Recent Updates in Treatment of Multiple Sclerosis

Abstract

M ultiple sclerosis is a disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms. MS usually appears in adults in their thirties but it can also appear in children. Environmental factors during childhood may play an important role in the development of MS later in life. A relationship between season of birth and MS has also been found which lends support to an association with sunlight and vitamin D. National Multiple Sclerosis Society standardized four subtype definitions: relapsing remitting,secondary progressive, primary progressive and progressive relapsing. The person with MS can suffer almost any neurological symptom or sign. The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale. Symptoms of MS usually appear in episodic acute periods of worsening (called relapses, exacerbations, bouts, attacks, or "flare-ups"). Viral infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse. Stress may also trigger an attack. There is no evidence that vaccination and breast feeding, physical trauma, or Uhthoff's phenomenon are relapse triggers. MS has been considered to be an autoimmune disorder where myelin-specific T cells initiate an inflammatory process that results in CNS demyelination. Patients with MS have been observed to have myelin-specific T cells which are of an activated or memory phenotype and are more likely to be of a Th1 phenotype.