Multiple sclerosis (MS) is not a new condition, but it is one that scientists are still trying to understand. They don't know exactly what causes the disease or how to stop it. But they do know that women, especially young women, are disproportionately affected.
"MS is an abnormal immune response that damages the central nervous system and can dramatically affect your quality of life," says Mirela Cerghet, M.D., a neurologist at Henry Ford Health. "It primarily strikes when people are in their 20s and 30s, and women are three times more likely to develop MS than men."
What Is MS?
MS is a progressive disease where the immune system attacks the fatty myelin sheaths that act as insulation around nerve cells. Myelin sheaths allow for effective communication between nerve cells.
There are a few different types of MS:
- Relapsing/remitting (RRMS): The most common type of MS, RRMS, is characterized by symptoms that spontaneously disappear (remit) or recur (relapse). Symptoms may shift over time, striking different areas of the body with variable severity.
- Primary progressive (PPMS): PPMS is typically a more severe form of disease characterized by progressive symptoms without any periods of recovery or remissions. Some forms of PPMS are more progressive and damaging than others.
- Secondary progressive (SPMS): SPMS follows RRMS, as the disease progresses and neurologic function gets worse over time. Some people with SPMS experience relapses and show new evidence of disease on imaging tests. But not everyone with RRMS will develop SPMS.
With all forms of MS, the immune system damages nerve cells in the brain and spinal cord, resulting in symptoms ranging from blurry vision to problems with spatial awareness, balance and speech.
What Causes MS?
"We really don't know why patients develop MS," Dr. Cerghet says. "However, we do know that certain genetic factors can increase risk for autoimmune diseases." In fact, scientists have uncovered more than 200 genes that may make people more prone to developing MS.
And yet, MS is not an entirely genetic disease. Environmental factors also play a role. For example, the rates of MS are higher among people who live further from the equator. They're also higher among smokers, people who are overweight or obese, and those who are deficient in vitamin D.
Who Is At Greatest Risk Of Developing MS?
Relapsing MS primarily strikes white women between the ages of 20 and 40, while PPMS seems to affect men and women equally. While doctors have plenty of theories about why this is, the specifics aren’t clear.
"We know that having low levels of certain hormones, such as androgens, increases the risk of developing disability with MS. On the other hand, high levels of estrogens and progesterone are protective in women with MS," Dr. Cerghet says. "That's one reason pregnancy is a protected state for women with MS; their hormone levels are higher. Unfortunately, once those hormones drop after delivery, women are more likely to relapse."
How Do You Know If You Have MS?
"There's no single test that can diagnose MS," Dr. Cerghet says. Instead, doctors rely on a mix of criteria that include clinical symptoms, physical examination, imaging tests and spinal fluid results to make a diagnosis. To make matters more complicated, symptoms of the relapsing/remitting form of disease come and go, which makes MS difficult for doctors to see and diagnose.
Is Treatment Available For MS?
If you have MS, your doctor will generally prescribe treatment to stall the progression of the disease. The goal is to not only reduce the number and severity of relapses you experience, but also to prevent additional nerve cell damage. You may also receive treatments to address symptoms like chronic pain and spasticity.
While there are nearly 20 FDA-approved medications for relapsing forms of MS, there's only one approved medication for PPMS.
Over the last 5 years, international collaborations between doctors, researchers and patient organizations have evolved to better understand the challenges facing patients with progressive MS and develop better treatments.
Is MS Preventable?
Not at this stage of the game. "Until we know what triggers MS, it's almost impossible to prevent it," Dr. Cerghet says. But there are several things you can do to reduce your risk and boost your control of MS — and many other chronic conditions:
- Ensure your vitamin D levels are sufficient
- Avoid smoking
- Maintain a healthy diet
- Exercise regularly
- Maintain a healthy weight
- Reduce your stress levels and address mental health issues
- Take steps to lower your risk of viral and bacterial illnesses (infections can trigger an MS flare)
There's also plenty of reason to be hopeful. MS isn't a death sentence, and it doesn't have to alter the trajectory of your life. Instead, doctors are increasingly viewing the disease as a condition people can manage, much like high blood pressure and diabetes.
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Dr. Mirela Cerghet is a neurologist and program director for the Multiple Sclerosis Fellowship at Henry Ford Hospital in Detroit.