new silent MRI lesion or recurrent symptomatic relapse.

Progressive MS: gradual worsening of neurologic impairment not due to incomplete recovery from a relapse

Primary Progressive: onset with gradual progressive impairment.
Secondary Progressive: initial relapsing – remitting course followed by progressive worsening.

MS Symptoms

Common MS symptoms includes:

Sensory disturbances (numbness, tingling, itching, burning)
Walking difficulties (due to fatigue, weakness, spasticity, loss of balance and tremor)

Vision problems (diplopia, blurred, and pain on eye movement)
Intestinal and urinary system dysfunction (constipation and bladder dysfunction)
Cognitive and emotional impairment (inability to learn and depression)
Dizziness and vertigo
Sexual problems

MS Diagnosis

A complete neurological exam and medical history are essential in diagnosing MS.

MS diagnostic tools includes:

Blood tests – done to rule out other diseases with similar MS symptoms.
MRI with intravenous injection of a contrast highlight areas of MS (lesions) in the brain and spinal cord.
MRI is the most valuable tool to aid in the proper diagnosis of MS.

CSF analysis – done by a Spinal tap (lumbar puncture), in which a small sample of cerebrospinal fluid is removed from spinal canal. This sample can rule out infections and other conditions with symptoms like MS and can check abnormalities in antibodies that are associated with MS.

Evoked potential tests – records the electrical signals produced by the nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli and measures how quickly the information travels down the nerve pathways.

How do you treat MS?

MS therapies are based on the use of anti-inflammatory and immunomodulatory drugs, but these treatments are not able to stop the destruction of nerve tissue.

The initial treatment strategy for MS is largely based on disease-modifying drugs such as interferon-β and glatiramer acetate. The effects of these treatments are partially for symptomatic alleviation and do not stop the ongoing neurodegeneration.

Currently, a stem cell-based regenerative medicine paradigm has been proposed for the treatment of MS. Adult stem cells, including hematopoietic and mesenchymal stem cells (MSCs), are undifferentiated cells used to treat MS due to their immunomodulatory effects and neuroprotective potential.