Mayo Clinic Explains Multiple Sclerosis

Summary

Dr. Oliver Tobin, a neurologist at Mayo Clinic, discusses multiple sclerosis (MS), a condition where the immune system attacks the protective myelin sheath of nerve cells. He explains how MS can affect the brain, optic nerve, and spinal cord, leading to symptoms like vision loss, weakness, numbness, and mobility issues. Risk factors include low vitamin D, smoking, obesity, and infections. Diagnosis involves symptoms, MRI, and spinal fluid analysis. Treatment focuses on managing relapses with corticosteroids, plasma exchange, and medication. Dr. Tobin emphasizes the importance of a multidisciplinary team for effective management and living well with MS.

Takeaways

• 🧠 Multiple sclerosis (MS) is a neurological disorder where the immune system attacks the myelin sheath, the protective covering of nerve cells in the brain and spinal cord.
• 👨‍⚕️ Dr. Oliver Tobin, a neurologist at Mayo Clinic, explains that the damage to the myelin sheath can slow or block nerve signals, and while the body can repair the damage, it's not always effective, leading to lesions or scars.
• 🚫 MS can affect anyone, but it most commonly appears in people between the ages of 20 and 40, with women being three times more likely to develop it than men.
• ☀️ Low levels of vitamin D and reduced sunlight exposure are associated with an increased risk of developing MS.
• 🚫 Overweight individuals and smokers are more likely to develop MS and may experience more severe disease progression.
• 🌐 The prevalence of MS is higher in northern and southern latitudes, with people of Northern European descent at the highest risk, and those of Asian, African, and Native American ancestry at the lowest risk.
• 🏥 There is no single test for MS diagnosis; instead, diagnosis relies on a combination of symptoms, physical examination, MRI scans, and spinal fluid analysis.
• 💊 Treatment options for MS include corticosteroids for relapses, and over 20 medications are approved for the prevention of MS attacks and new MRI lesions.
• 🏋️‍♀️ Physical activity is strongly recommended for people with MS, and consulting with physiatrists or therapists can help manage physical difficulties.
• 🤝 Maintaining social connections, staying involved with hobbies, and joining support groups can be beneficial for mental health and emotional well-being for those with MS.
• 🔬 Ongoing research is expanding our understanding of MS and leading to the development of more effective treatments and medications.

Q & A

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a disorder in which the body's immune system attacks the protective covering of the nerve cells in the brain, optic nerve, and spinal cord, called the myelin sheath. This damage can slow or block signals being transmitted within the nervous system.

What happens when the myelin sheath is damaged in MS?

When the myelin sheath is damaged, it exposes the actual nerve fibers, which can slow or block the transmission of signals. The body can repair the myelin sheath, but not perfectly, leaving lesions or scars, which is where the name 'multiple sclerosis' (multiple scars) comes from.

Who is most likely to develop MS?

MS can occur at any age, but it mostly first appears in people between the ages of 20 and 40. Women are up to three times more likely than men to develop relapsing-remitting MS. Other risk factors include low levels of vitamin D, obesity, smoking, and infections like the Epstein-Barr virus.

What are the common symptoms of MS?

Common symptoms of MS include loss of vision in one eye, loss of power in an arm or leg, numbness in the legs, fatigue, depression, spasms, walking difficulties, incontinence issues, and sexual dysfunction. Symptoms often come on over 24-48 hours, last for a few days to weeks, and then improve.

How is MS diagnosed?

MS is diagnosed through a combination of symptoms, physical examination, MRI scans, and spinal fluid analysis. There's no single test for MS, but these methods help doctors confirm the diagnosis.

What is relapsing-remitting multiple sclerosis (RRMS)?

Relapsing-remitting MS (RRMS) is the most frequent type of MS, characterized by attacks or relapses where symptoms worsen, followed by periods of remission where symptoms improve or disappear.

What treatments are available for MS attacks or relapses?

Treatments for MS attacks or relapses include corticosteroids to reduce inflammation and improve symptoms. If corticosteroids are not effective, plasmapheresis (plasma exchange) is another option, with around 50% of patients seeing improvement after this treatment.

What preventive medications exist for MS?

There are over 20 medications approved for the prevention of MS attacks and the prevention of new MRI lesions. These medications help manage the progression of the disease.

How can people with MS manage their condition long-term?

