The term neurological disorder can be a bit daunting. After all, it involves the brain, which is arguably the most complex of all organs in the history of evolutionary biology, and particularly in humans. We humans have even used our own complex brains to understand, in microscopic detail, how they function, what causes various dysfunctions, and which ways we can progress in treating neurological disorders.
What makes the term neurological disorder so daunting is that it covers a rather wide range of neuroanatomical and neurochemical issues, including brain tumors, brain injury, Parkinson’s Disease, Alzheimer’s Disease, and Multiple Sclerosis (Carlson, 2013). And while extensive research has been done on all above-mentioned conditions, this paper will focus on one in particular: Multiple Sclerosis (MS). Namely, let’s explore what all is entailed with MS; the pharmacological, cognitive, and alternative treatment therapies that are now widely available; the research behind the various treatment options and how they are perceived; and why a collective approach to treatment may be the most beneficial.
First, let’s start with the basics: MS, an autoimmune disease, is considered the most common of neurological / nervous system disorders among adults between the ages of 20 and 50 (Koskie, 2020). MS, also referred to as Encephalomyelitis Disseminate or Disseminated Sclerosis (Koriem, 2016), disrupts autoimmune function by infiltrating and damaging the myelin sheaths that protect axons, thereby impeding neurotransmitters from functioning properly and causing nervous system dysfunction throughout the brain and spine (Carlson, 2013).
That, in turn, causes a mix of debilitating symptoms, including muscle spasms and weakness, lack of motor coordination, speech issues, and chronic pain (Koriem, 2017). Additionally, the thalamus, a part of the brain that co-manages cognitive function and naturally declines with age, more rapidly decreases in those afflicted with MS. And as we will see later in this paper, treatments that impede cognitive decline are a key component of managing MS. (Hasan et al, 2011).
MS has some demographic properties too: It is more predominant among females than among males, it tends to afflict people who live farther from the equator, and it has been linked to childbirths that occur in late Winter / early Spring (Carlson, 2013). What is especially striking is the U.S. has the largest concentration of MS cases, with approximately one million diagnosed out of ~2.3 million cases total throughout the world (Koskie, 2020).
Exploring the demographics further, it may seem odd at first glance that a person’s proximity to the equator could lead to developing MS; yet the primary connection between the two is this: The farther that people live from the equator – especially in much colder, more frequently overcast climates – the greater the chance of having a Vitamin D deficiency. This includes children who live in colder climates; that is, there is an increased chance that children can develop MS when they are born in winter in the late Winter / early Spring timeframe (Koriem, 2017).
In fact, a study conducted in 2010 revealed significant percentage differences of MS cases in warmer climates versus colder climates. For example, MS cases in Europe are 200 for every 100,000 people in Northern Europe versus .0.5 for every 100,000 people in Africa. Therefore, environmental factors can have a demographic component as well (Koriem, 2017).
While there is currently no cure for MS – and the treatment options we will be exploring vary in efficacy and are considered subjective — the above-mentioned contributors to what may trigger the disorder are just a few of the wide-ranging factors in how MS can develop. Environmental factors such as stress and viral infections have also been linked to the onset of MS, though not exclusively (Carlson, 2013).
One possible connection between certain viruses and MS is that when a virus attacks the immune system, myelin proteins could infiltrate the blood stream, causing the immune system to attack them in return. It is also possible that the virus attaches itself to the myelin protein, which will engage the immune system anyway as it combats the virus. (Carlson, 2013). In other words, the immune system is performing its essential function by guarding against invading substances, even if said substances are an integral part of cell function and neurotransmission.
MS biomarkers have also increasingly become a factor in understanding MS pathology. Three of the common, primary biomarkers for MS are nitric oxide (a neurotransmitter that supports brain function and blood flow), osteopontin (a protein that helps regulate immune function), and neurofilaments. For example, any instability imposed on neurofilaments, which aid in axon growth and support overall neuron function, can lead to neurological abnormalities. Neurofilament instability is often due to a lack of neurofilaments being produced or a gene mutation within a neurofilament. This, in turn, leads to nerve cell damage, a primary feature of MS proliferation throughout the CNS. (Koriem, 2017).
