Catherine Davis

Dr. C
Eng. Comp. 1201.506
14 November 2021
Multiple Sclerosis

Watching someone struggle to live with Multiple Sclerosis (MS) is a life-changing

experience. After watching the documentary "Introducing, Selma Blair," watchers get a little

more insight into what that life is like. Selma Blair, a famous actress, spoke about her story of

living with MS and its impact on her life. "I was ashamed, and I was doing the best I could, and I

was a great mother, but it was killing me," Selma said in an interview (Introducing, Selma Blair).

Many people with MS struggle to do daily tasks and feel as though they are not giving 100%

when they are; their bodies just cannot do anymore. Many people with MS feel that if they get

stronger or work harder, they can get better, which doing these things can help them function

better, but nothing will get them back to 100%. For some people, symptoms can start when they

are only teenagers and will not even receive a diagnosis until 20 to 30 years later. (Introducing,

Selma Blair) This is because many doctors usually say that the symptoms are because of anxiety

or tiredness, and this issue is predominantly found in women. This causes many issues because

with a disease like MS, it is crucial to find out the diagnosis sooner rather than later in hopes of

trying to stop the progression of symptoms from getting worse. "It's so good that she's out there,

just showing people that it's O.K.," Ms. Benassi said. (Introducing, Selma Blair) Like Ms.

Benassi, many struggle with the idea that it is okay to not be okay. Wanting to find a cure and

fight back against the disease has been proving exceedingly tricky for scientists. Finding where

this disease comes from can bring light to finding a cure, but most treatments such as medicines

and other alternative ways are the only thing that doctors can offer patients with MS.
 Multiple Sclerosis is a disease where one's own body's immune system attacks the brain,

specifically myelin. When reading and learning more about MS from the National MS Society

website, people can learn so much about what the disease is and everything about it. MS gets the

name Multiple Sclerosis because people have multiple areas of scarring when they have the

disease. With MS, an abnormal response of a person’s immune systems is directed against the

Central Nervous System. This abnormal response causes the body to have inflammation which

can damage myelin. Myelin is the fatty substance that surrounds and insulates the nerve fibers.

("National Multiple Sclerosis Society") Once someone has issues with myelin being destroyed,

all messages going through that pathway are slowed down or even stopped completely and never

reach the Central Nervous System. When someone with MS tries to send a signal, the nerve's

electric impulse is damaged, causing the issues that they have with walking, speech, and other

tasks. The life expectancy also has decreased by 5 to 10 years. Most people diagnosed with MS

are in their 20s to 50s, and two to three times more women are diagnosed than men. ("National

Multiple Sclerosis Society") There is no definite idea of what might give someone MS, but some

doctors and scientists say that it might be from environmental and genetic factors. MS is not in

DNA and cannot be directly inherited, but if a parent or sibling has MS, individuals are at a

greater risk of getting it. There also has been found that some viruses link to MS, such as the

Epstein Barr virus. The race of someone might be a factor also with the Northern European being

the highest risk and Asian, African, and Native American being the lowest. Also, the

geographical location of someone is a factor with the most common countries having mild

climates such as Europe, New Zealand, the United States, and parts Australia. Finally, if

someone has low vitamin D or low exposure to sunlight, that may put people at greater risk.

Other health conditions have been linked to making someone be at an elevated risk, such as
having pernicious anemia, being a smoker, or having experienced second-hand smoking.

("National Multiple Sclerosis Society") Finding a cure for MS has been proven exceedingly

difficult and has left those who suffer from the disease trying to find treatments to make life

easier and slow down the progression of some of the symptoms.

When suffering from MS, it takes many people to help, not only doctors but also family

members. Mayo Clinic's website offers a vast amount of information on all the people that are

involved in working with an MS patient. People who suffer from MS have countless amounts of

doctors that are there to help with all the different disabilities that come with MS while also

treating the MS itself. From neurologists, physical medicine, physiatrists, urologists,

psychologists, and neuropathologists all play a crucial role in helping make life with MS more

manageable. ("Multiple Sclerosis") Having a supportive family is another key part when people

have MS. They have a multitude of issues with muscle stiffness, spasms, paralysis(legs),

problems with bladder, bowel, mental changes, depression, and epilepsy. ("Multiple Sclerosis")

Fig. 1. Diagram of some of the symptoms of MS with images. (The many symptoms of Multiple
Sclerosis)

Finding a cure is proving to be an extremely challenging task for doctors and scientists

worldwide, according to the National MS Society. Some have said that doctors need to focus on
the regeneration of myelin and rebuild that in those pathways. The issue with this is the body

makes oligodendrocytes which do aid in the regeneration and rehabilitation of myelin, but it is a

slow and incomplete process on its own. ("National Multiple Sclerosis Society") So far, the only

thing doctors and scientists have managed to do is find ways to slow the development of MS and

help with the vast numbers of possible symptoms that people experience.

