Delve into the intricacies of multiple sclerosis, understanding its different types and the latest advancements in its disease management.
The first signs of MS generally appear between the ages of 20 and 40 with exception varying either way. The progress the disease takes after that varies, depending on the severity of the inflammation or how quickly the myelin breaks down.
Sometimes the symptoms may persist for several weeks. In addition, there can also be a more gradual progression of the symptoms if demyelination is more in the foreground. If this is the case, you will notice a gradual loss of bodily functions, often over a period of years, without any real improvement in the meantime. The course the disease takes in any one individual enables us to make a rough distinction between different types of MS.
Dividing MS into groups according to the progress of the disease is often involves looking at the full history of the patient. A particular form of the disease does not mean that we can predict how MS will progress in future.
Relapsing-remitting MS (RRMS): This type shows clearly defined flare-ups or relapses with some amount of recovery in between. This is the most common form of MS at the time of initial diagnosis.
Secondary progressive MS (SPMS): While technically a form of progressive MS, this type acts more like a relapsing form of MS in its early-to-mid stage, with relapses and remissions being quite common. But then a more continuous loss of physical and cognitive functions starts to take over, and flare-ups or relapses become less common. If left untreated, approximately 30% of people with RRMS will develop SPMS within 10 years of their initial diagnosis.
Primary progressive MS (PPMS): In this type of multiple sclerosis, patients experience a continuous worsening of their illness from the onset with no relapses or remissions. There are variations in rate of progression over time with occasional plateaus and temporary, minor improvements. PPMS is relatively rare.
Progressive relapsing MS (PRMS): A relatively rare type approximately 5% at onset. People with PRMS experience a steady worsening of the disease with clear, acute relapses with or without recovery. In contrast to RRMS, periods between relapses are characterised by continuing disease progression.
ADVANCEMENTS IN DISEASE MANAGEMENT
Disease-modifying therapies (DMTs) have long been the cornerstone of MS management, aiming to reduce relapses, delay disease progression, and improve quality of life. Several new and highly effective DMTs have emerged, offering patients more personalised and targeted treatment options.
1. Monoclonal antibodies: Monoclonal antibodies, such as ocrelizumab and rituximab, have demonstrated efficacy in reducing relapse rates and slowing disability progression. These agents target B cells, playing a crucial role in the inflammatory cascade associated with MS.
2. Sphingosine-1-phosphate receptor modulators: Fingolimod and siponimod are oral medications that act on sphingosine-1-phosphate receptors, preventing lymphocyte egress from lymph nodes and reducing their entry into the central nervous system. These drugs have demonstrated efficacy in reducing relapse rates and slowing disability progression.
EMERGING THERAPEUTIC APPROACHES
1. Neuroprotective strategies: Research is actively exploring agents with neuroprotective properties to preserve neuronal integrity and function. Agents targeting oxidative stress, mitochondrial dysfunction, and excitotoxicity are under investigation for their potential to complement existing therapies.
2. Personalised medicine and biomarkers: Advancements in understanding the heterogeneity of MS have paved the way for personalised treatment approaches. Biomarkers, such as neurofilament light chain and imaging markers, are being investigated to guide treatment decisions and predict disease progression.
References available on request.