Long-term management of MS involves working with a trusted interdisciplinary medical team, including specialists like physiatrists, physical or occupational therapists. Regular physical activity, maintaining mental health, and staying connected with friends and family are also crucial for managing MS.

What ongoing research is being done on MS?

Scientists are actively researching MS to better understand the disease and develop new treatments. This includes expanding knowledge about MS risk factors, disease mechanisms, and creating more effective medications.

Outlines

00:00

🧠 Introduction to Multiple Sclerosis

Dr. Oliver Tobin, a neurologist specializing in multiple sclerosis at Mayo Clinic, introduces the basics of MS. He discusses what MS is, its symptoms, diagnosis, and treatment options. MS is an autoimmune disorder where the immune system attacks the myelin sheath, the protective covering of nerve cells in the brain and spinal cord. This can slow or block nerve signals and potentially damage the nerve fibers. The body can repair the myelin, but the process is imperfect, leading to lesions or scars, which is where the name 'multiple sclerosis' comes from. MS typically presents first in individuals between the ages of 20 and 40 and is more common in women. Risk factors include low vitamin D levels, obesity, smoking, and certain genetic and environmental factors. Common symptoms include vision loss, weakness in limbs, and sensory disturbances. Diagnosis involves a combination of symptoms, physical examination, MRI scans, and spinal fluid analysis.

05:01

💊 Managing Multiple Sclerosis

The video script explains the management and treatment of MS attacks, which can be treated with corticosteroids or plasmapheresis if steroid treatment is ineffective. Over 20 medications are approved for preventing MS attacks and new MRI lesions. The importance of a multidisciplinary medical team is emphasized for managing the disease and its symptoms. Physical activity is strongly recommended for individuals with MS, and mental health is also a significant consideration. The script suggests maintaining personal connections, being kind to oneself, and considering support groups. The Mayo Clinic is actively involved in research to improve understanding and treatment of MS, and viewers are encouraged to seek more information through their resources.

Keywords

💡Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system. It occurs when the immune system mistakenly attacks the protective covering of nerve cells, called the myelin sheath, which is compared to the insulation on an electrical wire. This damage can slow or block the signals transmitted within the nerve fibers and can also lead to nerve fiber damage. The term 'multiple sclerosis' comes from the presence of multiple scars or lesions in the brain and spinal cord, which result from this damage. The video explains that MS is a chronic condition that can lead to a range of symptoms and that it typically appears in people between the ages of 20 and 40.

💡Myelin Sheath

The myelin sheath is a protective layer that surrounds nerve fibers and is essential for the proper transmission of nerve signals. In the context of the video, it is highlighted that in MS, the immune system attacks this myelin sheath, leading to the exposure and potential damage of the underlying nerve fibers. This disruption in the nervous system is what causes the various symptoms associated with MS.

💡Relapsing-Remitting MS

Relapsing-remitting MS is the most common form of the disease, characterized by periods of symptom flare-ups (relapses) followed by periods of remission where symptoms improve or disappear. The video script mentions that these relapses typically last for a few days to a few weeks and then symptoms may improve significantly. Understanding this pattern is crucial for managing the disease and its symptoms.

💡Vitamin D

Vitamin D is a nutrient that plays a role in immune function and bone health. The video script notes that low levels of vitamin D and low exposure to sunlight, which helps the body produce vitamin D, are associated with an increased risk of developing MS. It also mentions that people with MS who have low vitamin D tend to have more severe disease, highlighting the importance of vitamin D in both the risk and progression of MS.

💡Risk Factors

Risk factors for MS include genetic predisposition, certain environmental factors, and lifestyle choices. The video script outlines various risk factors such as low vitamin D levels, being overweight, smoking, and gender (women are more likely to develop MS). It also points out that certain infections, like the Epstein-Barr virus, and geographic location (higher prevalence in northern and southern latitudes) can influence the risk of developing MS.

💡Symptoms

The symptoms of MS can vary widely and may include loss of vision, loss of power in an arm or leg, sensory disturbances, spasms, fatigue, depression, incontinence, sexual dysfunction, and walking difficulties. The video script emphasizes that these symptoms can come on quickly and last for varying durations, which underscores the importance of proper diagnosis and management.

💡Diagnosis

Diagnosing MS is complex as there is no single test for it. The video script explains that diagnosis involves a combination of typical symptoms, physical examination findings, MRI scans of the brain or spine, and spinal fluid analysis. It also mentions additional tests like blood tests and OCT (optical coherence tomography) to rule out other conditions with similar symptoms.

