Ep 92 Multiple Sclerosis: Scarred nerves & skating saints

Early diagnosis of multiple sclerosis (MS) is crucial for effective treatment and management of the condition. Nikki, who was diagnosed in 2007 at the age of 27, shared her experience of being diagnosed after experiencing only headaches, which turned out to be a symptom of MS. Had her GP not discovered it when she did, Nikki might not have shown any symptoms for a decade, and her condition would have been much worse. The diagnostic process involved various tests, including a spinal tap, which she described as a painful experience. After several attempts with different medications, Nikki found relief with an infused medication, but the high cost and side effects are challenges she continues to face. Nikki's story underscores the importance of being proactive about health concerns and advocating for timely and appropriate medical care.

Living with multiple sclerosis (MS) comes with numerous challenges and uncertainties. MS affects people differently, and for Nikki, her condition has led to various symptoms such as coordination and balance issues, numbness and tingling, fatigue, speech difficulties, and bladder control loss. Her condition also increases her risk for PML, a potentially life-threatening brain infection. Despite these challenges, Nikki remains grateful for her ability to walk and live a relatively independent life. However, she fears the future and the potential burden she may become to her loved ones as her condition progresses. The uncertainty and fear of the unknown can be overwhelming, but Nikki tries to focus on the present and find joy in her daily life. Ultimately, living with MS requires resilience, acceptance, and a positive attitude.

Key takeaway from this discussion about multiple sclerosis (MS) is that while we can learn a lot about the specific biology of this complex disease, it's essential to remember that the experience of someone living with MS goes beyond diagnostic criteria and measurable scales. MS is an autoimmune inflammatory, chronic, demyelinating neurodegenerative disease of the central nervous system, characterized by demyelination, inflammation, and scar formation. The most common form is the relapsing-remitting type, affecting up to 90% of cases, while the primary progressive form accounts for about 10%. The discussion highlighted the importance of listening to people's stories and acknowledging the feelings and challenges they face, emphasizing the inadequacy of our current definitions and measures of diseases. The podcast also paid tribute to Sylvia Lowery, a pioneer in raising awareness and research funds for MS, and shared a recipe for Sylvia's Sour, a quarantini cocktail named in her honor.

Myelin is a crucial component of our nervous system, acting as an insulating sheath around nerve fibers to enable proper signal transduction. Demyelination, the destruction of this sheath, can lead to various neurological symptoms due to impaired nerve impulses. Multiple Sclerosis (MS) often begins with a clinically isolated syndrome, which is the first manifestation of the disease. This syndrome can present as various neurological symptoms depending on the location of demyelination in the brain or spinal cord. For instance, optic neuritis, affecting the optic nerve, can result in vision loss or changes. Demyelination can occur in any part of the white matter, leading to a wide range of symptoms, including weakness, spasticity, abnormal sensation, and autonomic dysfunction. The demyelination process in MS happens gradually, and while there is no cure, remyelination is possible in some cases.

A clinically isolated syndrome (CIS) in multiple sclerosis (MS) is characterized by neurological symptoms that last for at least 24 hours. These symptoms, such as loss of vision, tingling, or weakness, can be indicative of MS if accompanied by typical MRI findings. The presence of multiple lesions on MRI, even without clinical symptoms, can also lead to an MS diagnosis. Untreated, MS often leads to recurrent relapses and progressive worsening of disability due to damage to the underlying nerves during each demyelination event. Early diagnosis and treatment are crucial for managing the condition effectively.

Multiple Sclerosis (MS) is a complex condition involving damage to the myelin sheath surrounding nerve fibers in the brain and spinal cord. While the brain and spinal cord can repair the myelin sheath, the process results in scarring, or gliosis, which leads to progressive disability over time. This damage is not only due to the direct impact on the myelin sheath but also from inflammation that harms the cells responsible for making myelin. The body's natural repair process includes regeneration and scar formation, but the scarring can result in neuronal damage. MS symptoms, such as fatigue, are believed to result from multiple areas of demyelination affecting various signals in the nervous system. There are two primary forms of MS: relapsing-remitting MS, where discrete relapses are followed by periods of recovery, and primary progressive MS, where neurologic function worsens continuously from the onset. Despite ongoing research, the ultimate cause of MS and the underlying mechanism of damage remain unclear. Autoimmunity, specifically B cells, T cells, and self-reactive antibodies, are known to play a significant role in MS's mechanistic underpinnings.