There are four types within the large area of MS: clinically isolated syndrome, relapsing-

remitting MS, secondary progressive MS, and primary progressive MS, with relapsing-remitting

MS being the most common. ("National Multiple Sclerosis Society") There is also another

syndrome, although not considered a type of MS, that has found the same type of abnormalities

in the brain and spinal cord unrelated to other diseases called radiologically isolated syndrome or

RIS. With RIS, most people go on to have MS within ten years of diagnosis, but this is not true

for all who have RIS. Doctors try to monitor a person's MRI in hopes of finding if they develop

MS so treatments can start early. With RIS, they will go in for an MRI with a simple issue like a

headache, and doctors will find lesions that are like those with MS.

One type of MS is clinically isolated syndrome or CIS. CIS is the first incident of

neurologic symptoms that are affected by inflammation and the loss of myelin in the central

nervous system. ("National Multiple Sclerosis Society") For the episode to be considered, it must

last 24 hours, but these occurrences are just characteristics of MS and not an actual diagnosis of

MS. Some people with CIS may actually progress to an MS diagnosis, but some with CIS do not.

With CIS, people get the same lesions on the brain that are found with people with MS. These

types of people have a high likelihood of having another episode and getting relapsing-remitting

MS. Most of the treatments for clinically isolated syndrome are disease-modifying therapy which

helps to delay the onset of MS. ("National Multiple Sclerosis Society")

 Another form of MS is called relapsing-remitting MS or RRMS. RRMS is the most

prevalent MS form, with around 85% of people having RRMS. ("National Multiple Sclerosis

Society") This form of the disease can be identified by distinctively defined attacks with

neurological symptoms that are either new or increased from a previous episode. These relapses

or attacks are followed by a recovery time that can be either a partial or a complete recovery.

This recovery time or remission is when some or all of someone's symptoms disappear. RRMS

has two subcategories under it, active and not active. If there is new activity on the MRI in a

specific time period and there are relapses, then the MS is active. Following a relapse if there is

found to be an increase in disability, then the MS is not active.

The next type is secondary progressive MS. This form begins as relapsing-remitting MS

and then converts into secondary progressive when the neurological functions worsen over time.

Secondary progressive also has two subcategories of active and not active. Active being with

relapses and new MRI activity like RRMS and not active that has evidence of no relapses of new

activity in the MRI and over time a progression in disability. ("National Multiple Sclerosis

Society")

Primary progressive Multiple Sclerosis (PPMS) is the last form of MS. Primary

progressive MS is distinguished by the neurological functions getting worse from the beginning

of the disease without any early relapses of remission. Fifteen percent of people diagnosed with

MS have this form. ("National Multiple Sclerosis Society") The two subtypes are also active and

not active like the previous two. Active means someone has an occasional relapse and has

evidence of new MRI activity over a specific time. Not active is evidence of progression in

disability over time with or without relapses. PPMS is hard to treat because there are more

treatments that help people with RRMS.

 Treatments are available for all people that suffer from MS, but they are not cures to get

rid of the disease but ways to help slow down or modify the disease course, treat relapses,

manage symptoms, improve function and safety, and address emotional health. People also like

to do treatments to provide care, promote comfort, help better function, give people more

independence, and help with overall health and wellness. There are dozens of medicines to treat

relapsing-remitting MS, but there currently is only one to treat both relapsing-remitting and

primary progressive. There are several medications also to treat secondary progressive and

clinically isolated syndrome. All the medications reduce relapses, reduce the lesions that are

found on the brain and spinal cord, and slow the disabilities that are found with MS. The

treatments that many with MS use are medications and rehabilitation strategies such as physical

therapy. These people do several types of therapies to help with accessibility, mobility, speech,

swallowing, memory, and other cognitive functions. ("Treating Multiple Sclerosis," 2021) There

is a big focus on the mental health of people that suffer from MS because most can develop

depression, anxiety, and have bad mood changes. With medications, there are three types

infused, injectable, and oral.