Also, although MS has not been deemed as a genetic-based disease, there appear to be epigenetic factors and hereditary aspects: For example, studies have shown that identical twins born from a person afflicted with MS are 30% or more at risk to develop MS than the 5% risk among non-identical twins. (Koriem, 2017).
Which leads to the question: How was MS first discovered? Jean Martin Charcot, a nineteenth century scientist who has been called “the father of neurology”, helped MS grow further out of obscurity by publishing scientific literature and giving lectures in 1868. These findings resulted from Charcot’s extensive research with his long-time colleague, Alfred Vulpian. Charcot and Vulpian together studied various patients exhibiting MS-like symptoms, and the information in their individual papers on the subject often overlapped (Zalc, 2018).
It could even be said that the relationship between Vulpian and Charcot was similar to the fable “The Tortoise and the Hare”, as Charcot was move slow-moving in his research than his partner who advanced quickly in his career. Yet Charcot’s work ended up becoming the primary, pioneering foundation for MS research and diagnostic work (Zalc, 2018).
What’s more, there are even earlier documented accounts of MS, though they were mostly speculative and well before the disorder had been officially vetted and named. Sir Augustus D’Este, a member of the English royal family during the first half of the 19thcentury, kept a diary about his struggles with muscle weakness, spasms, numbness, and depression. However, Augustus’ diary did not become well known until 1948: 80 years after Jean Martin Charcot’s groundbreaking work, and almost 30 years after Bruce Frederick Cummings published his own account (under the pseudonym of WNP.Barbellion”) of his struggle with MS symptoms in an article called “The Journal of a Disappointed Man” (Pearce, 2005).
The early accounts of MS symptoms, along with Charcot’s findings, helped pave the way for many medical advances throughout the 20th century and to present day. Based on research conducted in the 1940’s and 50’s about the immune system’s role in affecting MS, the 1960’s was a defining decade in correlating a direct link between the immune system and damage to the myelin sheath (Roth, 2016).
Then, because of significant strides in imaging technology, specifically MRI, image captures were more clearly able to show myelin sheath damage to due to MS. This led to the rise of various drug therapies developed in the 1990’s to manage MS symptoms. In recent years, research has focused even more specifically on the immune system and how it fuels the disorder, as well as some possible solutions to curb the chain reaction like effect that autoimmune conditions impose on the central nervous system (Roth, 2016).
Moving on from the foundational aspects of MS, what are the exact treatment options? First, it is important to note that there is not just one single form of MS. In fact, there are several types: primary progressive (PPMS), secondary progressive (SPMS), relapsing-remitting (RRMS), and progressive relapsing (PLMS). The general symptoms among all types are similar overall, but the differences are key: For instance, with RRMS, a person may have periods of worsening symptoms, with breaks/remission in-between in which symptoms decrease or temporarily disappear. Alternatively, a person with PPMS will, as the name implies, experience progressively worse symptoms over time and without any periods of remission (Koskie, 2020).
That said, how is a person with MS diagnosed properly? It often begins with a process called “differential diagnosis,” which separates MS symptoms from other disorders with similar symptoms. Medical doctors often further isolate their diagnosis by conducting one or more of the following tests: blood panels that segregate the possibility of other conditions; an MRI, which can show damage to the brain and spine; and a spinal tap, which can not only help isolate the MS diagnosis, but also factor any underlying infections that cause conditions similar to MS (Mayo Clinic, 2020).
Yet here is somewhat of a contradiction about treatment options for MS: While many options have been tested and have shown some degree of benefit in relieving symptoms or slowing the disease’s progress, there currently is no single, empirical treatment that directly fights MS. However, the good news is that the treatment options keep evolving, and that we may see more precise solutions within this century (Koriem, 2017).
