US Pharm. 2018;43(1):11.

Autoimmune Disease With Variable Symptoms

Multiple sclerosis (MS) is a disabling neurologic disease that occurs more commonly in younger adults between the ages of 20 and 50 years. MS is considered an autoimmune disease because it occurs when the body’s immune system attacks its nerve cells. It affects over 350,000 people in the United States alone. The progression of MS is unpredictable, with some people experiencing mild symptoms and others experiencing symptoms that worsen over time and cause significant disability. Over the past 2 decades, major progress in treatment has occurred, but a cure is not yet available, as the cause of the disease remains unclear.

Damaged Insulation Around Nerves

Multiple sclerosis (MS) results when the immune system malfunctions and attacks the myelin sheath—a protective insulating layer surrounding each nerve cell. This destructive process is called demyelination. Demyelination causes scar tissue (sclerosis) that disrupts the normal flow of nerve impulses. Why the immune system malfunctions like this in some people and not others is not completely understood, but there seems to be a genetic predisposition and some unknown trigger in the environment that sets the whole process into motion.  

MS is usually diagnosed in adults between the ages of 20 and 50 years, although it does occur in younger and older people. As with other autoimmune diseases, women are about three times more likely to develop it than men. MS affects people from all ethnic backgrounds, but it is most common in people who are descendants of northern Europeans. Smokers and people with type 1 diabetes, thyroid disease, or inflammatory bowel disease are also at a slightly higher risk of developing MS. Interestingly, climate appears to affect the risk of MS. It is more common among people living in temperate areas with warm summers and cold winters, such as the northern parts of the U.S. and Canada.  

Unpredictable Disease Course

MS progresses differently in each patient, which makes it difficult to predict. For many, MS begins with a first attack over 1 to several days, followed by a seeming recovery or remission. Long periods of time may go by before a second and third attack occur. This course is called relapsing-remitting MS. The other patterns of MS include primary progressive, secondary progressive, and rare and unusual types. Identifying the type of MS a patient has is important because it determines which drug therapies may be beneficial.

The symptoms of MS vary greatly depending on which nerves are affected. In general, they include the following: numbness or weakness of the arm and leg on one side or the trunk and both legs; partial or full loss of vision; double vision; tingling or pain in parts of the body; electric shock sensation with certain neck movements; lack of coordination or trouble walking; slurred speech; fatigue; dizziness; and bowel and bladder control difficulties. MS can cause severe disability, but it is only rarely fatal. Most people with MS have a normal life expectancy.

Treatments Slow Progression, Reduce Symptoms 

There is no cure for MS, but different therapies exist to treat initial attacks, improve symptoms, and, more recently, slow disease worsening. To treat MS attacks, doctors sometimes use high-dose steroids, such as methylprednisolone, to reduce the inflammation and suppress the immune system. A procedure known as plasma exchange can be used for those who do not respond well to steroids. Plasma exchange involves using plasmapheresis to take the blood out of the body, remove the harmful components from the plasma, and return the rest of the blood to the body.

Newer medications, called disease-modulating drugs, have been developed to reduce progression in people with early stages of MS, such as the relapsing-remitting type. They work by modulating or suppressing the inflammatory reactions to the disease. Immune-related side effects are common with these drugs and involve flu-like symptoms, inability to fight off infections, and allergic reactions. If you have any questions about treatments for MS, speak with your trusted local pharmacist or another healthcare provider.