There are multiple choices of medicines that are injectable such as Ocrevus, Lemtrada,

and Novantrone. ("National Multiple Sclerosis Society") Ocrevus is an infused medication used

as a disease-modifying agent. The FDA has approved Ocrevus to treat all types of MS, even

primary progressive MS, which few can. (Burton, 2017) Lemtrada is also an infused medicine is

also a disease-modifying agent that helps people that suffer from relapse-remitting MS and

secondary progressive MS. This type of medication is usually for people that have done two or

more successful MS therapies. Novantrone is another infused medicine that is a disease-

modifying agent that treats secondary progressive, progressive-relapsing, and worsening

relapsing-remitting. Some of the injectable medicines are Rebif and Glatopa. Rebif is a disease-

modifying agent and all types of MS except primary progressive MS. Glatopa is a disease-

modifying agent as well and all except primary progressive MS. The oral medications that are

available are Zeposia and Ponvory. Zeposia is another disease-modifying agent that treats all but

primary progressive MS. Ponvory, like Zeposia, is a disease-modifying agent that does not treat

primary progressive. ("National Multiple Sclerosis Society") Most of the medicines that are

available for MS, as stated above, are disease-modifying agents and rarely treat primary

progressive MS. However, there are other medications that some use to help with treating MS.

From trying bee-sting therapy to aloe infusions, nothing helps. Botox, for example, helps with

bladder dysfunction and spasticity in the lower and upper limbs. Ampyra helps with walking

functions and improves the movements of nerve singles along nerve fibers. Finally, Paxil is used

for depression and some anxiety types. ("National Multiple Sclerosis Society") All these

medications and many others help with so much more, and the list of medications that MS

patients can take is lengthy since medications are all that doctors can offer right now.

Physical therapy, occupational therapy, and speech-language therapy are other things that

doctors advise patients to do to help them with building strength and make sure they try and keep

up skills that they lose from MS. ("National Multiple Sclerosis Society") For example, many

people lose function in their legs, so they like to use physical therapy to keep the muscles

moving and working and getting what they can strong. Physical therapy also helps with the

fatigue aspect of MS and helps to make them have more strength to have more energy to get

through the day. Using occupational therapy to be able to keep up with day-to-day tasks is

essential. This way, people with MS can be more independent and not have to rely on as many

people every second to be there for them. Many also go to cognitive therapy to help them cope
with having MS and make their specific life work best for them. Having someone to help the

patients with dealing with something as life-altering as MS is a massive challenge, and that is

what therapy sometimes does for people. Patients also like to go to vocational therapy in hopes

of building up to be able to work in a typical working environment. Having help is sometimes

necessary to learn how to adapt to having MS and finding new ways to work. All diverse types

of therapies do so much for people by helping to strengthen their muscles, speech, emotions and

helping with getting them to be able to work as much as they can. Therapies can do as much as a

medication can do in helping to treat a person with MS.

From using normal medications to going to several types of therapies, there are still other

conventional medicines that some like to use. Other over-the-counter type medications such as

vitamin D pills have been found to help people with MS with helping in muscle and bone

strengthening. ("National Multiple Sclerosis Society") Also, when reading a scientific article

from the BMC Neurology about a study done in Iran, making sure that people focus on keeping

fitness up and exercising a lot can also help. (Razazian, 2020) When people keep a healthy

lifestyle, this can help to grow the immune system and help to strengthen bones. Finally, some

have tried to use other forms of treatments such as acupuncture to find any way to relieve the

pain and make life a more accessible and more normal way to live.

Through all the hardships that come with MS, there have been feasible ways not to cure

fully but help with treating MS in a highly effective way. A new way that might help MS

patients was discussed in the New York Times Magazine article, "A Controversial 'Cure' for

MS." Dr. Zamboni found what he believed was the real cause of MS, which was called chronic

cerebrospinal venous insufficiency, or CCSVI. (Tullis, 2012) With MS, the immune system

attacks the brain and blocks veins that prevent blood from draining, which causes iron to back up
in the brain and damage the nerves that send messages throughout the body. This iron build-up is

what was destroying and weakening the myelin shield around the axon. Since MS has around 50

genes related to it, no one could tell if this fix was going to help with all forms. (Tullis, 2012)

This was proving to be an issue because MS is a vexing disease, and there was no way of telling

who and what type of situation would react to the treatment and whether it would be successful

or not. Most of the treatments that are offered help with the immune system and not anything

else. They thought that there would be more blood flow linked to MS when they fixed the issue.

The other thing that they found out about CCSVI is that it was different whether people were

standing up or sitting down. The operation was to perform CCSVI surgery, where they opened

the blood vessels in hopes of getting more blood flow to all the different veins that were not

previously getting that blood flow. (Tullis, 2012)

The case discussed in the article in The New York Times Magazine focused on one guy

named Gottschalk who wanted to get the procedure done. "I've had enough of this! I have to do

something that maybe will help me," Gottschalk said. (Tullis, 2012) He was so sick and tired of

dealing with MS and everything else that the disease was throwing at him, so he decided to get

CCSVI surgery. Gottschalk had a brother who was very scared of how risky the procedure was

and how invasive it was when the procedure was not 100% made to help cure MS. Gottschalk

was using a cane initially and seemed to be very tired all the time. (Tullis, 2012) After the

procedure was done and all was complete, he seemed to have improvements in all his symptoms.

