MULTIPLE SCLEROSIS AND OTHER AUTOIMMUNE NEUROLOGICAL DISORDERS

Innovative treatments and caring physicians

MULTIPLE SCLEROSIS AND OTHER AUTOIMMUNE NEUROLOGICAL DISORDERS

Innovative treatments and caring physicians

MULTIPLE SCLEROSIS (MS)

Multiple sclerosis (MS) is an autoimmune disorder, which is a disease in which the body’s immune system targets normal, healthy tissue. The immune system is designed to recognize foreign substances—whether they are bacteria, viruses, parasites, or foreign proteins—and initiate a response to attack and destroy these invaders. The immune system also plays a critical role in preventing cancer, identifying malfunctioning cells and initiating an attack on them before they can grow and spread.

Autoimmune disease occurs when this normal, healthy response is directed against normal proteins on the body’s own cells.  Depending on which organ is affected, a specific syndrome arises. If it is the skin, psoriasis, eczema, or vitiligo may occur.  If it is the internal organs, patients may develop cirrhosis, kidney failure, heart failure, or respiratory failure. There are many autoimmune disorders that affect the brain, nerves, and muscles—the most common of which is multiple sclerosis.

In MS, the immune system attacks myelin, which lines our nerve cells and helps signals transmit quickly from the brain and spinal cord to the rest of our body’s nerves and muscles. When myelin is damaged, the nerve cells begin to malfunction. Sometimes, the nervous system can repair itself from these attacks and symptoms may improve on their own. But even when repair has occurred and symptoms improve, the symptoms can often recur when there is stress on the body such as heat exposure, fatigue, sleep deprivation, or when a patient is ill with the flu or other infection. If multiple sclerosis is left untreated or is particularly active permanent damage can occur. Most of the time, long term treatment is needed to prevent further attacks or progression of the disease.

Several other disorders are very similar to multiple sclerosis both in how they attack the nervous system and the symptoms they create. It is important to differentiate these disorders from multiple sclerosis as they often require different treatments. Neuromyelitis optica (also known as NMO or Devic disease) is one such disorder that often causes more severe weakness and vision changes than typically occur in MS.  Anti-MOG associated and Anti-GFAP associated disorders mimic both multiple sclerosis and NMO but can be differentiated by blood work.  Paraneoplastic syndromes are a large and highly variable group of autoimmune disorders that can be associated with cancer, attack healthy nervous system structures, and cause a wide array of symptoms.

Finally, patients with other autoimmune disorders such as sarcoidosis, lupus, Sjogren’s disease, or vasculitis may suffer neurological symptoms when the brain is also involved.  These patients benefit from co-management by multiple specialists in addition to a neurologist—including pulmonologists and rheumatologists.

MULTIPLE SCLEROSIS (MS) SYMPTOMS

The symptoms of multiple sclerosis are highly variable and require a thorough assessment by a skilled neurologist. Multiple sclerosis has a tendency to affect younger patients (ages 20s-40s) and affects women more often than men. Symptoms of an MS attack develop slightly slower than a stroke (which reaches its worst point within seconds to minutes), but still develop relatively quickly (usually getting to their worst point within a few days).

The symptoms that develop depend on what area of the nervous system is attacked. Multiple sclerosis can affect the nerves and muscles in the eyes, causing vision loss or double vision. It may cause numbness or weakness in one arm or one side of the body.  When the spinal cord is attacked, it may case similar numbness or weakness to the arms and/or legs with associated bowel and bladder symptoms.  A whole host of other symptoms are associated with multiple sclerosis including trigeminal neuralgia (sharp, brief stabbing pain on one side of the face), fatigue, anxiety or depression, muscle cramps or spasms, impaired balance, and pain —but it is important to remember that these symptoms alone do not necessarily make a diagnosis of MS and can occur in many other diseases as well. This is why specialty evaluation is often needed to distinguish MS from other neurologic and non-neurologic diseases.

How we can help

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Evaluation

Patients with suspected multiple sclerosis should be seen by a neurologist. Sudden onset of new neurologic symptoms should always be evaluated in an emergency department.

The most important part of evaluating for multiple sclerosis is a careful history and detailed neurologic examination. Lab tests and other evaluations may be performed to evaluate for diseases that can mimic multiple sclerosis. A spinal tap is needed for some patients but is not always necessary to make a diagnosis. Imaging tests (particularly MRI scans of the brain or spinal cord) can also help confirm a diagnosis of multiple sclerosis. It is important to remember that abnormalities on an MRI can be caused by many different diseases. A neurologist can help evaluate the “whole picture” (history, exam, and test results) to determine whether someone has multiple sclerosis or another disease. Sometimes, even after a comprehensive evaluation there may be some uncertainty regarding a diagnosis. In these cases time, symptom management, and close monitoring may be necessary to obtain a clearer answer.

Treatment

The first treatments for multiple sclerosis became available in the 1990s, and in recent years the treatment options have expanded greatly. This has given neurologists an arsenal of therapeutic options for combating the disease. Multiple sclerosis is now a much more treatable disease than it once was and many patients are able to live full and active lives despite their disease. Treatment for multiple sclerosis is divided into two categories:  disease modifying therapy, which alters the immune system and minimizes ongoing or new damage, and symptomatic agents, which help control symptoms and improve quality of life on a day-to-day basis.

Choosing a disease modifying therapy requires careful consideration of each patient’s disease severity, other medical illnesses, and life plans (for example, plans for pregnancy). Possible side effects of the medications must be considered as well. Clinic evaluations and periodic MRIs are used to evaluate the effectiveness of a therapy over time, and lab tests are often used intermittently to evaluate for side effects of the medications. There has been some evidence linking vitamin D levels to disease activity in multiple sclerosis, so a vitamin D supplement may also be recommended for some patients.

Symptomatic medications help with other day-to-day symptoms of MS including fatigue, stiffness, pain, mood issues, and bowel or bladder problems. Many non-medication treatments such as physical and occupational therapy, assistive devices, counseling, and diet and exercise adjustments can also be very helpful in symptom management. Our goal is to find the right combination of treatments to help each patient live a meaningful and enjoyable life.

Information for Providers

If referring from outside the WVU system, please ensure that patients bring a CD with all pertinent imaging studies with them to their appointments.

Often we are able to obtain images electronically as well, but it is best for patients to bring the images with them as well as a failsafe. Complete medical records and lab results also allow us to provide a more thorough and complete evaluation at a first visit.

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