Understanding Multiple Sclerosis: A Q&A with MS Neurologists


In this article:

  • Nearly one million people are currently living with diagnosed multiple sclerosis (MS) in the United States.

  • Multiple sclerosis is an autoimmune condition where the body mistakenly attacks myelin, an insulating layer of the brain and spinal cord.

  • The most common presenting symptoms of multiple sclerosis include sudden loss of vision, trouble balancing, or weakness in the limbs.

Multiple sclerosis (MS) is a disease that affects nearly 1 million people in the United States. That’s almost 1 million people (in addition to loved ones and caregivers) navigating relapses, symptoms, and living with the disease.

As part of a series that aims to bring awareness to the disease during Multiple Sclerosis Awareness Month, we’re talking to respected neurologists at both Providence and Swedish about what MS is and new research leading to innovative treatments and hope for those who have been diagnosed. We sat down with Stanley Cohan, MD, PhD, neurologist and medical director at Providence Multiple Sclerosis Center and Pavle Repovic, PhD, neurologist at Swedish Multiple Sclerosis Center and neurology research leader at Swedish Neuroscience Institute to discuss MS and how it can affect those we love.

This blog and the physicians included are supported by the Providence Neuroscience Institute.

What causes multiple sclerosis?

Dr. Repovic:

That’s a simple question with no specific answer. We don’t know what causes multiple sclerosis (MS). We know the immune system plays a very important role in MS pathology. But why some people develop it and others don’t remain the greatest unanswered question in this field.

Dr. Cohan:

Anyone can get MS. There is no race that is free of risk. It can occur in males or females, though females have a three times higher risk. However, it is believed that when men get MS, they are more likely to experience severe disability, and it may progress at a faster rate. MS most often develops in young and middle-aged adults, but it can occur at any age, including in small children.

Are there risk factors for developing multiple sclerosis?

Dr. Cohan:

An extremely important and most common risk factor for multiple sclerosis is having a first-order relative with MS. (A first-order relative is a sibling or a parent.) Keep in mind that most individuals with a first-order relative will not get multiple sclerosis, but their risk is higher than the general population.

Dr. Repovic:

There are also environmental risk factors, which are likely higher than a genetic component. The data so far implicates vitamin D deficiency, exposure to Epstein-Barr Virus (EBV), childhood obesity and living further away from the equator. There is currently a debate whether this distance from the equator correlates with vitamin D deficiency or whether exposure to the sun and UV radiation may be another independent risk factor.

What is the connection between multiple sclerosis and the Epstein-Barr virus?

Dr. Cohan:

Most multiple sclerosis neurologists have believed that Epstein-Barr plays some role in MS for quite some time, though it is not exactly clear how. For example, women who develop mononucleosis are more likely to develop multiple sclerosis. Researchers have also found genetic material of Epstein-Barr in white blood cells overlaying multiple sclerosis lesions in brain specimens collected from MS patients.

We should not say Epstein-Barr causes multiple sclerosis because Epstein-Barr is widely distributed in the population. It is estimated that the virus infects more than 90% of humans, whereas multiple sclerosis affects less than 1% of the population. Most people with the Epstein-Barr virus do not develop multiple sclerosis.

Dr. Repovic:

We know that the Epstein-Barr virus appears to be a necessary component of a cascade of events that lead to MS. What’s interesting, though, or where the latest set of data brings this debate, is if the Epstein-Barr virus is truly the necessary component of developing MS.

In a recently published study, researchers followed about 900 young adults on active duty with the U.S. military who had been diagnosed with multiple sclerosis. They compared those individuals with multiple sclerosis to more than 10 million young adults on active duty. They found that only one of the individuals with multiple sclerosis did not have clear evidence of exposure to the Epstein-Barr virus.

So, if you turn this around, and say if this virus is truly critical for someone to develop multiple sclerosis, could immunizing for the Epstein-Barr virus prevent MS? I know many people in the field have wondered about that out loud; that would be proof that this virus is critical to developing MS. That’s a long, somewhat challenging study to conduct. But I hope that the field will move in that direction. For example, one could see a study of relatives of someone with multiple sclerosis and have a higher risk of developing MS get immunized while young against EPB virus.

What happens in the body with multiple sclerosis?

Dr. Repovic:

Multiple sclerosis is an autoimmune condition where the immune system becomes confused and targets a component of your body called myelin under the mistaken belief that it is a foreign body that needs to be eliminated. Myelin in the nervous system, brain, spinal cord and optic nerve is produced by oligodendrocytes. This myelin is believed to be the target of the immune attack in multiple sclerosis.

Every so often, the immune system of someone with multiple sclerosis attempts to eliminate myelin. This leads to a local inflammatory reaction and the formation of a scar. Depending on where the scar occurs, the person may experience trouble with their eyesight, balance, strength, or problems with sensation, or feeling, in the form of numbness, tingling or pain.   

What are the warning signs of multiple sclerosis?

Dr. Cohan:

Sudden symptoms, such as visual changes, changes in strength and balance, altered sensation in limbs or one side of the body or both legs, double vision or vertigo. These are the most common early symptoms.

Symptoms can evolve over hours to days. Although there are no symptoms that only characterize multiple sclerosis, these are the most common presentation. Tell your doctor immediately if you experience these symptoms. They can help identify the cause.  

Dr. Repovic:

It’s not unheard of for someone to experience these problems and not know what is going on. They might sit on it, and then things get better, so they forget about it. If something is persistent and problematic, it probably needs to be investigated and not ignored.

How is multiple sclerosis diagnosed?

Dr. Cohan:

There are no definitive blood tests or diagnostic tests that say, ‘This is multiple sclerosis.’ The disease is typically diagnosed after reviewing the history of symptoms, a neurological exam and an MRI scan of the brain and spinal cord. Taken together, these are the gold standard for diagnosing MS.

Imagining a brighter future

Drs. Cohan and Repovic agree that there is still much to learn and understand about multiple sclerosis. However, several promising studies are in the works that may lead to better and lasting treatment.

Our next article in this series dives into what the future holds for multiple sclerosis and discusses the clinical trials currently underway at Providence and Swedish multiple sclerosis centers.

Read the article, Clinical trials and research bring hope to MS patients.


Find a doctor

If you have questions about multiple sclerosis or at risk of developing the disease, find a neurologist through the Providence Institute Patient Engagement Center (PEC), or learn more about the Neuroscience Institute.

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This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

About the Author

Neuroscience is super complex, and the Providence Brain & Spine Team taps into the many decades of expertise to provide useful and helpful advice and tips on non-surgical and surgical options to treat any disease of the mind.

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