In Spain, nearly 55,000 people (2.5 million worldwide) have been diagnosed with Multiple Sclerosis (MS), a progressive and chronic neurodegenerative disease that is the main cause of non-traumatic disability in young adults.
It is an autoimmune disease of the central nervous system in which the body’s defense system is confused and attacks the brain and spinal cord, producing inflammatory lesions that destroy the myelin -the sheath that protects the nerve fibers-, leaving scars that prevent the normal functioning of nerve fibers.
This process could be compared to the plastic that covers the electricity cables: when the insulating plastic is damaged, the electricity slows down. The same thing happens with the transmission of nerve impulses when myelin is damaged.
The disease of a thousand faces
MS is given this nickname because its course and symptoms vary from person to person. Its manifestations will depend on the area of the brain in which the lesions occur and may include tingling, weakness, imbalance or blurred vision, among others. There are different types of disease.
“Among them, the most frequent is relapsing-remitting (RRMS), which is characterized by the presence of outbreaks that are subacute episodes of neurological symptoms caused by brain, spinal cord or optic nerve involvement, which may or may not leave sequelae”, explains Dr. Francisco Gascón, neurologist at the Multiple Sclerosis Unit of the University Clinical Hospital of Valencia.
Another form is primary progressive MS (PPMS) which is characterized by progressive neurological deterioration from the onset of the disease. In addition, a percentage of patients with RRMS will eventually develop a secondary progressive MS, “in which they will present a progressive neurological deterioration, independent of the outbreaks, with accumulation of disability”, points out the neurologist.
Although both the speed with which it progresses and the possible outbreaks can be unpredictable, in recent years it has been observed that there are a number of factors that contribute to some patients progressing more quickly and severely, reaching greater disability and more severely. earlier than others.
“Among these factors – says Dr. Gascón – is the high inflammatory activity in the first two years of the disease, the high number of outbreaks, the high activity in resonance, the presence of IgM oligoclonal bands in cerebrospinal fluid and, above all, , the delay in the start of treatment and in the control of inflammation”.
The key role of inflammation
Although it is a disease of unknown origin, it is known that both genetic and environmental factors are involved, including infections in childhood, lack of vitamin D and smoking. It is also known that inflammation, a consequence of autoimmunity, is a very important factor since it causes lesions in the Central Nervous System. Inflammation has traditionally been associated with flare-ups and predominates in the initial phases of the disease, contributing to the appearance of sequelae.
“However, it has been observed that in the progressive and more advanced forms of the disease there is also inflammation that contributes to neurodegeneration and the accumulation of disability,” explains Dr. Gascón.
In the early stages of the disease, the most frequent type of inflammation is acute, while in later phases the development of the chronic inflammatory response within the central nervous system and neuronal degeneration that is associated with brain atrophy predominate. In other words, in the long term, if the inflammatory state is maintained, the lesions will progress, favoring neuronal destruction.
For this reason, as the neurologist explains, early diagnosis of the disease is key: “What happens in the first years of the disease will determine what happens in the medium-long term. In this way, early diagnosis allows us to establish the most appropriate treatment in each case early, to control inflammation from the beginning, which will influence the prevention of disability in the medium-long term”.
Advances in treatment
For the approach and treatment of inflammation that improves the patient’s prognosis, Dr. Francisco Gascón explains that “in the last two decades, multiple new drugs have been developed to control inflammation in MS with different mechanisms of action, efficacy and safety profiles, including some of high efficacy, which allow us to select the most appropriate drug for each patient according to their particular characteristics”.
Despite this, multiple investigations are still underway aimed at developing both new disease-modifying drugs and some remyelinating drugs that point to an encouraging horizon for patients with Multiple Sclerosis: “In the coming years, new treatment alternatives will be incorporated,” he says. the neurologist Francisco Gascón, who is positive about future expectations.
“Today it is possible to control the disease in a large number of patients, as well as improve the quality of life of those who do not. There are multiple lines of research that keep me optimistic.”