Multiple sclerosis is a progressive autoimmune disease in which an individual’s immune system attacks their own cells, specifically, the myelin. It is a lifelong condition that has a wide range of symptoms including vision, balance, movement, sensation and sometimes serious disability. It’s mostly diagnosed in people ages 20 to 30. About 100 people a week are diagnosed with this condition. It’s caused by the immune system attacking the protective layers around the nerves. The nerves can no longer be protected and then become susceptible to damage.

The exact cause of MS is unknown. However, scientists believe that four factors may play a role in the development of the disease: immunologic, genetic, environmental, and viral. Several genes are believed to play a role in MS. The chance of developing MS is slightly higher for a person who has a close relative with the disease. Epidemiologists have seen an increased pattern of MS cases in countries located furthest from the equator. This correlation causes some to believe that vitamin D may play a role. Researchers are also considering the possibility that viruses and bacteria may cause MS. Viruses are known to cause inflammation and a breakdown of myelin (demyelination). Therefore, it’s possible that a virus could trigger MS. There are also some other risk factors including sex and ethnicity as women are two to three times more likely to develop MS than men are as well as people of northern European descent having the highest risk of developing the condition.

I  watched and read up on cases of patients who have MS and I can see how the diagnosis of the disease completely changes their lives. The fact that it is a progressive disease for which the causes are not fully understood makes it additionally quite frightening for the public. The nature of the condition can make everyday tasks such as getting dressed, eating and walking difficult for the individual. I recently read about the research into a potential cure for this autoimmune disease. The particular type that the research looked at was the relapsing-remitting form, which is the most common type. In RRMS, there are episodes of inflammatory activity. During a relapse, there are new or worsening symptoms. Relapses are followed by periods of recovery, during which the disease does not progress. Residual symptoms may remain during this time. People with RRMS may go on to develop a progressive form of the disease.

There’s some incredible research that’s being conducted at the moment about the use of a  bone marrow stem cell treatment which is usually given to cancer patients. It uses the patient’s own stem cells from their bone marrow. It can be a difficult treatment to go through as it involves intense chemotherapy. The chemotherapy is combined with growth hormones and designed to flash out stem cells. The stem cells leave the bone marrow and then circulate the blood where they can be extracted. The patient is given drugs to completely delete their immune system. Meanwhile, the stem cells are purified to remove those cells that cause MS. The patient must be kept in isolation for this phase of the treatment as they will be particularly vulnerable to infection. The stem cells are infused back into the blood and they then make their way into the bone marrow where they slowly rebuild the immune system with new cells that are not now programmed to attack the patient’s body.

The results from some of the patients who have been given this treatment do seem quite promising, but the patients will have to be monitored over many years to see whether the treatment is permanent. Stem cell transplants have been carried out before in MS patients, but those people had a relapse after a couple of years. The reason why this therapy is different is because it completely destroys the immune system. One of the patients in an investigation in Canada actually died during the trial from suffering from very severe liver damage and a bacterial infection which caused sepsis, or blood poisoning. This demonstrates just how risky it is to completely strip a person of their immune system and ability to fight infections. Extreme measures of isolation will, therefore, have to be taken.

A very insightful quote comes from Mark Freedman, a neurologist at the University of Ottawa, said, “I hesitate to use the c-word. A cure would be stopping all disease moving forward and repairing all damage that has occurred. As far as we can ascertain no new damage seems to occur beyond the treatment and patients don’t need to take any medication, so in that sense, I think it has induced a long-standing remission. Some patients did recover substantial function and it allowed them to do things they couldn’t do for years, but others did not.” In the cases I watched some of the neurological damage caused by the disease reversed over time due to the transplant for some patients, whereas not with others. This could be established as a mainstream treatment in a few years, but now major trials are being conducted in 4 different cities worldwide. I think time will be the only way to tell just how successful the treatment is and whether it can ever be defined as a cure.

Posted by:Life of a Medic

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