💡Treatment

Treatment for MS aims to manage symptoms, prevent relapses, and slow disease progression. The video script discusses the use of corticosteroids to reduce or improve symptoms during relapses and plasmapheresis for those who do not respond to steroids. It also mentions over 20 medications approved for the prevention of MS attacks and new MRI lesions, indicating the ongoing development of treatments.

💡Interdisciplinary Medical Team

An interdisciplinary medical team is crucial for comprehensive care in MS, as it involves healthcare professionals from various fields such as neurology, physical therapy, occupational therapy, and mental health. The video script stresses the importance of such a team in monitoring and managing the health of individuals with MS, addressing their individual symptoms and needs.

💡Quality of Life

Maintaining a good quality of life is a significant aspect of living with MS. The video script suggests that physical activity, mental health support, and maintaining personal connections are important. It also encourages being kind to oneself and adjusting plans as needed, acknowledging that MS can cause fluctuating abilities from day to day.

💡Research

Research plays a vital role in advancing the understanding of MS and developing new treatments. The video script concludes by mentioning that scientists are continuously working to expand knowledge about the disease and create more effective treatments and medications, offering hope for the future.

Highlights

Multiple sclerosis is a disorder where the immune system attacks the myelin sheet, the protective covering of nerve cells.

Damage to the myelin sheet can slow or block nerve signals, and may also damage the nerve fibers themselves.

The body can repair the myelin sheet, but this repair is often imperfect, leading to lesions or scars.

Multiple sclerosis gets its name from the multiple scars left by the damage.

MS can lead to nerve cells dying off faster in damaged areas compared to normal areas.

The most common type of MS is relapsing-remitting, characterized by episodes of symptoms followed by remission.

MS typically first appears in people between the ages of 20 and 40.

Low levels of vitamin D and low sunlight exposure are associated with an increased risk of developing MS.

Overweight individuals and those who smoke are more likely to develop MS and experience more severe disease.

Women are three times as likely as men to have relapsing-remitting MS.

Certain infections, including the Epstein-Barr virus, have been linked to MS.

MS is more prevalent in higher northern and southern latitudes, with higher risk for people of Northern European descent.

People of Asian, African, and Native American ancestry have the lowest risk for MS.

Having other autoimmune diseases slightly increases the risk for MS.

Symptoms of an MS relapse usually come on quickly and last for days to weeks.

Common MS symptoms include vision loss, limb weakness, numbness, spasms, fatigue, and depression.

Diagnosing MS involves looking at symptoms, physical examination, MRI results, and spinal fluid analysis.

There is no single test for MS, but a combination of tests can help secure a diagnosis.

Blood tests and OCT scans may be recommended to rule out other diseases or to assess the optic nerve.

A multidisciplinary medical team is essential for managing MS and addressing individual symptoms.

Corticosteroids and plasma exchange are treatments that can help during an MS attack.

Over 20 medications are approved for preventing MS attacks and new MRI lesions.

Physical activity, mental health support, and maintaining personal connections are important for living well with MS.

Support groups can provide valuable connections and understanding for those living with MS.

Scientists continue to research MS, developing new treatments and medications.

Transcripts

I'm Dr. Oliver Tobin and neurologists

specializing in

multiple sclerosis at Mayo Clinic.

In this video, we'll be covering

the basics of multiple sclerosis.

What is it? Who gets

us the symptoms, diagnosis, and treatment?

Whether you're looking for answers about

your own health or that of someone you love.

We're here to provide you

with the best information available.

Multiple cirrhosis is a disorder in which

the body's immune system attacks

the protective covering of

the nerve cells in the brain,

optic nerve and spinal cord

called the myelin sheet.

And this sheet is often compared

the insulation on an electrical wire.

When that covering is damaged,

it exposes the actual nerve fiber,

which can slow or block

the signal is being transmitted within.

The nerve fibers themselves

might also be damaged.

The body can repair

damage to the myelin sheet,

but it's not perfect.

The resulting damage leaves lesions are

scars and this is where the name comes from.

Multiple sclerosis, multiple scars.

Now everyone loses brain cells

and spinal cord cells as they get older.

But if part of the brain or spinal cord

has been damaged by MS,

the nerve cells in that area will die

off faster than the areas

around it that are normal.

This happens very slowly,

usually over decades and

typically shows up as

gradual walking difficulty

happening over several years.

