Current Understandings of Disease Mechanisms and Therapeutic Approaches in Multiple Sclerosis

Juliet Gallagher

Ongoing research is needed to improve diagnostic and treatment strategies for multiple sclerosis (MS), according to a review article in Medicine.

The researchers constructed a thorough review of the pathophysiology, diagnosis, and treatment of MS to highlight current understandings and areas where further research is necessary.

“MS emergence is a perplexing matter; its origins remain a mystery,” said Maha Haki, PhD, Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq and coauthors. “However, newer investigations infer that it arises from a fusion of genetic vulnerability and environmental agents from development to young adulthood.”

Factors that seem to indicate a higher susceptibility to MS include a lack of vitamin D, birth season, tobacco use, and exposure to Epstein-Barr virus. MS is more common in women and those of Northern European descent. The disease involves the destruction of myelinated axons in the central nervous system (CNS) driven by immune system dysfunction, particularly autoreactive T cells, which disrupt the blood-brain barrier and attack the myelin.

The most common type of MS is relapsing/remitting MS (RRMS) which presents with episodic attacks and substantial or complete recovery following the initial attack. Secondary progressive MS (SPMS) is always preceded by RRMS, presenting with a constant deterioration in function after an initial relapsing phase that is not linked to episodic attacks. Primary progressive MS (PPMS) presents with a lower frequency of attacks and a steady decline in function with no periods of remission. Rarely, patients can present with progressive/relapsing disease, which only accounts for 5% of patients with MS and presents with steady deterioration from the onset of symptoms, regardless of any relapses or remission.

“There is no clear diagnostic procedure,” the authors wrote, “Documentation of 2 or more symptomatic episodes and 2 or more indicators of disease in physically disjointed white matter tracts are diagnostic requirements for the diagnosis of definite MS.”

Diagnostic tools such as magnetic resonance imaging (MRI), evoked potential (EP) testing, and cerebrospinal fluid analysis are commonly used to help diagnose MS.

Treatment of MS varies but can include corticosteroids and plasma exchange for managing severe attacks, disease-modifying therapies such as interferons, glatiramer acetate, or recently developed oral medications such as dimethyl fumarate, fingolimod, and teriflunomide, as well as symptom-specific treatments such as baclofen and physiotherapy for spasticity. However, additional research is needed to develop remyelination therapies and treatments to repair brain damage caused by MS.

“This comprehensive analysis enhances the understanding of MS and underscores the ongoing need for research to develop more effective treatments,” researchers conclude.

Reference

Haki M, Al-Biati HA, Al-Tameemi ZS, Ali IS, Al-Hussaniy HA. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine. 2024;103(8):e37297. doi:10.1097/MD.0000000000037297