On Tuesday evening, January 11, Navigating the Medical System featured an informative virtual lecture on Multiple Sclerosis (MS), hosted by Congregation Etz Chaim. Jai S. Perumal, MD, Assistant Professor in the Department of Neurology and Neuroscience at Weill Cornell Medicine and Attending Neurologist at NewYork-Presbyterian Hospital Queens, shared a detailed lecture on Multiple Sclerosis.
She shared how important it is to take an oral history of a patient and to do an exam before ordering tests. One of the things she likes about being a neurologist is that you build long-term relationships with your patients.
She then taught that MS is a disease of the central nervous system. MS is an autoimmune disease where immune cells attack the brain, the spinal cord, or the optic nerve. The thicker the insulation, the better the conduction of the nerve. Inflammation from MS chews away at this insulation, causing various levels of injury.
The immune cells in the blood are directed against brain protein (myelin). These cells enter the brain and secrete other proteins, which cause inflammation in the brain. Inflammation results in damage to the myelin and the nerve fiber called axon. Once the axon is completely severed, it will die.
The highest incidence of MS is in North America and Europe. The lowest incidence is in Africa and Asia. So, what if a person moves to a different location? She said studies show that the first 14 years of life have the highest impact. She taught that along with genetic factors, early environmental factors determine if MS will occur. In the United States, the highest incidence is in the Northeast. The next highest incidence is in the Midwest, and then comes the West and the South.
She added that 97% of the time, a first degree relative of someone with MS doesn’t develop the disease. She listed some possible causes or factors that could contribute to developing the disease, and these include infections, low vitamin D, and smoking. New studies indicate that the bacteria in the gut is different in patients with MS.
The average age people develop MS is the mid-20s. The ratio is 2.5-1, women to men getting it. Symptoms can be the same as other conditions. This is why MRI tests are important. Symptoms can include vision problems, numbness, tingling, weakness, urinary frequency, sexual dysfunction, and memory difficulty. The symptoms occur where the lesion happens in the body. She emphasized, “Symptoms do not make a diagnosis!” A physician needs to look at the whole picture. How does the symptom present, and where does it localize? An MRI needs to be taken, then, of the brain and spinal cord to detect if there are lesions there. Blood tests are more important if other similar diseases are suspected. A spinal tap is not necessary in every case.
Some diseases like Lupus or Lyme disease can present with lesions in the brain. She pointed out that not all white spots are MS. Smaller white spots that show up on an MRI in the higher up or outer parts of the brain are not MS. As one grows older, the likelihood of finding spots is higher.
She then detailed the different types of MS. There is Relapsing-Remitting (85%-90%), and there are Secondary Progressive and Primary Progressive (10-15%). She explained that the name Remission is a misnomer because this disease needs to be treated all the time. The pattern of MS changes from up and down to a steady thing.
“If we control the initial part, we can keep the slope on a horizontal level.” Our goal is for the patient to never get to the Secondary Progressive stage.
Primary Progressive occurs when a person is in the late 40s or 50s and did not have clear onset symptoms. Relapsing responds well to treatment. In Primary Progressive MS, drugs don’t work.
“The goal of treatment is to prevent any further damage.” Six months after a relapse, it levels off.
The drugs over the past decade treat symptoms and the underlying cause.
The lecture was followed by a lively Q&A. Everyone left very informed about MS. Thank you, Dr. Breite, for these enlightening community medical lectures.
By Susie Garber