Two increasingly developing treatments, which could lead to more breakthroughs in manipulating the immune system’s relationships to MS, are interferon β and glatiramer acetate. Interferon β is the more popular choice as it remarkably slows the disease’s progress. Glatiramer acetate, on the other hand, is based on a collection of amino acids that ironically could fuel MS symptoms, but instead help in reducing them. Both options, however, do not work well on PPMS or SPMS; instead, they are more geared toward treating RRMS (Carlson, 2013). However, that doesn’t mean there aren’t similar treatment options for people with PPMS: In fact, an injectable infusion therapy called ocrelizumab, which interestingly treats both RRMS and PPMS, has provided a modicum of relief for PPMS specific symptoms (Mayo Clinic, 2020).
In addition, various medications are available to help manage MS. Prednisone and methylprednisolone can help decrease inflammation throughout the nervous system. Fingolimod, Dimethyl Fumarate, and Teriflunomide are just few of about a half a dozen oral medications that can help control relapses. Also, infusion therapies, such as Natalizumab and Alemtuzumab, can manipulate the immune system by preventing immune cells from targeting the brain, spinal cord, and the nervous system overall (Mayo Clinic 2020).
As with all medication options, side effects are often a part of the equation. And the more powerful the medication, the more that the person taking that specific medication must be regularly monitored. For example, Fingolimod can either lower or raise blood pressure; Dimethyl Fumarate can decrease cell blood counts; and Teriflunomide can damage liver function, as well as cause birth defects in individuals who are pregnant or plan to have a baby (Mayo Clinic, 2020).
Drug therapies, though, are not the only ways to manage MS. Because many people with MS experience memory loss and an all-around decline in their cognitive abilities (Sumowski et al, 2018), and often fall into depression (which can be linked to abnormalities in the limbic system, due to MS development), psychotherapy / behavioral management can be an effective supplement to drug therapy (Staff et al, 2009).
For instance, a somewhat recent study on the benefits of psychotherapy to treat MS concluded that psychotherapy can be a significantly positive addition to other therapies. The 20 MS patients who participated were required to complete 12 cognitive behavioral therapy (CBT) treatments and report their feedback accordingly (Gromisch et al, 2020).
The CBT specifically addressed chronic pain symptoms and their underlying causes. Aside from the inflammation-based pain caused by autoimmune episodic attacks in MS patients, psychotherapy sessions included discussing environmental factors: work and family life, stress triggers, and types of social activities. By discussing these aspects in more detail, the participants learned ways to cope with stress and other triggers that increase anxiety, and which can be taxing on the nervous system. Some participants were even able to manage their depression more effectively (Gromisch et al, 2020).
Another study, conducted in 2018, explored the neuroanatomical reasons for cognitive decline in MS patients. Damage to the hippocampus, for example, can cause memory loss / decreased cognitive function. Therefore, exercises that target cognitive function can help strengthen the hippocampus. Also, and as with the results in the above psychotherapy study, managing stress effectively can also help hippocampal function (Sumowski et al, 2018).
Now that we have covered pharmacological and behavior therapy approaches to easing MS symptoms, what about alternative treatments? It turns out that certain alternative therapies might also provide some relief, whether that be for pain, anxiety, or depression. It is important to note, though, that alternative therapies have not been proven to be a complete replacement to those prescribed by a medical doctor. However, as with psychotherapy, incorporating various alternative treatments can yield positive results (Michigan, 2019).
One possibly glaring solution to easing MS symptoms is a heathy diet. There is no shortage of information out there about leading a healthy lifestyle, and that a poor diet can contribute to a vast array of medical issues, not excluding MS. Therefore, a healthy diet may be crucial in helping, at the minimum, reduce MS symptoms. Vitamin supplements, especially B12 and D3, are often recommended, as are diets low in saturated fat. Gingko Biloba might help increase energy and produce an uplifting sense of well-being, and reflexology might provide some relief for nerve pain. However, as with all alternative treatment options, consulting a medical doctor should be part of the regimen (Michigan Medicine, 2019).
