Know your risk factors for MS

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Multiple sclerosis (MS) is a disease that affects thousands of Ohioans and many more around the world and can have a major impact on the daily lives of patients and families.

Many people have heard of MS before but have little knowledge about what it is or how it is treated. 

For an overview of MS and tips for patients and families, we turned to Jaime Imitola, MD, director of the Progressive Multiple Sclerosis Clinic and Translational Research Program, part of the Multiple Sclerosis Center at The Ohio State University Wexner Medical Center. 

“This disease, which can cause mental or movement disability, is especially impactful because it often occurs in a younger demographic,” says Dr. Imitola. 

“Patients may have to leave their jobs, give up on everyday activities or even future life goals.”

What is MS?

MS is an autoimmune disease of the central nervous system. 

“‘Autoimmune’ means the immune system will attack a part of the body that is healthy,” explains Dr. Imitola. “In MS, the immune system attacks myelin, the protective coating around our nerve fibers, making it difficult for the brain to communicate with the body.” 

This can result in numbness, weakness, pain, tremor, fatigue, thinking and memory problems, partial blindness and difficulty speaking, among other symptoms.

The disease can begin at any age, but usually most often is diagnosed in people 20-40 years old and is three times more common in women.

Why is MS so much more common in women?

In general, women are more at risk of a variety of autoimmune diseases including MS, systemic lupus, Erythematous and rheumatoid arthritis. The female-to-male ratio in MS is 2:1 to 3:1 and has increased over time. 

Although the reason is still unclear, there is a suggestion that susceptibility may associated with more robust immune responses in women, according to Dr. Imitola. 

What puts you at risk for MS?

Your risk for getting MS can be affected by a few factors. The first is your genes.

“There are about 150 genes that we know are associated with an increased risk for MS,” says Dr. Imitola.

Another risk factor is the environment around you and your lifestyle choices.

If you have a vitamin D deficiency, certain viruses or are a smoker, your risk is increased.  

“When those factors add up, you may get the disease. But that doesn’t mean if you have those factors then you are definitely going to have the disease, it just means that your risk increases,” says Dr. Imitola.

What are the different types of MS?

MS is classified into four categories: relapsing/remitting MS (most frequent), primary progressive MS, secondary progressive MS and progressive relapsing.

“In relapsing/remitting MS, your symptoms and relapses come and go. In progressive MS, you continue to accumulate symptoms and disability over time,” explains Dr. Imitola.

Progressive disease happens after many years but Dr. Imitola says he and other doctors have learned to place emphasis in disability progression and red flags in MS before patients enter progression.

However, problems can arise if too much emphasis is placed on these categories because sometimes the diagnosis of progressive MS is not well established. 

“We can have two patients in the same category who have very different experiences of the disease,” says Dr. Imitola. 

“MS should be individualized and it’s important that people are treated with personalized care to prevent progression of the disease, not just one standard.”

What is the prognosis for those with MS?

This is important question because the prognosis of survival (dying from MS) is good, in general. However, the prognosis of disability progression (wheelchair and severe disability) is more likely, but depends of many factors, such as the number of lesions and location relative to the spine.

Dr. Imitola says there is no specific test to determine prognosis, but he and other doctors rely on data from clinical trials and known red flags to predict the progression of the disease. 

How do we treat MS?

“With MS, we want to treat early and aggressively,” says Dr. Imitola. “We can use medications that prevent the immune system from attacking the body.”

Additional treatments can help with the symptoms of fatigue and pain. Additionally, he says there is a strong emphasis on using physical therapy to prevent potential falls resulting from the movement disability.

 

What advice would you give to newly diagnosed MS patients and their families?

Dr. Imitola recommends that patients look for the best care they can with people who are compassionate and knowledgeable about the disease. 

“Look for people who will give you personalized care and who are dedicated to making your treatment as effective as possible.”

And don’t get all your answers from the internet.

“MS is different for each patient. Don’t compare yourself to the experiences of those online.”

It’s also helpful to belong to a community that is dedicated to coaching patients and families through the MS treatment process.

“At Ohio State, we have a Scarlet & Gray MS Community, which is a group of patients and families working alongside MS doctors and other specialists. Members and volunteers of this community are helping patients manage their multiple sclerosis by offering classes, lectures and events. The group even goes to Capitol Hill and local governments to advocate on behalf of patients in regards to access of care and cost of medications,” says Dr. Imitola.

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