MS, or Multiple Sclerosis, is an immune-regulated disease where the immune system mistakenly attacks the myelin sheath protecting nerve fibers in the central nervous system. This damage accumulates over time, leading to the symptoms associated with MS. The exact cause of MS is still unknown, but there are several genetic and environmental factors that have been linked to an increased risk. These include genetic polymorphisms near or in regions involved in immune response, decreased sun exposure or low vitamin D levels, smoking, and Epstein-Barr virus (EBV) infection. EBV, a human herpes virus, is particularly interesting as it preferentially infects and replicates in B lymphocytes, the cells responsible for producing antibodies. EBV has been implicated in the development of various cancers and has long been suspected as a potential factor in MS due to findings in cerebrospinal fluid. Recent evidence has provided strong support for this theory. While we don't have all the answers yet, understanding these factors can help in the ongoing research and potential prevention or treatment strategies for MS.

Recent scientific research provides strong evidence that infection with the Epstein-Barr Virus (EBV) significantly increases the risk of developing Multiple Sclerosis (MS). This association is supported by numerous studies, including a recent one published in Science, which found a 32-fold increase in risk for those who had EBV seroconversion before MS diagnosis. The study also identified a causal relationship between EBV infection, axonal degradation, and MS diagnosis. Additionally, another recent paper discovered antibodies produced in people with MS that bind to a specific EBV antigen and cross-react with a human cell surface protein associated with autoimmune demyelination. While the exact mechanisms of how EBV infection leads to MS are still unknown, these findings suggest that EBV is a necessary precursor to the development of MS. With this new understanding, there is a growing emphasis on early detection and treatment, including disease-modifying therapies that target B cells and other components of the immune system to prevent damage and prolong the time between relapses.

The evolutionary origins of Multiple Sclerosis (MS) remain a mystery due to the lack of clear knowledge on its causation. MS is a complex disease that may involve interactions between genetic predisposition, environmental factors, and viruses like EBV. While it's suggested that humans' large brains and high myelination may contribute to MS, the exact reason why humans develop MS while other primates don't is still unclear. Additionally, the shift in the gender ratio of MS diagnoses over the past century could be due to various factors, including changes in diagnosis methods and societal attitudes towards women's health. The earliest recorded cases of MS date back to the 14th century, with Saint Ludwina of Schiedam being one of the first documented cases. Despite these historical records, the disease's causes and origins remain elusive, making it a significant challenge for researchers to understand.

The history of multiple sclerosis (MS) diagnosis and treatment is marked by uncertainty and a lack of effective interventions. This is evident in the cases of Ludwina of Schiedam, the earliest recorded case of MS symptoms, and Augustus Dest, a grandson of King George the 3rd who also experienced MS symptoms. Ludwina's case is debated, but it seems more likely to be MS than other early stories. Dest's diaries provide valuable insights into the disease and its impact on daily life. However, treatments during their times were varied and often ineffective, including leeches, hot baths, and electrotherapy. Even after MS was formally described as a disease, doctors continued to experiment with different therapies without much success. These historical accounts highlight the challenges faced in understanding and managing MS and the progress made over time.

Jean Martin Charcot, a French neurologist and pathologist, played a significant role in the identification and early description of Multiple Sclerosis (MS). Charcot, who worked at a teaching hospital for poor Parisian women, noticed unusual plaques in the nervous systems of several deceased patients who had reported symptoms like numbness, vision problems, and movement difficulties. He believed these plaques indicated a new disorder, which he described in detail in a series of lectures in 1868. Charcot's descriptions, which included the disease's symptoms, pathology, and potential causes, remained influential for decades. However, some of his beliefs, such as the idea that emotional stress could cause MS, were later disproven. Despite this, Charcot's work sparked significant interest in MS research and helped shape the understanding of the disease for many years.

