Posted by Brigham and Women's Hospital April 3, 2013
“Multiple sclerosis (MS), translated literally, means multiple scars,” says Dr. Howard Weiner, Director, Partners Multiple Sclerosis Center and Co-Director, Center for Neurologic Diseases at Brigham and Women’s Hospital (BWH). Brain scans of patients with MS clearly show the scarring that occurs with this progressive neurologic illness. “The good news,” Dr. Weiner notes, “is that there are now several treatment options available and all have beneficial effects for MS patients.”
Dr. Weiner, along with Dr. James Stankiewicz, BWH Department of Neurology, recently presented the latest views on the causes and treatment of MS, as well as current research, at a lecture sponsored by the McCourt Foundation.
1. Who develops MS?
MS affects about 400,000 people in the U.S. It usually develops in people between the ages of 18 and 50. Women are two and half more times likely than men to develop the illness. MS occurs more frequently in patients who live in northern climates (latitudes above the 37th parallel).
2. What are the risk factors for MS?
“MS is thought to be caused by a combination of factors,” says Dr. Stankiewicz. Exposure to the common Epstein-Barr virus may be one factor that triggers the disease. It also is believed that certain genetic variants may make people more susceptible to MS. Family members of patients with the disease are at increased risk of developing it. Finally, environmental factors, such as Vitamin D levels and possibly sunlight exposure, appear to play a role in whether a person develops MS.
3. What happens when patients have MS?
MS is considered an inflammatory disease in which the body’s immune cells attack the nerve cells in the brain and spinal cord. The attack of these inflammatory cells causes damage to the myelin sheaths (outer covering of nerve cells) as well as the axons or bodies of the nerve cells. Symptoms of MS include vision problems, difficulty walking, pain, muscle weakness, and fatigue. As many as half of people with MS may also experience problems with concentration, attention, and memory.
4. There are several types of MS:
- Relapsing-Remitting MS (RRMS): With RRMS, the most common form of MS, patients experience attacks or flare-ups of MS symptoms followed by periods where symptoms improve or diminish.
- Secondary-Progressive MS (SPMS): In this stage, MS symptoms worsen more steadily. Dr. Weiner has observed that 85 percent of patients have RRMS at time of diagnosis, but, over time, the course of the illness changes for many patients. Ten years after diagnosis only 40 to 45 percent of patients have RRMS, with 40 to 45 percent advancing to SPMS.
- Primary-Progressive MS (PPMS): In this less common type of MS, symptoms steadily worsen from the time of diagnosis. An increased number of men experience PPMS compared to other forms of MS.
5. How is MS treated?
Dr. Weiner recommends beginning treatment with disease-modifying drugs as early as possible to prevent and minimize scarring to the brain. At the present time, he notes, there are several disease-modifying agents, including both injectable drugs and oral medications. A new oral medication is expected to be available in April 2013.
Dr. Stankiewicz also considers Vitamin D supplements in treatment and adds that lifestyle changes, such as keeping stress levels manageable and exercising, will help patients manage their symptoms. Finally, he emphasizes that smoking should be avoided, as it has been clearly shown to worsen MS..
6. What is the focus of MS research?
“It’s an exciting time in the area of MS research. Our current challenge is how to find effective treatments for a chronic disease whose progression can vary considerably,” says Dr. Weiner.
For the past ten years, Dr. Weiner has studied over 2,000 MS patients as a part of the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB). The goal of CLIMB is to use advanced brain imaging to better understand MS and why some patients do better than others. With improved understanding, Dr. Weiner is convinced new treatments can be developed that will halt the progression of all types of MS and reverse the neurological problems it causes. He even believes that a vaccine could eventually be developed to prevent MS altogether.
Interested in learning more? Visit our Partners Multiple Sclerosis Center.
– Jamie R.