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Timothy L. Vollmer, MD
Department of Neurology
University of Colorado Health Sciences Center Professor

Co-Director of the RMMSC at Anschutz Medical Center

Medical Director-Rocky Mountain MS Center
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Multiple Sclerosis Institute
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Weill Medical College of Cornell University

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New York-Presbyterian Hospital
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Department of Neurology
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Living well with MS

Oladapo Ashiru

Multiple sclerosis is a chronic degenerative neurological disorder involving gradual destruction of the protective fatty sheath in which nerve cells are wrapped. This protective wrap, called the myelin sheath, is progressively destroyed and eroded away in a process called demyelination, leaving nerve cells without insulation and largely ineffectual in carrying out normal physiologic functions.

Myelin sheath damage and eventual affectation of nerve fibres themselves lead to interruption of normal electrical signal transmission between the brain and the spinal cord; and the rest of the body, especially the muscles.

Expectedly, this dysfunction has a multifaceted and often devastating impact on the human organism.

Multiple sclerosis is believed to be a rare in blacks and is particularly uncommon in the tropics. However, more cases have been diagnosed in Nigeria in recent times, particularly in centres where there is access to radiological imaging equipment such as the Magnetic Resonance Imaging for diagnosis.

Origin/cause of multiple sclerosis

Medical science is still unclear as to the exact origin or cause of multiple sclerosis, and the subject remains central to many on-going medical researches all over the world. In MS, there is an abnormal immune response by the body such that it mistakenly attacks itself. This attack is directed at a yet-unknown antigen on the cells of the CNS. This is why some scientists believe MS to be an immune-mediated rather than an auto-immune disease.

It is important to note that MS is not hereditary, although its occurrence in a first degree relative significantly increases an individual’s risk of developing the disease.

Environmental factors

While a specific aetiology has not been identified, several environmental factors are now recognised to play a role in the development of multiple sclerosis. These factors serve as triggers in the already genetically-predisposed individual.

Several studies indicate that if a person living in a low-risk environment for MS such as the tropics changes geographical location to a place with high incidence of the disease, the individual assumes the risk of MS prevalent in that environment. This suggests that exposure to certain components of the environment may play a significant role in the development of MS.
Possible correlation between MS and Vitamin D is also being researched, as it has been noted that the incidence of MS is lower in populations who live closer to the equator than others who do not. Exposure to sunlight mediates the body’s production of natural vitamin D, which supports the immune system and has a protective effect against immune-mediated diseases.
Smoking has also been implicated in not just the development of MS but also in the severity of MS symptoms and signs when they do occur. Cessation of smoking even after MS has developed has been shown to reduce severity of attacks and reduce frequency of relapses.

No strong link has been made yet between infectious organisms and multiple sclerosis but on-going research is focusing on certain viruses like Ebola, measles and human herpes virus- 6, as well as bacteria like chlamydia pneumonia

Clinical features

Many times the diagnosis of multiple sclerosis depends heavily on the clinical acumen of the physician, and a lot of cases go undiagnosed. Multiple sclerosis is not easy to diagnose generally, but its rarity among blacks makes it that much harder to pinpoint in the tropics. The paucity of diagnostic tools, in this case MRI, in most health care facilities, greatly impairs confirmation of diagnosis even when the clinical suspicion is high.

MS symptoms follow a flare-remission pattern. Initially, most patients experience spontaneous resolution or remission of their symptoms after a few days, although it is now believed that each episode leaves the individual with one residual neurological deficit or the other. This tends to be cumulative over the years and eventually culminates in great morbidity and eventual death, especially without medical intervention. Some of the symptoms include numbness in the extremities, face or other parts of the body. Recurrent and unexplained weakness of the limb(s) with spasticity,  tremours of the hands and lack of muscular coordination.

Others, such as difficulty swallowing, itching, seizures and breathing difficulty may occur later.

Story Source: The above story is based on materials provided by PUNCH
Note: Materials may be edited for content and length

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