December 18 of each year is celebrated as National Multiple Sclerosis (MS) Day, an inflammatory and demyelinating disease of the central nervous system that is the leading cause of disability in adults under 45 years of age, with the exception of traumatic pathology. Dr. Arias Gómez writes about this disease and narrates the advances and research of the latest ECTRIMS (European Committee of Treatment and Research in Multiple Sclerosis).
The first symptoms
Dr. Arias states that: “the most frequent initial symptoms of MS are loss of vision due to optic neuritis and altered sensation in one part of the body due to lesions affecting the sensory pathways. In general, these two types of presentation are the most benign and it is usual for patients to recover with minimal or no sequelae. Other more severe symptoms are spinal cord, brainstem and cerebellum, and motor pathway involvement”.
A progressive disease
According to Dr. Arias Gómez, MS has several evolutionary forms; the most frequent is the one with episodes of relapse (outbreaks) and recovery; the patient is always predisposed to have a serious outbreak that leaves important sequelae that make it difficult or prevent him from leading a normal professional life, especially when, due to his age, his personal project has yet to be completed. It should also be noted that MS often leads to chronic fatigue, both physical and mental, which considerably impairs their quality of life; subtle and progressive cognitive impairment is also not uncommon, which is disabling in many situations.
The disease of unknown causes
As it is a chronic disease whose ultimate cause is unknown, MS has no curative treatment, although in recent years a series of drugs have been developed that interfere with or suppress the pathogenic action of the immune system in these patients. These medications provide increasingly better control of the disease, but they have not only the disadvantage of their high economic cost but also the possible production of serious adverse effects, says the doctor.
Advances and new developments in the treatment of MS
At the last ECTRIMS (European Committee of Treatment and Research in Multiple Sclerosis), attended by Dr. Arias Gómez and held in Berlin from October 12 to 14, new advances and recommendations derived from the study of long series of patients were presented, which allow us to predict the more or less severe course of patients already at the onset of their disease.
In general, two main types of treatment are advocated, some inductive, choosing the most potent drugs for cases of aggressive onset, and others in the form of escalation for those with a more benign onset. First-line immunomodulatory drugs (glatiramer acetate, interferon beta 1a and 1b, teruflunomide and tecfidera), second-line drugs with selective immunosuppressive capacity such as fingolimod and highly effective drugs such as alemtuzumab and natalizumab are currently available. Cladribine and ocrelizumab are also available in some countries and will soon be available in Spain. Ocrelizumab has demonstrated efficacy in progressive forms and cladribine is a drug that is administered orally for 2 weeks each year and has considerable efficacy in reducing the rate of flares and progression of disability. To the role of drugs should be added the treatment of vitamin D deficiency, smoking cessation and combating obesity, since these three modifiable factors are associated with a worse evolution of the disease, reports the doctor.
The congress also addressed some pathologies closely related to MS, which used to be confused with this entity. Neuromyelitis optica, which is a disease of the astrocytes caused by a special type of autoantibody called anti-aquaporin4 , and the pathology secondary to another antibody called anti-MOG (myelin-associated glycoprotein) are worth mentioning. The importance of early and decisive treatment has been pointed out because severe relapses often occur in both types of conditions, the doctor concludes.