|
DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. Multiple sclerosis is a common disease affecting 2.5 million people around the world, and we still don't understand it completely. We don't know what causes it and we don't know what cures it. There are a lot of theories, and we've made a lot of progress in understanding the symptoms of MS and how they evolve, but there's still a lot to learn. To tell us what we do know about the disease are two experts. First is Dr. Jeffrey Greenstein. He's a neurologist from Temple University. Thanks for being here.
DR. JEFFREY GREENSTEIN: Thank you for inviting me.
DAVID R. MARKS, MD: Next to him is Dr. Rick Munschauer, also a neurologist, and he's from the University of New York at Buffalo. Thanks.
DR. FREDERICK MUNSCHAUER: Hi, Dave.
DAVID R. MARKS, MD: Tell us what MS is.
DR. FREDERICK MUNSCHAUER: That's a loaded question. Multiple sclerosis is a disease characterized by inflammation of the brain or spinal cord. It only affects the brain or spinal cord. We don't know what the cause is, but we can see evidence of inflammation by MRI scanning and, if someone dies from MS -- which is rare -- you can see that there are elements of inflammation within the brain itself. The inflammation seems to be directed towards the insulation around nerves. We call that "myelin." It's a disease that we don't know what turns it on, and we have some ideas of how we can control the inflammation. We don't know how people get it, either.
DAVID R. MARKS, MD: Well, there are some theories about viral causes. Do those hold any water?
DR. JEFFREY GREENSTEIN: There are actually two theories, one of which is that there is some sort of virus, but viruses have been looked for for many decades, and we've never really found a virus in the brain or the spinal cord that we can say is causing MS.
The theory that is most current is that this is an immune condition, what we call an "autoimmune condition," where the person's immune system turns in on themselves, and particularly the myelin, and causes the problems related to MS.
DAVID R. MARKS, MD: Who gets this problem?
DR. FREDERICK MUNSCHAUER: MS can occur, really, in a wide range of ages. We've seen MS in children, and we've seen MS in people who are collecting social security. But in general, it attacks people somewhere between the ages of 15 and 45 to 50. It's more prominent in women than it is in men -- about three times more common in women than it is in men. It happens all around the world. It turns out, however, that people who live in the more northern latitudes, or at least far away from the equator -- either far north, such as in North America, or far south, such as in Australia -- have a higher prevalence or higher rates in which multiple sclerosis affects individuals. Maybe that has something to do with what the cause of MS is. We don't really know. But it's a worldwide condition.
DAVID R. MARKS, MD: So there may be a temperature link? Is that what you're saying?
DR. FREDERICK MUNSCHAUER: Well, I think that we need to explore that. Clearly, the further you live north or south of the equator, the higher the risk you are for having multiple sclerosis. There probably are some genetic factors underlying it. Multiple sclerosis is not a genetic disease like other kinds of common genetic diseases. It's not genetic like blue eyes or brown eyes or whatever, but people inherit a predisposition to getting multiple sclerosis. So it may be our genes, it may be our environment, it may be some complex interaction between genes and environment that trigger, as Jeff said, this autoimmune reaction.
DAVID R. MARKS, MD: What about racial factors?
DR. JEFFREY GREENSTEIN: Well MS is a lot more common in certain racial groups. For example, Caucasians tend to get MS much more frequently, but it does occur in people who are, for example, Native American Indians, and it does occur in Africans, as well. Rather interestingly, it seems to occur more commonly in some of these people after they migrate to areas that are more temperate, so that while genes play some role in predisposition to MS, they're not the only thing that causes MS or precipitates it, and it may well be an interaction between infections and other environmental factors and the immune system that actually brings MS out.
DAVID R. MARKS, MD: In "bringing it out," you mean symptoms? So what are the common symptoms?
DR. JEFFREY GREENSTEIN: Common symptoms include things like loss of vision, double vision, dizziness, weakness, loss of sensation, problems controlling bladder and bowel function.
DAVID R. MARKS, MD: A lot of people, of course, don't have symptoms for a lot of the time.
DR. FREDERICK MUNSCHAUER: That's true. Multiple sclerosis in the majority of people is characterized by the sudden onset of a symptom, such as weakness or incoordination in one side of the body that can resolve over days or weeks or months, and then people can have no symptoms for a long period of time, months or even years. But what we know now is that multiple sclerosis may still be active. When we'd look at evidence of inflammation, as measured by doing MRI scans, we see that even in between attacks of MS, people with MS clearly have episodes of inflammation that don't produce symptoms but may, over time, lead to some further neurologic problems.
DAVID R. MARKS, MD: What does that mean for the long-term outcome? Are people going to die from this disease?
DR. JEFFREY GREENSTEIN: No, people don't die from MS. It's extraordinarily rare for someone to die from MS. Those cases are cases that we tend to write up in medical journals. For the vast majority of people with MS, the expectation is that there may be these relapses or exacerbations of the disease, and for perhaps 80% of the people who have MS, going into a period where there's more progression of the disease. So it's a disease that's primarily disabling, rather than one which is fatal to anybody who has it.
DAVID R. MARKS, MD: So the clinical course is variable, then?
DR. FREDERICK MUNSCHAUER: That's right. It's very variable, and in any one individual, it's impossible to predict how MS will affect them. But we need to treat everybody, because since we can't predict who's going to get quite sick and who may have a more benign course of the illness, it's important to treat people, and to treat people early, before damage has been done which you can't heal from.
DAVID R. MARKS, MD: And there are good treatments available?
DR. JEFFREY GREENSTEIN: Yes, there are very good treatments. They're FDA-approved.
DAVID R. MARKS, MD: They're not cures?
DR. JEFFREY GREENSTEIN: They are not cures and they are by no means perfect, but they're a very, very good start.
DAVID R. MARKS, MD: This was great. This was MS 101, more than I learned in medical school. I want to thank both of you for being here. Thank you for joining our webcast. I'm Dr. David Marks. Goodbye.
|
SUMMARY
