Multiple Sclerosis: What It Is & What It Is Not

When people think of a face associated with MS, often times it is associated with a Caucasian person. Although the majority of MS cases being reported are in that population, there are many other faces of MS, including those of
African American men and women.

We hosted a Facebook chat with the Professor & Chair Head of the Department of Neurology, Annapurni Jayam Trouth, MD.

Question: What is Multiple Sclerosis (MS)? How do I know if I have MS? What causes the symptoms of MS?

Dr. Annapurni: Multiple Sclerosis is a disorder of the body’s immune system, where the body develops antibodies to the white matter (myelin) in the brain or spinal cord. These antibodies attack myelin, which is a protective covering around the nerves or tracts within the brain, causing inflammation and breakdown of the myelin and can ultimately affect the nerves also and cause cell death.

The transmission of information through the nerves is affected causing multiple symptoms like:

- weakness
- numbness
- visual impairment
- loss of vision
- imbalance
- double vision
- gait difficulties
- speech difficulties

Because the inflammation can subside on its own, multiple sclerosis is characterized by periods of remission and exacerbation. Exacerbations can be rapid in onset to developing over a few days and remissions can last from weeks to years. Relapsing Remitting Multiple Sclerosis is the most common presentation starting at a young age, even in the teens or earlier. The common age group involved is 20 to 40 years of age and women are more susceptible. People in temperate climates are also more susceptible. If you develop any of the symptoms mentioned and it does not go away, but persists or worsens, you should get checked out. Sudden loss of vision in one eye, or optic neuritis, is a frequent initial presentation.

Question: At what age can you get MS?

Dr. Annapurni: It most frequently starts between 20 and 40 years of age, but has occurred in children younger than 10 and in older people also. It is highly unusual to start after 50 years of age.

Question: How do you get MS? Is MS contagious or hereditary?

Dr. Annapurni: MS is not considered as an inherited disorder – there is no direct transmission through chromosome defects. However some families could have certain types of genes controlling the immune system being transmitted making them more susceptible to it, and therefore more members in certain families may be affected. It is definitely not contagious.

Question: What kind of doctor/s do I need to see?

Dr. Annapurni: The best group of doctors who treat Multiple Sclerosis are Neurologists. You can ask your Primary Care Physician to refer you to a Neurologist.

Question: How does diet impact MS?

Dr. Annapurni: Diet has no impact and food factors are not contributory to the occurrence of Multiple Sclerosis

Question: Is there a cure for MS? Will it just go away?

Dr. Annapurni: There is no cure for MS. However there are medications which decrease the recurrence of symptoms, keeping patients stable, with no new events, for months to years. MS can spontaneously go into remission for several years sometimes. A very small number of people may have a clinically isolated episode all their lives.

Question: Will MS eventually make me disabled?

Dr. Annapurni: If relapses continue, you may become progressively worse and many patients have been disabled with disease progression. However, the course of the illness is much better now with about 40% of people who have MS achieving prolonged remission for years. The future for MS is much brighter than it used to be.

Question: How will MS impact my daily life?

Dr. Annapurni: That depends on the extent of your disability from the initial attack and your function before you were started on medications, as well as your response to medications.

Question: Are there MS support groups for me and my family?

Dr. Annapurni: Yes there are local MS support groups in various communities. MSAA is the Multiple Sclerosis Association of America and www.mymsaa.org is the web address.

Question: What treatments are available for MS? How do I stay up to date on MS research?

Dr. Annapurni: There are several treatments currently available to keep MS in remission and your Neurologist will be able to guide you to the best one suitable for you. All the medications modulate the immune system. Some are injections, given at least 3 times per week, under the skin (subcutaneously); one of them is an intramuscular injection given once a week; there is an intravenous preparation given once a month; and there are oral medications which have more recently been introduced. All the medications are associated with some side effects, which will be explained to you by your Neurologist. Depending on your particular case, you will make a choice with the help of your Neurologist depending on your tolerance of the medication and its side effects. If your first choice is ineffective or intolerable, a switch to another form of medication can be made. The MSAA has a periodic publication which keeps the layman informed of advances in the field. Your doctor will also be able to keep you informed of advances in the field. The internet also is a frequently used resource for information. You should always discuss whatever information you get from whichever source with your treating doctor.

Question: Are there any alternative measures to treat or cure MS?

Dr. Annapurni: There are several ways to treat MS as I have described. Today, we can only prevent relapses and keep patients longer in remission. There is no cure for MS. Once the exact cause is known for triggering the change in the immune system, there could be a cure in the future, by directly attacking the cause.

Question: If I have it will my children get it?

Dr. Annapurni: As I said before, there is no direct transmission from mother to child.

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