Several conditions affect the nervous system, which leads to disability and makes the affected individual dependent on others for their daily activities. Multiple sclerosis (MS) is one such condition, immune-mediated disease of the central nervous system, in which there is damage to the protective covering (myelin sheath) around the nerves.

There are four types of MS namely, relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive-relapsing MS (PRMS). The symptoms are predominantly common to all types and include movement and balance issues, loss of sensation, weakness, bowel, bladder, or sexual dysfunction, involuntary movements of muscles, tremors, etc. Some patients may also have fatigue, vision problems, pain, impaired speech, psychological problems, etc. The condition may progress gradually with increasing severity or may be associated with periodic relapses. Symptoms and defects may diminish during periods of remission, although in most cases worsening of the patient’s condition over the years occurs due to cumulative deficit and incomplete recovery from repeated episodes.

Risk factors and causes of multiple sclerosis

There are no known risk factors for the disease. MS affects individuals in the third or fourth decade of their lives. Rarely, the condition may affect those under 20 years or over 50 years of age. Women are presumed to be more commonly affected than men. Some studies have even mentioned smoking, obesity, and race as risk factors, but there is no clarity on these. An affected individual could suddenly or gradually experience any of the abovementioned neurological symptoms.

The exact cause of MS is unknown but it may involve a combination of genetic susceptibility and non-genetic triggers such as virus, low vitamin D levels, or environmental factors. A strange explanation about the cause of MS is the role of hygiene. Some studies have stated that persons living in developing countries with relatively poor hygiene tend to acquire protective immunity.

Treatment

Conventional management mostly focuses on symptomatic treatment using immune-suppressive drugs and monoclonal antibodies. However, these agents cannot change the natural course of the disease. Furthermore, there is limited data regarding their long-term safety profile. Beta-interferon therapy was considered a major advance in the management of MS; however, its effect is still limited.

Regenerative medicine and cell-based therapy is a novel treatment, which utilizes the body’s healing ability to treat diseases. This form of therapy may be effective for MS through mechanisms including neuroprotection, immunomodulation, and neuroregeneration. By this therapy, scars formed in the nerves/nerve tissue and dead cells in the nervous system can be eliminated and, the local healthy cells can be stimulated to perform their functions more efficiently. Moreover, new neural cell development can be facilitated, which contributes to the replacement of healthy cells. In MS patients, problems result from an imbalance between the deleterious immune response and failure of the remyelinating mechanisms. Cell- and growth factor-based therapy can aid in the correction of these abnormalities through their various properties safely and effectively. Results of treatment are seen in the form of improved strength of muscles and functional system improvements concerning behaviour, cognitive changes, bowel and bladder function, etc.

There are additional supportive modalities that complement cell-based therapy. Transcranial magnetic stimulation (TMS) is one such non-invasive modality. TMS is a neuromodulatory and neurostimulation therapy that works by electromagnetic induction of an electrical field in the brain. Through this, enhanced connectivity of neural networks can be achieved. Thus, this holistic novel approach would result in enhanced long-term treatment outcomes.

Prevention

MS cannot be prevented but early diagnosis and timely intervention may aid in reducing the severity. Basic preventive measures can include changes in dietary habits and avoid/stopping drinking alcohol and smoking. Patients with MS benefit from a diet rich in antioxidants, vitamins, and polyunsaturated fats. Include cruciferous vegetables like broccoli, cauliflower, kale etc. to reduce oxidative stress and excitotoxicity of nerve cells. Also, include brightly coloured fruits or vegetables, but avoid milk, eggs, or gluten-containing grains. Refined/packaged foods are high in trans-fats, preservatives, sugar and salt, and should be avoided to prevent an increase in inflammation in the body, which may exacerbate the symptoms and lead to progressive disease. Maintaining a regular exercise schedule is also important to ensure that the individual can maintain activities of daily living independently for as long as possible.

Outlook

“Multiple sclerosis is a chronic neurological disease that often leads to disability. The complex and non-specific aetiology, progressive nature, as well as relapses pose challenges in treatment. Nonetheless, we are now beginning to understand the molecular mechanisms associated with MS, and can design personalized cell- and growth factor-based therapies. By targeting the core pathology, we can achieve more definite results that are maintained for longer periods. Research is booming in this subject, and soon, we will be able to formulate a robust protocol that will enable patients with MS to lead their life independently,” concludes Dr Mahajan.

The author Dr Pradeep Mahajan, is a regenerative medicine researcher at StemRx Bioscience Solutions Pvt. Ltd., Navi Mumbai