Written by Daria Sysoeva and Edited by Alexander Alva
The brain is a complex network of neurons that are constantly communicating with one another. The myelin sheath, the protective coating surrounding neurons, is important in facilitating the rate of neuronal communication [1]. Multiple sclerosis is a disorder where the immune system attacks the central nervous system, fragmenting and often destroys the myelin sheath. In patients with multiple sclerosis, the immune system sets off inflammation responses along the nerves and supporting cells, damaging their myelin sheath [2]. Since the myelin sheath is integral in communication, the destruction of this protective layer results in improper communication between the brain and the rest of the body [3]. This obstruction leads to symptoms including impaired coordination, vision problems, problems with balance, and slurred speech [4]. How this disease comes about is still being studied, but there is some evidence suggesting that the development of multiple sclerosis involves the combination of genetic and environmental factors [2].
There are four types of multiple sclerosis (MS): Relapsing-Remitting MS (RRMS), Secondary-Progressive MS (SPMS), Primary-Progressive MS (PPMS), and Progressive-Relapsing MS (PRMS) [2]. The most common form of MS is RRMS, which is present in approximately 85% of patients. Patients with RRMS experience sporadic inflammatory attacks, which cause damage to the central nervous system [2]. Remission, or periods of time when symptoms disappear, is also very common in RRMS, however, even during remission, MS is still active [5]. SPMS, the second most common form, is characterized by a more consistent decline of health, while PPMS is present in about 10-15% of patients and affects the spinal cord more than the brain [5] [2]. The rarest form of MS is PRMS, which is present in only about 5% of patients and does not have remission periods, but may have sporadic relapses of symptoms [2].
Although there is no cure for multiple sclerosis, there are some promising FDA-approved treatments that are available. The most popular treatment for multiple sclerosis is the usage of beta interferon drugs [6]. The specific mechanisms that these drugs use to undermine this disease remains largely unknown, but beta interferon is known to regulate the immune system by reducing inflammation and protecting nerve cells from potential damage caused by MS [7].
In addition to drug therapy for MS, there are also a few non-drug reliant treatments that help make MS more manageable. These types of treatments are called non-pharmacological cognitive treatments, and the three most well-known are sleep, aerobic training, and neuropsychological rehabilitation [8]. Sleep is crucial for MS patients who may experience poor sleep quality as a symptom, where sleep deprivation may worsen symptoms of MS, as it is associated with general cognitive decline. Another treatment that may improve cognitive function is aerobic training. Studies that tested aerobic training’s effects on cognitive performance suggest that it may improve cognitive functions such as working memory and selective attention due to more oxygen entering the brain [8]. A relatively new treatment for MS is neuropsychological rehabilitation, which is used in helping patients recover from other brain injuries. This type of treatment is often personalized to the patient, and its general goal is to help patients understand their condition as well as to strengthen certain cognitive functions through exercises [9]. Despite the variety of treatments and therapies available, none guarantee a cure. Research regarding new treatments and therapies remains underway as scientists are still trying to fully understand this disease.
References:
- Williamson, J.M., Lyons, D.A. (2018). Myelin Dynamics Throughout Life: An Ever-Changing Landscape?. Frontiers in Cellular Neuroscience, 12:424.
- “Nerve cells (neurons).” Multiple Sclerosis Trust, 2018, Accessed 26 Jan. 2021.
https://mstrust.org.uk/a-z/nerve-cells-neurons#:~:text=During%20an%20MS%20attack%2C%20th e,nerve%20become%20delayed%20or%20blocked. - Ghasemi, N., Razavi, S., Nikzad, E. (2017). Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell journal, 1:1-10.
- “MS Symptoms & Diagnosis.” Bayer Health Care – Multiple Sclerosis, Accessed 26 Jan. 2021. https://www.multiplesclerosis.com/global/symptoms_and_diagnosis.php.
- “Types of MS and MS Treatment Options.” Bayer Health Care – Multiple Sclerosis, Accessed 26 Jan. 2021. https://www.multiplesclerosis.com/global/treatment.php.
- Goldenberg, M.M. (2012). Multiple Sclerosis Review. P & T: a peer-reviewed journal for formulary management, 37:175–184.
- Minagar, A. (2013). Current and Future Therapies for Multiple Sclerosis. Scientifica, 2013:1-11.
- Miller, E., Morel, A., Redlicka, J., Miller, I., Saluk, J. (2018). Pharmacological and Non-pharmacological Therapies of Cognitive Impairment in Multiple Sclerosis. Current Neuropharmacology, 16:475–483.
- “Neuropsychological Rehabilitation: A Primer for Physicians.” UHHospitals, 2019, Accessed 26 Jan. 2021. https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2019/10/neuropsychological- rehabilitation-a-primer-for-physicians.