A glitch in the brain: understanding multiple sclerosis

On 23 August, Hollywood actor Selma Blair posted a sweet, funny, yet heartbreaking message on Instagram. The female lead of Brown’s Requiem was diagnosed with multiple sclerosis (MS) last year. The auto-immune disease has taken a toll on her but hasn’t crushed her.

What is multiple sclerosis?

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MS is a chronic condition of the central nervous system (CNS). It is characterized by disruption of neuronal signals within the body and brain - leading to mild to severe disability. It is believed to be caused by the breakdown of myelin sheath — a layer around neurons that helps them conduct information quickly and efficiently — in brain cells.

Who gets MS?

There is no known cause for multiple sclerosis; it can affect anybody. However, according to the National Institute of Health, UK, this condition usually affects people in their 20s and 30s, with a two to three times higher risk in women than in men.

In India, the mean age of people living with MS, as recorded by the All India Institute of Medical Sciences (AIIMS) registry, is slightly higher at 33 years, give or take nine years. According to the AIIMS data, the male to female prevalence ratio in India is 0.65.

In “Multiple Sclerosis: An overview”, published in the Annals of Indian Academy of Neurology, Dr Bhim Singh Singhal, director of neurology at the Bombay Hospital Institute of Medical Sciences, wrote that with wider availability of MRI scans, the number of MS diagnosis in India is on the rise. Still, the country-wide prevalence is hard to gauge as advanced medical facilities and the collection of epidemiological data continue to pose challenges in many rural and semi-urban areas.

Some factors that increase the risk of multiple sclerosis include:

• Genetics/family history
• Age and gender
• Environmental factors such as smoking and vitamin D deficiency
• According to the National Multiple Sclerosis Society, U.S., immigration to a particular area predisposes the person to the MS risk factors of that area
• Though it might show up immediately in children, adults are more likely to transfer the risk to the next-generation rather than have the condition themselves

Symptoms

MS symptoms can vary from one individual to another, and in the same individual over time. The primary symptoms include tingling sensation and numbness in the body, fatigue, dizziness, vision problems, difficulty walking, depression and reduced cognition.

Apart from this, MS is also associated with secondary, lifestyle problems like bladder infections because of repeated UTIs, pressure sores, weakness, decreased bone density and loss of muscle mass due to inactivity. Depression and social isolation comprise the tertiary symptoms of MS.

Diagnosis

Since the early symptoms of MS overlap with other mental health conditions, it is often misdiagnosed. However, early detection is the only way to delay severe symptoms. Doctors use a combination of a blood test, cerebrospinal fluid analysis, MRI and sensory perception tests to check for the presence of MS in patients. According to the NHS, UK, confirmatory diagnosis can only be made if there is evidence of at least two separate attacks, either noticeable or detected on an MRI. MRI is the best imaging technique for MS diagnosis since it can detect even minor brain scars.
A recent study, published in the peer-reviewed journal Computer Methods and Programs in Biomedicine, showed that computer-aided diagnosis (CAD) system based on electroencephalogram (EEG) can help in the early diagnosis of multiple sclerosis. The study assessed MS patients during visual attention tasks - in which patients were asked to focus on a particular colour or direction. Real-time readings of their brain activity were taken using EEG. The study concluded that the method was helpful in accurately diagnosing the severity of MS with high sensitivity. Though the procedure is still under research, it may have a major impact on MS diagnosis in the future.

Treatment

MS cannot be cured completely. Physiotherapy and medications are used to manage symptoms and maintain health. Steroids and muscle relaxants are generally given to reduce the duration of MS attacks and to ease muscle spasms.
In 2018, ocrelizumab, a monoclonal antibody-based drug was approved by the U.S. Food and Drug Administration, as a disease-modifying medication for primary progressing and relapsing multiple sclerosis. Monoclonal antibodies are immune system proteins that target specific cells or tissues.

As per Cyndi Zagieboylo, President and CEO of the National MS Society, U.S., this is the first-ever drug approved for progressive MS and could be a “real game-changer” in MS treatment.

Clinical studies indicate that intravenous administration of ocrelizumab can reduce the risk of disability by at least 24% and reduce the risk of flares by 47% in multiple sclerosis patients.

However, this drug comes with all the risks of a monoclonal antibody - from a high risk of infections to an infusion reaction. An allergy that develops after the administration of the drug, infusion reaction can be life-threatening. Immediate discontinuation of the drug is usually advised in such cases. People living with MS who have received this drug should bring any skin rashes, itching or hives to their doctor’s attention.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest online resource for verified medical information. At myUpchar, researchers work closely with specialist doctors to bring you reliable information on all things health. To read more on this topic, please visit https://www.myupchar.com/en/disease/multiple-sclerosis