Physician's Notebooks 9 -- http://physiciansnotebook.blogspot.com - See Homepage
22. Multiple Sclerosis – Update 13 Septr 2021
The following Column in order of appearance in the text allows you to search & find or scroll to a particular subject of the chapter
The following Column in order of appearance in the text allows you to search & find or scroll to a particular subject of the chapter
MS Names & Brief Description
Genetics
What is the Disease Process
Why Does Someone Get MS
Behaviors that Worsen MS
Behaviors that Worsen MS
MRI Has Revolutionized Early Diagnosis of MS
Researchers discovered some causes of MS
Preventives of MS
Treatments
End Note: Clinical Trials Website and Coenzyme Q10
MS Names & Brief Description: Multiple Sclerosis (Commonly, MS; but in French, La sclérose en plaques, or SEP) strikes young adults (and may occur in middle age) and may de form a life. (Loss of sensation, inability to pass urine, weakness in walk, early dementia)
Genetics: If MS is diagnosed in your identical twin, your risk to get it is 1 in 3; if in your non identical twin, 1 in 25 same as in your brother or sister; in your parent, 1 in 50; in your first cousin, 1 in 100; and compare a general risk without family involvement of 1 in 1000. Further genetic interest is that the presence of Human Lymphocyte Antigen DR2 increases risk to get MS by 5, and HLA DR3, B7, and A3 increases risk by 3. The HLA genetic markers may be tested for easily. (Click 3.7 The HLA System - Predictor of Disease)
What is the Disease Process?
Neurons are Nervous System cell bodies from which nerve fibers grow in order to transmit or receive signals. The fibers are for electrical transmission. Myelin sheaths (see below figure) improve transmission of signals. The formation of myelin sheaths starts in the fetus and is not complete till age 20s.
Myelin Sheathing of Peripheral Nerve Fibers
MS is due to an attack by a type of white blood cell on the myelin sheaths in the CNS. This attack causes severe inflammation. With damage to the myelin sheath, the nerve impulses get slowed and short-circuited within and between nerve trunks in brain and spinal cord.Why does someone get MS?
Factors that put one at risk to get Multiple Sclerosis are: Gender, it is 2 to 3 times more frequent in females; there is genetic DNA from parents that affects the inflammatory process making it more likely that the white cell will attack its own body tissue; also, there is low level of protective factor, vitamin D, which explains why a person in high or low latitudes (away from the Equator) has higher risk of MS; and, finally, an inciting immunologic factor in childhood. A recent finding of borderline low vitamin B12 in blood and the CSF (cerebrospinal fluid) in MS patients should alert to sensitivity to vitamin B12 deficiency as risk factor for getting MS. The interesting effects of introducing new infection to a "virgin" population is seen in the Faeroe Islands where MS was unknown until British troops occupied them during World War 2 after which successive "epidemics" of MS have hit. Similarly in Iceland. But this should not imply a direct infection; rather, an immune response to a previously not-experienced infection by a DNA-susceptible isolated population.
Interplay of disease cause and effect: One effect – demyelination – gives the diagnosis and an understanding of the symptoms and the modes of presentation during points in life. Knowledge leads to treatment and lifetime management.
In typical form, MS comes on as an attack and each attack is based on a limited area of CNS nerve fiber demyelination. Its effect at micro-level (single neuron) is to impair nerve impulse. When it occurs locally (in spinal cord or brain nerve fibers that control muscle) the affected part becomes weak or a patient experiences pin and needle numbness. If it occurs with enough neuron fibers, in particular location in the brain, one gets loss or weakness of function (e.g., paralysis when major motor nerve bundle demyelinates, or blindness when optic nerve demyelinates or dementia in cerebral white matter demyelination).
Behaviors and States that Worsen MS: A useful fact to know about MS symptoms are that they are quickly worsened by increase in body heat starting at as little as 0.5 degrees C (0.9 F). Also tobacco, fatigue and hyperventilation worsen symptoms quickly.
Demyelination in MS is episodic and focal and with each attack an imperfect repair occurs. MS starts in young adult, often with dramatic symptom. (Acute loss or blurring of vision one eye) An episode develops over hour to days, lasts week to months, improving gradually and, after first attack, sometimes completely. Then time passes during which it seems the illness is cured (average interval between attacks 2 to 3 yrs) before another attack occurs. Attacks are partly progressive with some improvement in remission but not back to original state and gradually the bad effects sum so as years pass the patient is left worse from each attack. Eventually sufferers are bed-ridden and demented. Variations are seen ranging from very rapid progression ending in death to single attacks that never again recur.