Of all the therapies covered in this paper, the mostly clearly substantiated ones are drug therapies and psychotherapy / CBT. In addition to the CBT case study presented earlier, many MS patients, either via other studies or surveys conducted, have reported a positive decrease in MS symptoms, or at least more psychologically effective ways to deal with them due to CBT (MST, 2020)
Drug therapies, while primarily geared toward RRMS, have had an overall positive effect on managing MS. Unfortunately, because pharmacological options come with side effects, and treating MS tends to involve a bit of trial-and-error with the medications, it can leave MS patients despaired and further depressed from dealing with chronic pain and muscle degeneration. Furthermore, as the drug options for RRMS are not helpful for those individuals with PPMS, it shows that much research is still needed to combat all forms of MS. In the meantime, the stress of dealing with ineffective solutions can be overwhelming. Hence why CBT can be a necessary supplement (Mult, 2014).
As it has already been established that there is currently no cure for MS, and that all treatment options are different approaches to reducing MS symptoms, it appears that the best course of action is, first, to understand the exact symptoms being experienced and any environmental factors that may be exacerbating them. Next, seek out a medical doctor who can correctly diagnose the exact type of MS and offer drug treatment options. Then, supplement medication use with a CBT program that teaches effective coping skills and psychological approaches to controlling pain. And lastly, incorporate a healthy diet, explore physical therapy and reflexology to help muscle coordination and ease nerve pain, and also include vitamin supplements.
In other words, because MS does not have a one-size-fits-all regimen for treating symptoms, a holistic approach to managing MS provides a “first aid kit” of sorts for proactively and reactively keeping MS symptoms at bay. And until a cure is discovered, that first aid kit can provide a better quality of life in the meantime.
References
Carlson, N. R. (2013). Physiology of Behavior (11th ed.). Retrieved from https://phoenix.vitalsource.com
Koriem, K. (2017). Multiple sclerosis: New insights and trends. https://www.sciencedirect.com/science/article/pii/S2221169116302453
Koskie, B. (2020). Multiple Sclerosis: Facts, Statistics, and You. https://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic#1
Roth, E. (2016). The History of Multiple Sclerosis: How Far Have We Come?. https://www.healthline.com/health/multiple-sclerosis/history
Mayo Clinic. (2020). Multiple sclerosis. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274
Pearce, J. (2005). Historical Descriptions of Multiple Sclerosis. https://www.karger.com/Article/FullText/87387
Hasan, K., Walimuni, I., Abid, H., Frye, R., Ewing-Cobbs, L. (2011). Multimodal Quantitative Magnetic Resonance Imaging of Thalamic Development and Aging across the Human Lifespan: Implications to Neurodegeneration in Multiple Sclerosis. https://www.jneurosci.org/content/31/46/16826
Zalc, B. (2018). One hundred and fifty years ago Charcot reported multiple sclerosis as a new neurological disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262215/
Sumowski, J., Benedict, R., Enzinger, C., Filippi, M, Geurts, J. (2018). Cognition in multiple sclerosis. https://n.neurology.org/content/90/6/278
Staff, N., Lucchinetti., Keegan, M. (2009). Multiple Sclerosis With Predominant, Severe Cognitive Impairment. https://jamanetwork.com/journals/jamaneurology/fullarticle/798003
Gromisch, E., Kerns, R., Czlapinski, R.,Breenken, B. Otis, J. (2020). Cognitive Behavioral Therapy for the Management of Multiple Sclerosis Related Pain. https://meridian.allenpress.com/ijmsc/article/22/1/8/12033/Cognitive-Behavioral-Therapy-for-the-Management-of
Michigan Medicine (University of Michigan). (2019). Multiple Sclerosis: Alternative Treatments. https://www.uofmhealth.org/health-library/hw189953
Mult, A. (2014). Current Therapies for Multiple Sclerosis: A Brief Review. https://austinpublishinggroup.com/multiple-sclerosis/fulltext/ajmsn-v1-id1004.php
Multiple Sclerosis Trust. (2019). Cognitive behavioural therapy (CBT). https://www.mstrust.org.uk/a-z/cognitive-behavioural-therapy-cbt