When you read about multiple cirrhosis,

you may hear about different types.

The most frequent being

relapsing-remitting multiple sclerosis.

And this is characterized by

a tax or relapses.

We don't know what causes MS,

but there are certain factors that may

increase the risk for trigger its onset.

So while MS can occur at any age,

it mostly makes its first appearance in

people between the ages of 20 and 40.

Low levels of vitamin D

and low exposure to sunlight,

which enables our body to make

vitamin D are associated with

an increased risk of developing

MS. As people who have MS,

you have low vitamin D tends

to have more severe disease.

So people who are overweight are

more likely to develop MS and

people who have MS and

are overweight tended to have

more severe disease and

a faster onset of progression.

People who have MS and who

smoke tends to have more relapses,

worst progressive disease,

and worst cognitive symptoms.

Women are up to three times as

likely as men to have relapsing-remitting MS.

The risk for MS in

the general population is about 0.5%.

If a parent or sibling has,

is your risk is about twice that or about 1%.

Certain infections are also important.

A variety of viruses

have been linked to amass,

including Epstein-Barr virus,

which causes mono.

Northern and southern latitudes

have a higher prevalence,

including Canada, the Northern US,

New Zealand, southeastern

Australia, and Europe.

White people, especially

of Northern European descent,

are at the highest risk.

People of Asian, African,

and Native American ancestry

have the lowest risk.

A slightly increased risk is seen if

a patient already has

autoimmune thyroid disease,

pernicious anemia, psoriasis,

type 1 diabetes,

or inflammatory bowel disease.

Symptoms of a relapse usually

come on over 24 to 48 hours,

last for a few days to a few weeks and then

improve in the region of 80 to a 100 percent.

Those symptoms include

loss of vision in and I,

loss of power and an arm or leg

or a rising sense of numlist and the legs.

Other common symptoms associated

with MS include spasms,

fatigue, depression, incontinence issues,

sexual dysfunction, and walking difficulties.

There's currently no single test

to make a diagnosis of MS.

However, there are four key features

which helped to secure the diagnosis.

Firstly, either

typical symptoms of multiple sclerosis.

Again, those are loss of vision and an eye,

loss of power and an arm or leg,

or sensory disturbance in an arm or

leg lasting for more than 24 hours.

Secondly, do you have

any physical examination

findings consistent with MS?

Next is the MRI of

your brain or spine consistent with MS.

Now here it's important to know

that 95 percent of

people over the age of 40

have an abnormal brain MRI,

just the same as many of

us have wrinkles on our skin.

Lastly, are the results of

the spinal fluid analysis consistent with MS.

Your doctor may recommend

blood tests to check for

other diseases that share the same symptoms.

They may also recommends

an OCT test or optical coherence tomography.

This is a short scan of

the thickness of the layers

at the back of your eye.

So the best thing to do when

living with MS is to find

a trusted interdisciplinary medical team

that can help you monitor

and manage your health.

Having a multidisciplinary

team is essential for

addressing the individual's symptoms

that you're experiencing.

If you have an MS attack or relapse,

your doctor may prescribe

corticosteroids to reduce or

improve your symptoms and if

your attack symptoms do

not respond to steroids.

Another option is

plasmapheresis or plasma exchange,

which is a treatment similar to dialysis.

About 50 percent of people

who do not respond to steroids

have a significant improvement with

a short course of plasma exchange.

There are over 20 medications

currently approved for

prevention of MS attacks

and prevention of new MRI lesions.

As learning to function with

MS can be challenging.

There are medical experts ready to

work with you to help you manage.

So you can still live a full life.

Consulting with a physiatrist,

physical or occupational therapist

can help you deal with physical difficulties.

Physical activity is strongly

recommended for all people with MS,

mental health and also

an important consideration.

So keeping

our personal connections with friends and

family and trying to stay

involved with your hobbies is important,

but also be kind to yourself and

realistic about what you report.

This can change from day to day,

so it's okay to give yourself

permission if something

seems like too much or

if you need to counsel plans.

You may also find support groups

helpful to connect with people who

understand what you are going through and

discuss your feelings and

concerns with a doctor or a counselor.

Meanwhile, scientists are hard at work,

expanding our understanding

of this disease and

developing new treatments and

medications which are ever more effective.

If you want to learn more,

watch more of our videos

or visit Mayo Clinic.org.

We wish you well.