Unraveling the Mysteries of Multiple Sclerosis

Advanced imaging, expanded diagnostic criteria and growing awareness of multiple sclerosis are helping patients get answers more quickly about this sometimes baffling disease — leading to earlier interventions and a better long-term outlook.

Multiple sclerosis (MS) often strikes in the prime of life. An autoimmune disorder, it can cause fatigue, muscle weakness, vision problems, bladder and bowel issues and cognitive changes. As it progresses, MS can leave patients wheelchair-dependent or unable to walk without assistance.

“We are able now to diagnose MS sooner and more accurately so that people can get started on treatment without waiting for the next relapse,” says neurologist Amy Wei-Hsin Laitinen, M.D., director of multiple sclerosis and neuroimmunology at Marcus Neuroscience Institute at Boca Raton Regional Hospital, a part of Baptist Health.

What is Multiple Sclerosis?

Some 1 million people in the U.S. are living with MS, which affects the central nervous system. It occurs when the immune system mistakenly attacks the protective covering around nerve fibers called myelin in the brain and spinal cord. This results in inflammation and scar tissue, also known as MS lesions or plaques, that can interfere with the brain’s ability to communicate with the rest of the body.

While there’s no cure for MS, experts at Baptist Health Brain & Spine Care are offering patients hope and a wide range of treatment options. “We have come a long way since the first medication for MS was introduced in the 1990s,” says Luis Compres-Brugal, M.D., director of the neuroimmunology/multiple sclerosis program at Baptist Health Miami Neuroscience Institute.

“Today, we have more than 20 medications,” Dr. Compres-Brugal says. “They are more targeted and more effective at both delaying the progression of the disease and preventing new attacks. And every day we are learning more about this disease.”

Advances in Diagnosing Multiple Sclerosis

The expansion of diagnostic criteria and recognition of more MS biomarkers are encouraging, says Dr. Laitinen, who recently presented an informational program for Multiple Sclerosis Awareness Month, held annually in March.

For example, the addition of the optic nerve as a qualifying location for lesions is an important expansion of the guidelines, she says. Also, the recognition that MS lesions occur near veins in the brain — something specific to this condition — can help confirm the diagnosis. Overall, the new insights help experienced doctors be more proactive.

“We don't have to wait another year for a brain lesion to pop up while patients are getting worse,” Dr. Laitinen explains. “If we can get to a sooner diagnosis while that person is doing well without symptoms, maybe we can keep them that way. That's really impactful and meaningful.”

In the past, people often went through years of uncertainty, frustration and misdiagnoses before finally getting answers. Without a single test that can confirm MS, doctors had to rely on a process of elimination. To complicate matters, symptoms like fatigue, numbness, vision problems and muscle weakness can mimic a host of other conditions. It wasn’t uncommon for people to be told they had something else entirely — or sometimes be dismissed as imagining their condition.

Relapses and Remissions Common with Multiple Sclerosis

The unpredictable nature of MS didn’t help. Many people experience relapses and remissions, meaning their symptoms flare up and then may disappear for long stretches. Early diagnostic guidelines required clear evidence of multiple attacks affecting different parts of the nervous system over time. That meant some people had to wait for years, enduring more relapses, before getting a firm diagnosis and starting treatment.

Increasingly sophisticated MRI scans now allow doctors to see MS-related damage much earlier, often before symptoms become severe. Now, MRI results and cerebrospinal fluid analysis can confirm MS, rather than waiting for multiple clinical episodes. Doctors can look for specific immune system markers called oligoclonal bands in cerebrospinal fluid, which can help confirm MS. In MRI scans, paramagnetic rim markers that encircle old lesions provide evidence of continued inflammation, even when symptoms recede.

“My hope is that moving forward, anyone with new symptoms does not have to go through that delay — being told one thing or another, waiting for the next relapse, and waiting for symptoms to get worse — to actually get to a diagnosis,” Dr. Laitinen says. “If a patient is not relapsing, but is still progressing, we can do something about that.”

Risks and Symptoms of Multiple Sclerosis

Women are three times more likely than men to be diagnosed with MS, and Hispanics and Black Americans often present with more severe disease. Risk factors include being between the ages of 20 and 40, having a close relative with MS, and living in an area with decreased sunlight where vitamin D levels may be lower. Some viruses, such as the Epstein-Barr virus, have been linked to MS, although more research is necessary to confirm the connection.

Common symptoms of multiple sclerosis include:

·       Fatigue

·       Numbness and tingling in the limbs

·       Muscle weakness, spasticity, stiffness and balance problems

·       Vision problems such as blurred or double vision, or even partial or complete vision loss in one eye

·       Bladder and bowel changes

·       Cognitive problems such as difficulty with memory, attention and concentration

Treatments include steroids and medications that help modulate the immune system. Today, many medications are administered via infusion, although some are given with injections and others are taken in pill form. To help slow progression and improve quality of life, patients may also receive physical, occupational, vocational, speech-language and cognitive therapies.

Amy Wei-Hsin Laitinen, M.D., director of multiple sclerosis and neuroimmunology at Marcus Neuroscience Institute at Boca Raton Regional Hospital, a part of Baptist Health

Luis Compres-Brugal, M.D., director of the neuroimmunology/multiple sclerosis program at Baptist Health Miami Neuroscience Institute

Finding New Therapies for Multiple Sclerosis

Dr. Laitinen notes that Marcus Neuroscience Institute is enrolling patients in two clinical trials investigating the efficacy of certain medications over time. Miami Neuroscience Institute is also planning to participate in research.

Involvement in clinical trials is just one aspect of comprehensive care to bring breakthrough treatments to patients. “It opens up a lot of treatment opportunities that just aren't available otherwise,” Dr. Laitinen says. “Baptist Health is committed to bringing patients new promising therapies.”

Jessica Griffith, R.N., a nurse with Marcus Neuroscience Institute’s comprehensive MS program, is proud of the work the team does to empower and improve the lives of patients and caregivers.

“We understand that living with MS can be challenging, but with the right interdisciplinary team, patients do not have to face it alone. It’s team effort,” she says. “When everyone works together and stays connected, patients not only get the best care possible, they also get the care they deserve.”