MRI Has Revolutionized Early Diagnosis of MS: Until MRI, the MS patient waited years before sure diagnosis could be made. Thus an attack of one-sided paralysis might be first diagnosed as stroke; an attack of temporary one-eye blindness as toxic; a picture of dementia, as Alzheimer's. Not only did this make neurotic wrecks of MS victims, it led to wrong treatment. In 2021 an MRI of spinal cord can diagnose MS before it shows symptom. Today if you have suggestive neurological symptom, an MRI of brain and spinal cord may be in order.
Accurate, early diagnosis improves life because it stimulates MS patient to start psychoanalysis and lifestyle change. And to do preventive treatments as detailed.
Researchers discovered some causes of MS. First, immune stimulators: Cases of MS may be brought-on or worsened by the older rabies vaccination. (Now replaced in U.S. by vaccine that has no CNS tissue.) And it is known that some MS may rarely be a late complication of measles and other viral infection including flu. And MS after trauma to back or head is controversial but seems to fit idea of tissue damage provoking immune-inflammatory response. However, the causes given so far only account for 1% of MS.
Preventives of MS are: 1) Assuring normal vitamin D blood levels by routine test as part of yearly blood sample and, if low, take vitamin D to normalize. Also megavitamin vitamin B12 and folic acid pills where increased risk for MS exists. 2) Avoidance of childhood viral respiratory infections. (Hygienic measures and sensible avoidance of infected persons, e.g., the current Covid-19 precautions) 3) Anti-inflammatory treatment using acetaminophen (or aspirin or NSAID in limited dose). 4) Not participating in baby-making (controversial) if you test for HLA-DR2 and other HLA increased risk variants (Premarital testing) or persons with close DNA relative having MS. Also, a baby born in November has significantly lowest risk to get MS and a baby born in May has highest risk. 5) Avoid untried or obsolete immunizations (but not Covid-19) like Rabies using non human vaccine. (Still used in foreign countries outside U.S.A.)
Treatments:
Psychoanalysis (Click 9.33 Psychoanalysis - Secret of Do It Yourself) does not cure or even reduce frequency of MS attacks but is important because a patient needs to decide what his or her goals in life are and then must integrate this lifetime illness and types of treatment with a life's plan.
Corticosteroids Zivadinov R, et al., in Neurology 57:1239, 2001, show that monthly high dose IV corticosteroid (methyl prednisolone 1 gram IV daily for 5 days per month over 5 years) reduced the number of and shortened the length of attacks of MS, and the treatments increased the interval of remission, reduced brain atrophy and physical disability and may slow the progress of MS so that a patient may live a full life and not get complications. (I have had the 5-day treatment to prevent cornea implant rejection.) Warning: do not substitute same level dose oral corticosteroids! A good study has shown only the IV steroid treatment works.
Several other recently developed treatments are being hyped but none has shown as good results as the corticosteroid treatment. If I got a first attack of MS, I would start a life regimen of daily oral vitamins B12, 2 milligrams, and vitamin C 6 grams, and be sure to keep my vitamin D blood levels normal by regular testing and vitamin supplement, and would strive to live a very healthy lifestyle according to Physician's Notebooks and get hold of a neurologist at University-HMO, expert in MS, who will treat each subsequent MS attack aggressively immediately with the IV courses of methyl prednisolone. Such a regimen may result in only one attack (or not more than one per 5 year intervals) and a normal active life. The guidance of an MS expert medical team will be important but one should keep one's own control, using the advice of this chapter and one's own seminar study (if possible also involving other educated, interested persons).
End Note: Clinical Trials Website: A current list of clinical trials maintained by the National Multiple Sclerosis Society is accessible by clicking http://www.nationalmssociety.org/research/clinical-trials/clinical-trials-in-ms/index.aspx. Finally, a recent trial of coenzyme Q10 (a semi-vitamin) using massive doses, 1200 mg per day, was found to offer marginal advantages in the progression of the disease over 6 to 18 months measured by certain scores of overall daily function. (See Adams and Victor's Principles of Neurology, 10th ed., page 1082, right column, bottom paragraph)
End of Chapter. To read next click 9.23 Psychosurgery/Brain Surgery and Tumors
1 comment:
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