HANCOCK - Multiple sclerosis, commonly known as MS, is an unpredictable autoimmune disease that primarily affects women, with an average age of diagnosis at 30. The treatments and prognosis of MS vary greatly from person to person.
"MS is thought to be an autoimmune condition. An autoimmune condition is one in which your immune system attacks your body and, in particular in multiple sclerosis, a component in the brain that is being attacked is insulation around the nerve fibers themselves," said Dr. Christian Dinsmore of Portage Health. "Those attacks occur in the nerves to the eye, they occur in the brain itself and they occur in the spinal cord. So that's where people get their symptoms and disabilities for multiple sclerosis."
The symptoms of MS vary widely. Common complaints include sensory problems, such as numbness and tingling, visions complaints, incoordination, weakness and issues concerning bladder or bowel control. The most common type of MS is know as relapsing-remitting MS.
"As an autoimmune disease, there are several kinds of MS but the most common is relapsing-remitting," Dinsmore said. "Patients do well and then have an attack of new neurologic symptoms. They recover from that attack but oftentimes there are residual problems left over from that attack. Over time, given enough attacks, there is going to be disability that is collecting with that."
To negate the effects of ongoing attacks, Dinsmore said patients try to start medication as early as possible.
"Many patients start therapy after a single attack to try and prevent further attacks. They're starting MS therapy before they have a diagnosis of MS in some cases, trying to prevent disability down the road," he said. "But it's always a difficult decision for patients and providers when to start therapy."
Recent medication advancements in MS over the past three years mean that patients no longer have to take injections to receive their medication, which had been the only option since MS medication was first released in the 1980s. Either the oral or injectable medications help decrease the frequency of recurring MS attacks.
"It (medication) decreases the risk of exacerbations anywhere from a third to 50 percent, based on the studies. By decreasing the exacerbations we decrease the collected disability over time," Dinsmore said. "So a person who is on the medication is expected to have less progression and difficulty with walking, or managing their bladder, or cognitive difficulties related to the disease. So that's where the argument is for taking medications. That the medications have traditionally been very expensive often presents some difficulty."
Even if patients do not immediately begin medication, providers will continue to monitor them closely using MRIs.
"We may see changes on an MRI before we see them clinically. So we're either starting therapy early or watching very closely looking for the opportunity to start therapy," Dinsmore said.
There is no way to tell who will have MS but there are certain factors that indicate a patient may have a higher risk. Genetics do play a role so if there is a history of MS in the family a patient may be at higher risk.
"If you look at a set of identical twins and if one has multiple sclerosis, the chance that other identical twin will develop multiple sclerosis is anywhere between 20 and 40 percent. So it's much higher than the general population, but on the other hand it's not 100 percent either," he said.
"So just knowing that alone suggests that there is a part of it that has to be genetic and there is a part of it that has to be something, and what is that something else is not clearly known at this point."
Factors such as vitamin D levels and ancestry are thought to impact the "other part" of MS. Lack of vitamin D - sometimes called the "sunshine vitamin" correlates with cases of MS, as does having northern European ancestry. Dinsmore noted that, perhaps because of those factors, MS is more common in the Upper Peninsula than the rest of the country.
"It's common in the Upper Peninsula, relatively more common than it would be in other parts of the United States because it's more common in northern latitudes It also seems more common up here because it's a disease more common to people with northern European ancestry," he said.
One factor commonly thought to cause MS is receiving vaccinations. Dinsmore was clear that vaccinations in no way cause MS.
"MS isn't related to vaccinations. One of people's fears is it's something that can be triggered by vaccinations but, if anything, getting regular vaccinations may decrease the risk of MS," he said.
MS manifests itself differently in every patient. Because the attacks can occur anywhere in the insulation of nerve fibers in the brain almost any neurological complaint can be linked to MS. Treatment, progression and disability also vary from patient to patient.
"Because the disease itself is so often very different from person to person, it's almost as if everyone who has MS really almost has their own disease that shares the same name," Dinsmore said.