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Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system which is made up of the brain, spinal cord and optic nerves. The exact antigen —
or target that the immune cells are sensitized to attack — remains unknown, which is why MS is considered by many experts to be “immune-mediated” rather than “autoimmune.”
Within the central nervous system, the immune system attacks myelin — the fatty substance that surrounds and insulates the nerve fibers — as well as the nerve fibers themselves.Myelin is a primary target of the immune attack in MS.
• The damaged myelin forms scar tissue (sclerosis), which gives the disease its name.
• When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing a wide variety of symptoms.
• The disease is thought to be triggeredin a genetically susceptible individual by a combination of one or more environmental factors.
• People with MS typically experience one of four disease courses, which can be mild, moderate or severe.
While the cause of MS is still not known, scientists believe that the interaction of several different factors may be involved. To answer this important question, studies are ongoing in the areas of immunology (the science of the body’s immune system), epidemiology (the study of patterns of disease in the population) and genetics. Scientists are also studying infectious agents that may play a role.
Immunologic Factors
In recent years, researchers have been able to identify which immune cells are mounting the attack, some of the factors that cause them to attack, and some of the sites (receptors) on the attacking cells that appear to be attracted to the myelin to begin the destructive process.
Environmental Factors
MS is known to occur more frequently in areas that are farther from the equator. Epidemiologists — scientists who study disease patterns — are looking at variations in geography, demographicsgenetics, infectious causes and migration patterns in an effort to understand why.
Studies have shown that people born in an area with a high risk of MS who then moveto an area with a lower risk before the age of 15 assume the risk of their new area. Such data suggest that exposure to some environmental agent before puberty may predispose a person to develop MS later on.
Growing evidence suggests that vitamin D plays an important role. People who live closer to the equator are exposed to greater amounts of sunlight year-round. As a result, they tend to have higher levels of naturally-produced vitamin D, which is thought to support the immune function and may help protect against immune-mediated diseases like MS. The evidence is also growing that smoking plays an important role in MS.
Infectious Factors
Since initial exposure to numerous viruses, bacteria and other microbes occurs during childhood, and since viruses are well-recognized as causes of demyelination and inflammation, it is possible that a virus or other infectious agent is the triggering factor in MS. More than a dozen viruses and bacteria have been or are being investigated to determine if they are involved in the development of MS, but none have been definitively proven to trigger MS.
Genetic Factors
While MS is not hereditary, having a first-degree relative such as a parent or sibling with MS does significantly increase an individual’s risk of developing the disease. Studies have shown that there is a higher prevalence of certain genes in populations with higher rates of MS.
Treatment
If symptoms interfere with everyday activities, physical therapy can address these issues. Therapists evaluate and address the body’s ability to move and function with particular emphasis on walking and mobility, strength, balance, posture, fatigue and pain. Treatment may include an exercise program, gait training as well as training in the use of mobility aids such as canes, walkers or wheelchairs. The goal is to promote safety, achieve and maintain optimal functioning, and prevent unnecessary complications. A speech therapist can also provide evaluation and treatment of speech and swallowing difficulties as well as problems with thinking and memory.
MS is thought to affect more than 2.3 million people worldwide. While the disease is not contagious or directly inherited, epidemiologists have identified factors in the distribution of MS around the world that may eventually help determine what causes the disease.
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