The historical context of medical discoveries and prevailing medical thought significantly influenced the diagnosis, treatment, and understanding of Multiple Sclerosis (MS). From the mid-1800s onward, advancements in microscopes and autopsies led to the identification of MS, but researchers also proposed various microbes as potential causes due to the germ theory trend. More recently, attention has turned to the role of the gut microbiome in MS. Early attempts to treat MS with antibiotics reflect the prevailing medical thought at the time, and diagnosis was often challenging due to reliance on observable signs rather than symptoms. People with MS were frequently diagnosed with other conditions, such as neurosyphilis or hysteria, and the stigma surrounding "invisible diseases" continues to this day. Pierre Marie's quote from the early 1900s, expressing optimism about preventing MS with a substance like coke, remains relevant as research continues to unravel the complexities of this debilitating disease.

The lack of visible symptoms in people with Multiple Sclerosis (MS) has led to a history of misdiagnosis and misunderstanding of the disease. MS was once commonly misdiagnosed as hysteria, and people living with MS were diagnosed as hysterical well into the mid-20th century. However, with the increase in neurologists and large-scale studies, MS became better understood, and awareness and diagnosis rates increased. The disease's pattern of occurring more frequently in northern climates has led some to suggest a historical connection. Sylvia Lowery, whose brother had MS, played a significant role in raising awareness and funding for MS research by founding the National Multiple Sclerosis Society and the Multiple Sclerosis International Federation. Her efforts helped bring together leaders in the field to set objectives for understanding and finding a cure for MS.

The story of multiple sclerosis (MS) is one of resilience, advocacy, and medical advancements. The founding of the National MS Society in the 1940s marked a turning point, leading to a significant increase in awareness and support for those affected. Celebrities and politicians played a crucial role in amplifying the cause, leading to resources and funding for research. Key medical advancements, such as clinical trials and the MRI, revolutionized the understanding and diagnosis of MS. Today, while there are effective medications to manage symptoms, there is still much to learn about the disease, including its causes and the full scope of its impact. With an estimated 2.2 million prevalent cases worldwide, MS remains a pressing health issue, particularly in North America and Western Europe.

While there is a correlation between multiple sclerosis (MS) and geographical locations closer to the equator having lower rates and northern latitudes having higher rates, it's not a definitive rule. Indigenous populations in northern areas can have very low MS rates. Migrants from low-risk areas to high-risk areas still maintain their low risk, but their children may have a higher risk. Prevalence of MS has increased due to earlier diagnosis and better treatments, leading to more diagnosed cases and longer lifespans. In 2016, over 18,000 deaths and 1,000,000,001 disability-adjusted life years were attributed to MS. Research on MS is crucial not only for understanding the disease but also for neurodegeneration and cell regeneration, leading to new treatments for MS and related disorders. New studies suggest that EBV infection may be a necessary precursor to MS, implying potential prevention through EBV infection prevention.

The rapid advancements in mRNA technology developed for COVID-19 vaccines are now being applied to research on Epstein-Barr Virus (EBV) and its potential role in Multiple Sclerosis (MS). Moderna, a leading vaccine developer, has recently initiated phase one trials for an mRNA vaccine targeting EBV. This interplay between basic science research on one disease can have significant implications for others, opening up exciting possibilities for MS treatments, prevention, or even cures. Tune in for an upcoming episode where we'll dive deeper into the world of EBV with Dr. Mika Lufthig, an expert in the field. For more information, check out the book "Multiple Sclerosis: The History of a Disease" by Jock Murray, as well as various scientific papers on the topic, particularly those published in January 2022. The National MS Society website is also a valuable resource for understanding MS symptoms and research. Your support helps us continue producing insightful content. Stay tuned!