Multiple Sclerosis Questions Answered

What is multiple sclerosis, or MS?

Multiple sclerosis is a condition in which there is an abnormal immune response directed against the central nervous system. This includes the brain, spinal cord, and optic nerves. Immune cells mistakenly target myelin, which is a fatty layer that surrounds the axons of the nerves. When axons are damaged, they cannot transmit signals from the brain to the rest of the body. 

Is multiple sclerosis treatable?

A couple of decades ago, there were very limited treatment options for multiple sclerosis. But thanks to research, we now consider MS to be a very treatable condition. 

What are the treatments for MS?

The treatments available for MS can be generally classified as injectable treatments, tablets, and IV infusions.

Injectable treatments include:

  • glatiramer acetate (Copaxone)
  • interferon beta-1a (Avonex)

Tablets include:

  • fingolimod (Gilenya)
  • teriflunomide (Aubagio)
  • dimenthyl fumarate (Tecfidera)
  • cladribine (Mavenclad)

IV treatments (intravenous infusions) include:

  • natalizumab (Tysabri) 
  • ocrelizumb (Ocrevus)

There are many more treatment options not listed here.

What causes multiple sclerosis? 

The short answer is: We don’t know yet.

MS is thought to result from a combination of factors. These include individual susceptibility as determined by one’s genetic makeup, their lifestyle factors, the environment in which they live, and exposure to possible infectious agents. Each one of us may have one of these risk factors, but MS seems to occur in individuals for whom all of these factors converge at a particular point in time.

Multiple sclerosis was thought to be a condition that primarily affected Northern Europeans. Then we found that the farther away people moved from the equator, the higher their chances became of developing multiple sclerosis. That’s not always true; there are some pockets around the equator that have a higher incidence of MS. But in general, we think that the farther away you move from the equator, the more likely you are to develop MS. The cause of this is unclear, but there are a few proposed mechanisms. One of them is a vitamin D deficiency caused by less exposure to sunlight.

Another study showed that when a young person moves from an area of low MS prevalence to an area of high MS prevalence—for example, if someone moves from China to the U.S.—they have a higher chance of developing of MS. Their chance of developing MS becomes similar to that of a person born and raised in the U.S. rather than someone born and raised in China.

These are among the many proposed mechanisms for the causation of multiple sclerosis. It should still be remembered that the exact cause of MS remains unclear.

Is multiple sclerosis genetic? 

MS is not a genetic disease, meaning it is not inherited from a parent. Huntington’s disease is an example of a genetic disease. However, there is a risk that could be inherited from family members and this could contribute to the dysregulated immune response. If you have no known family member with a history of multiple sclerosis, your chance of developing multiple sclerosis in the United States is typically one in 1,000. If you have an identical twin with multiple sclerosis, then your chance of developing MS is one in four. If you have a first-degree relative who has multiple sclerosis, such as your mom or dad, your chance of developing MS would be five times higher than the general population, so that would be one in 200.

What age does someone usually see symptoms of multiple sclerosis? 

MS is conventionally thought to be a disease that affects young individuals, around 20-40 years of age. Most of our patients do notice their first symptoms during that age range. However, symptoms of MS can begin in childhood and older adulthood as well.

Do environmental factors play a role in multiple sclerosis?

This is a concern for many patients. They are worried that being exposed to a certain type of virus triggered their MS. Multiple sclerosis is not directly caused by an infectious agent, so it’s not an infectious disease in that sense. It does not spread from one person to another person, and there is no proven way to prevent MS.

But it is thought that some infectious agents, such as the often-cited Epstein-Barr virus, may trick the immune system because they have certain components that resemble those of myelin. Therefore, the immune response that is initially directed against the virus may later be directed at something in the body that resembles the virus in some way. This phenomenon is called molecular mimicry. It is one of many potential mechanisms that are attributed to multiple sclerosis.

Can Covid-19 cause multiple sclerosis?

Currently, coronavirus is not thought to cause MS directly. However, we still have much to learn about the relationship between autoimmune conditions and viruses. It’s a long process from the point of getting exposed to a particular virus to the immune system getting confused to developing a particular disease. During that process, people are likely exposed to many viruses.

What are the differences among MS treatments?

In general, we are moving away from injectable medications because they are less effective at stopping the immune response against the brain and thus less effective at controlling the disease process. Most of the tablet options are considered to have intermediate efficacy, with an exception of caladribine, or Mavenclad, which is thought to be a high-efficacy medication. IV infusions are thought to be of high efficacy. They do the best job of stopping the abnormal immune response against the brain.

What is the frequency of IV infusions treatments for MS patients?

One of the main reasons IV infusions have been successful is that these medications are less disruptive to people’s lives. Infusions may be dosed once a month or once every six months. Some are even administered a few times a year for a couple of years, and then patients are done with the treatment for the rest of their lives. Depending on the medication, it typically takes anywhere between two to six hours to undergo an infusion. Receiving an infusion doesn’t automatically mean you will be admitted to the hospital. There are outpatient infusion centers around the country, including here at Barrow.

What can I expect during an infusion treatment for MS?

Before receiving your infusion, a nurse will review the medications you are taking and make sure that your vital signs, such as blood pressure and body temperature, are normal. Before you receive the actual medication, you may be given what we call “premeds” to ensure you don’t develop any adverse reactions to the infusion. Premeds may include Zofran for preventing nausea, Tylenol for preventing a fever, or Benadryl for preventing itching or rashes.

A lot of our patients are quite relaxed while receiving their infusions. They are able to scroll through their phones, work on their laptops, watch movies, read books, or listen to music. A nurse will periodically check on you to see if you are developing any infusion-related side effects. Once your infusion is done, you are observed for another 30 minutes or so and then discharged.

What are the side effects of MS infusion treatment? 

The majority of infusions are safe, and most of our patients do not experience any side effects. Some patients develop itching or a rash and others may develop flu-like chills or shivers. Other possible side effects may include a sore throat, a flushed feeling in the face, and cold-like symptoms. In extreme cases, patients can develop an anaphylactic reaction, which is a very severe form of allergic reaction during which the person can stop breathing. This kind of reaction may require emergency resuscitative measures, which infusion centers are prepared to perform.