Multiple Sclerosis: An Introduction
This is my first post for my new blog Perspectives in MS on Healthline, a blog that will examine multiple sclerosis from every angle. The main requirement I made with regards to this blog was that it would be entirely free from the influence of commericial interests. Readers should know that the opinions I express in this blog are not in any way sponsored by any pharmaceutical company.
Multiple sclerosis (MS) is a disorder of the central nervous system, which is composed of the brain and spinal cord. The illness affects about one in 750 people in the United States, which means there are currently about 400,000 people living with the illness. It typically affects people in the prime of their life, between the ages of 15 and 40. Aside from trauma, it is the major cause of neurological disability in young people.
MS is a mysterious illness. No one knows what causes MS, though certain risk factors have been identified. Once the illness has been diagnosed, it is not possible to provide anything other than a very general prognosis, though there are certain risk factors associated with an aggressive course of the disease.
To understand what happens in MS, it is important to review some basic neuroscience:
Neurons, the main cells in the brain, are composed of a cell body, called a soma, and a tail, called the axon. The cell bodies of neurons are in the outer part of the brain, called the grey matter, while the axons are in the inner part of the brain, called the white matter. Axons are the means by which neurons communicate with each other, and the structure of the axon can be compared to a telephone cord. The axon is the wire at the center of the cord. Each axon has a protective coating composed of fats and lipids, termed the myelin sheath. Myelin is made by cells called oligodendrocytes.
What Happens in MS
MS is considered an autoimmune disorder, meaning that the immune system of an otherwise normal person is tricked into attacking healthy parts of the body. In the case of MS, the primary target of attack by the immune system is the myelin sheath, though with advanced disease the axon itself can be damaged. When this happens, conduction within the nervous system slows, and patients can develop neurological symptoms. There is also some evidence that degeneration of the oligodendrocytes plays a role in the destruction of myelin in MS.
Treatments for MS
The first treatment for MS, an injectable interferon medicine called Interferon-B, was introduced in 1993. There are currently three formulations of this medicine, knows as Avonex, Betaseron, and Rebif. Today, the first-line treatments for almost all MS patients are still interferon medications or Copaxone, another injectable medication. These medicines have been used by hundreds of thousands of people over the years and have a very strong track record in terms of both safety and efficacy. However, they are far from a cure and have potentially intolerable side effects for many patients. In recent years, more powerful therapies, including an oral medication, have been approved and many more are likely to emerge in the near future. Nothing is for free, however, and with these more powerful treatments come more powerful, even potentially lethal, side-effects.
In this blog, I look forward to discussing many aspects of this potentially disabling illness. In future posts I will discuss the cause, diagnosis, symptoms, and treatments of MS. I also hope the address the many areas of controversies and disagreements that frustrate doctors and patients alike. I look forward to hearing feedback from readers and answering any questions that may arise.