Another story using this method from The New York Times Magazine was about

Zambonis' wife herself got MS, and he founded the procedure. She was diagnosed with MS in

1995 and was put on standard drugs to help with the MS, but all it did was keep her symptoms at

bay and not do anything to help improve them. Zamboni wanted to help her, and so he started his
own research into ways to help her and find ways to make her life better. He found that there was

someone who found that there could be a link between blood vessels and MS, but no one ever

found the vascular connection to MS. After finding increased research about MS, he found more

with the link to the veins to the brain. When looking at people that have died from MS, he found

multiple cases of venous hypertension in the brain or high pressure in the veins. (Tullis, 2012)

This is where he decided to start the scientific process and hypothesized that there had to be

some sort of blockage. All these strong revelations were coming about, and something that could

help was becoming known until Zamboni could no longer hold a scalpel. He finished off his

studies and found the CCSVI procedure to be helpful.

On the other hand, there were some issues with the procedure and MS. The procedure

itself did not treat MS directly but only symptoms that came with MS. The procedure was also

showing issues with their needing to be more than one procedure needed to help keep the

symptoms improving. Also, the procedure had different effects depending on whether the patient

was sitting up or laying down. The FDA also sent out a warning about the procedure that there is

no controlled or reliable evidence about it. (Tullis, 2012) MS is also associated with 50 different

gene types, so this procedure did not prove to help all. The other thing is that some turned to

other forms of non-conventional drugs such as marijuana to help with some of the symptoms, but

many have strong feelings of whether using this type of drug is good or not. (Tullis, 2012) Since

most drugs that are made to help people with MS are focusing on the immune system, people

like to stick with the fact that MS is just a chronic, incurable disease.

From all the treatments that are available and ways to make life easier, there still has not

been a full cure. For example, Selma Blair's story shows how so many struggle with the disease

and feel as though they are alone and have no voice. They are just left with the fact that they
have a life filled with treatments and medications that are just ways of stalling and not

progressing their symptoms, with no promise of a cure. Finding a cure for a disease that they find

the cause of is exceedingly difficult. That is why for now, all that MS suffering patients are left

with are drugs, doctors, and therapies.

 Works Cited

Burton, Thomas M. "FDA Approves Drug for Primary Progressive Multiple Sclerosis." The Wall
Street Journal, 28 Mar. 2017.
Fleit, Rachel, director. Introducing, Selma Blair. Discovery+, 2021,
www.discoveryplus.com/show/introducing-selma-blair-us.
"Home." National Multiple Sclerosis Society, 15 Oct. 2021, www.nationalmssociety.org/.
Julie Stachowiak, P. D. (n.d.). The many symptoms of multiple Sclerosis. Verywell Health.
Retrieved November 4, 2021, from https://www.verywellhealth.com/multiple-sclerosis-
symptoms-2440790.
"Multiple Sclerosis." Mayo Clinic, Mayo Foundation for Medical Education and Research, 12
June 2020, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/care-at-mayo-
clinic/mac-20350279?
gclsrc=aw.ds&&mc_id=google&campaign=1667987507&geo=9015814&kw=multiple+scl
erosis&ad=438767102316&network=g&sitetarget=&adgroup=64575762876&extension=
&target=kwd-
298645940136&matchtype=p&device=c&account=1733789621&invsrc=neuro&placemen
tsite=enterprise&gclid=CjwKCAjwzaSLBhBJEiwAJSRokjhbsCPg4TCBTzPqllOpOXjZK
gFtC6xlFesw1TUPJDZLOgQsc0cynxoC_3oQAvD_BwE.
Razazian, Nazanin, et al. "The Impact of Physical Exercise on the Fatigue Symptoms in Patients
with Multiple Sclerosis: A Systematic Review and Meta-Analysis." BMC Neurology,
vol. 20, no. 1, Mar. 2020, p. 93. EBSCOhost, doi:10.1186/s12883-020-01654-y.
"Treating Multiple Sclerosis." PPS Alert for Long-Term Care, vol. 24, no. 9, Sept. 2021, pp. 6-9.
EBSCOhost, search.ebscohost.com/login.aspx?
direct=true&db=ccm&AN=152453540&site=eds- live.
Tullis, Paul. "A Controversial 'Cure' for MS." The New York Times Magazine, 26 Oct. 2012