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Multiple Sclerosis

Multiple Sclerosis or MS is a potentially serious medical condition that can be confusing and difficult for treatment and especially the adjustment by the individual. It is considered a disabling disease of the Brain and Spinal Cord that involves the Central Nervous System.

MS is classified as a demyelinating disease in which the covering (insulating) around the nerve cells of the brain and spinal cord are damaged. This damage can be permanent or transient and can cause symptoms that come and go. This “coming and going” of symptoms can be difficult for the adjustment of the individual. Sometimes symptoms are worse or non-existent in some cases.

When the covering of nerve cells is damaged, the ability of the nervous system to transmit signals can become increasingly difficult. This will result in the many varieties of symptoms seen in MS.

The most common “first” symptom seen is a change in vision such as blindness or double vision.  There may be eye weakness, loss of balance, and other symptoms as well.

Relapses of symptoms are not usually predictable and can occur without warning. However, some relapses have a trigger such as lack of sleep, stress, changes in seasons, sicknesses, and more.

Different Forms or Length of Symptoms

1.)  New Symptoms – initial symptom

2.)  Relapsing Symptoms – Symptom that comes and goes.

3.)  Progressive Symptoms – More prolonged symptoms that worsen over time.

Potential Causes

–  The overall cause is unclear
–  Possible destruction by the immune system
–  Failure to produce myelin-producing cells
–  Possible Genetic component
–  Possible Viral infection
–  Climate
–  Smoking
–  Autoimmune diseases
–  Others

Symptoms

–  Eye changes
–  Double Vision
–  Blurriness in one or both eyes
  –  Dizziness
–  Confusion
–  Muscle Weakness
–  Muscle Spasms
–  Pin and needles sensation
–  Numbness
–  Problems in speech
–  Problems in swallowing
–  Fatigue
–  Pain – joints, muscles, etc.
–  Bladder changes
–  Bowel changes

Diagnosis

1.) Initial symptoms cause a patient to see their medical provider

2.)  Lab work is done to better understand the other possible causes

3.)  MRI of brain and spine

4.)  The only definitive proof is an autopsy or biopsy of the lesions.

Lesions of the Brain

–  The defining diagnosis of MS are plaques or lesions in the brain.

–  These show the effect of the condition on the nervous system.

–  Most commonly affects the white matter in the optic nerve, brain stem, basal ganglia, and spinal cord.

–  More specifically, MS involves the loss of oligodendrocytes – the cells responsible for creating and maintaining the fatty layer or covering around nerve cells. The myelin sheath is the covering and this nerve helps carry the electrical signal from the brain to the rest of the body.

Treatment

1.)  Steroids

–  Corticosteroids such as Prednisone or IV Methylprednisolone are designed to help with Inflammation.

2.)  Plasmapheresis

–  This is a process of plasma exchange

–  The liquid portion of your blood – the plasma – is removed and separated from your blood

–  The blood cells are mixed with a protein solution and put back into your body.

–  This process can be used in new symptoms, severe symptoms, or when an individual doesn’t respond to steroids

3.)  Disease-Modifying Therapy (DMT)

–  Ocrelizumab (Ocrevus) – approved from primary-progressive MS

–  Using Ocrevus – the individual may progress less than someone who is untreated.

4.)  Injectable Treatments

–  Interferon Beta Medications

A.  Avonex – interferon beta-1a – approval 1996 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

B.  Betaseron – interferon beta-1b – approval 1193 for relapsing-remitting disease (RRMS)

C.  Extavia – interferon beta-1b – approval 2009 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

D.  Plegridy – pegylated interferonbeta-1a – approval 2014 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

E.  Rebif – interferon beta-1a – approval 1998 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

–  Glatiramer Acetate

A.  Copaxone, Glatopa – medication to help block your immune system’s attack on myelin – approval 2017 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

–  Disease-Modifying Therapy (DMT)

A.  Kesimpta (ofatumumab) – approval 2020 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

5.)  Oral Treatments

A.  Finolimod (Gilenya) – approval 2010 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

–  Can be used in patients 10 years and older

B.  Dimethyl Fumarate (Tecfidera) – approval 2013 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

C.  Diroximel Fumarate (Vumerity) – approval 2013 relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

D.  Teriflunomide (Aubagio) – approval 2012 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

E.  Siponimod (Mayzent) – approval 2019 – relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

F.  Cladribine (Mavenclad) – approval 2019 – relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

–  Good safety profile and therefore is used for inadequate response or tolerance to a different MS medication.

G.  Monomethyl Fumarate (Bafiertam) – approval 2013 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

H.) Ponesimod (Ponvory) – approval 2021 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

I.)  Ozanimod (Zeposia) – approval 2020 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

6.)  Intravenous Infusion Treatments

A.  Alemtuzumab (Lemtrada) – approval 2014 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

–  FDA recommends that this medication be reserved for those who have had an inadequate response or tolerance to 2 or more MS therapies

B.  Mitoxantrone (Novantrone) – approval 2000 for those where the neurological status is significantly abnormal between relapses.

C.  Ocrelizumab (Ocrevus) – approval 2017 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

D.  Natalizumab (Tysabri) – approval 2004 for relapsing forms of MS, Isolated syndrome, relapsing-remitting disease (RRMS), and active secondary progressive disease.

–  Not to be used in combination with another disease-modifying treatment or immune suppressant