What is Multiple Sclerosis? - Towards Better Understandings
Multiple Sclerosis derives
symptomatic of its presence. It is a progressive chronic (long lasting)
disease. While the underlying cause/s of MS are yet to be clearly established
The presence of
iron laden lesions
differentiates MS from
MS is one of the most common neurologically
associated diseases among young adults and is more common
in women than in men.
affects people between the ages of 20 and 40.
74% of all cases are women. Less than 5% of patients present
with MS before the age of 16.
The Failing Gatekeeper -
Cerebrovascular Endothelial cells
March 2017, in a
publication titled "Emerging Roles
of Endothelial Cells in Multiple
Sclerosis Pathophysiology and Therapy",
Dr Steve Alexander, President,
International Society for Neurovascular
Disease (ISNVD) summed up MS as follows
"the complex pathogenesis of MS can only
be appreciated when and if vascular
contributions are recognized as a
significant part of MS etiology. Indeed,
many novel therapies for MS target the
mechanistically relevant vascular
inflammatory features of these
conditions and implicate cerebrovascular
endothelial cells as the failing
gatekeeper of the
comments reinforce those of
Asking the Right Questions
He went on to say "'there is an urgent
need for new therapies to protect and
restore BBB function, either by
strengthening endothelial tight
junctions or suppressing endothelial
More broadly are the questions "What
breakdowns?" and "What can be done to
better manage such causes?"
Shutting the gate after the event may
assist but it is not the answer.
- which is
MS. It surrounds nerve fibres in the central nervous system
as an insulator to help conduct nerve pulses or messages from nerve endings to
the brain and visa versa. Scarring of the myelin causes a slowing down,
distortion or, in severe cases, complete blockage of the flow of messages from
the nerves to the brain and back again. Identifying processes that regulate
Impairments - contributing factors
The impact of MS associated
moderate or severe, frequently escalates
While It is often
cardiovascular disorders are also identified
as significant contributing factors.
whereby the body produces an
inflammatory reaction against its own
tissue (in this case myelin) appears
somewhat contradicted by March
2017 research that identifies the
positive role of the immune system (Tyro3
in regulating myelination.
In July 2017 Oxford University researchers provided
evidence that, in the case of those with progressive MS,
the blood clotting protein fibrinogen is extensively deposited in their motor cortex, where
regulation of fibrinolysis appears perturbed. This severe fibrin(ogen)
deposition is accompanied by significantly reduced
neuronal density. The
role of the primary
motor cortex is to generate neural impulses that
control the execution of movement. Researchers said future studies are needed to
clarify the source and acknowledged
of fibrin(ogen), and its potential impact on clinical disability -
find out more.
the Root Causes of MS?
While these two
scenarios are not necessarily mutually
exclusive long term studies are yet to
support the auto-immune hypothesis. For
demonstrate that immunosuppressant
drugs do not
impact upon long term disease
progression nor do they
reverse the damage to restore function.
It is also established that ''dampening
down'' the immune system brings with it
risks of serious
Concerns are also
expressed that such treatments not
only do not address underlying vascular
problems but also, in some cases, may
exacerbate such problems. Notwithstanding, such
treatments continue - especially for
those with the relapsing/remitting MS
sub-type with the aim of reducing the
frequency/impact of exacerbations.
there is significant
(2011 - 2017)
that the impact of the most common symptoms
identified by those
living with MS is alleviated through
the non pharmaceutical treatment of the blood flow
known as Chronic Cerebro Spinal Venous
- a condition identified as
present for more
80% of the MS population
(many thousands across all MS sub-types)
tested to date. The most
dramatic and immediate benefits are
experienced by those
A Functional Medicine Perspective
A range of underlying issues potentially contribute
to MS progression and symptom severity. These
all or any of the following - acting
individually or in combination:
Distance from the
equator (insufficient sunshine exposure), undiagnosed/unresolved
or otherwise acquired),
(including side effects),
chronic infections (such as
Chlamydophila Pneumoniae (Cpn), dietary imbalances (including
gluten intolerance), "negative"
smoking and inadequate sleep. For some Interesting
observations about the importance of addressing
such issues see the
document "10 Strategies to reverse
Attention to Lifestyle Issues
Attention to a such issues can be significant
in managing the most common disabilities
reported by those with MS - as well as
potentially partially ''winding back''
some damage already occasioned. Given
that vascular irregularities are
to contribute to disease progression, it
makes good sense to adopt lifestyle
choices that enhance vascular health -
rather than place additional pressure on
what, for many, may already be a
compromised vascular system. Ownership
of decision making (positive
vascular screening, appropriate exercise,
proper nutrition and effective sleep spring to mind
as key elements of this approach.
How is MS Currently Diagnosed?
While it is yet to become widely available
Ultra-High-Field 7-Tesla MRI is the way of the future in confirming an MS
more about this technology
For the moment
and because of
uncertainty about the origins of MS it
is not easy to diagnose. It may show up differently in each person. MS
is typically diagnosed by observing the occurrence of
symptoms over a period of
time, combined with the results of medical tests.
In addition to neurological examination
and a comprehensive medical history
common medical tests include,
magnetic resonance imaging (MRI), lumbar
puncture and evoked potentials -
more about diagnosis
important to eliminate other chronic illnesses
as MS. For all of these reasons there is
delay between the appearance of symptoms and the diagnosis of MS.
This is a very important time for newly
diagnosed people with MS which, if not managed properly, may have negative
long term effects for the individual and their family.
There are compelling reasons to include
comprehensive vascular (CCSVI) screening
as an integral part of this process.
Different Sub Types or Stages of MS?
While MS can follow different patterns for
different people, its clinical course has been classified under 4 broad
categories, each of which might be mild, moderate
Based upon pre CCSVI treatment understandings they broadly are:
A relapsing-remitting course (RRMS)
characterized by partial or total recovery after attacks
(also called exacerbations, relapses, or flares). This
is the most common form of MS. Seventy to seventy-five
percent of people with MS initially begin with a
percentage of whom subsequently progress to secondary
progressive MS within 10 years of diagnosis.
A relapsing-remitting course
which later becomes steadily progressive. Attacks and
partial recoveries may continue to occur. This is called
secondary-progressive MS (SPMS). Of the 70-75% who start
with relapsing-remitting disease, more than 50% will
develop SPMS within 10 years; 90% within 25 years.
generally do not remit. Fifteen percent of people with
MS are diagnosed with PPMS, although the diagnosis
usually needs to be made after the fact when the person
has been living for a period of time with progressive
disability but not acute attacks.
A progressive course from the outset
which is also characterized by obvious acute attacks.
This is called progressive-relapsing MS (PRMS) and it is
quite rare. Approximately 6-10% of people with MS appear
to have PRMS at diagnosis.
Factors that further accelerate MS
prevalence and progression include distance from the
lifestyle choices. More
about underlying variables.
are Typical MS Symptoms and Issues?
At an individual
level symptoms and their severity can be
unpredictable. They may include loss of balance and
co-ordination, diminished vision, weakness of limbs, extreme fatigue (especially
during hot weather), constantly cold extremities, impaired speech and loss of bladder control. A person with
MS might experience one, several or all of these symptoms, depending on the
nature and extent of underlying issues.
There is however significant commonality
on the overall range of issues
experienced by MS populations. Examples
of pwMS experience more than average levels of fatigue, 68%
experience heat intolerance and 58%
can experience cognitive problems.
(each of which can be mild, moderate or severe)
are so identified.
More about this research and
associated treatment modalities.
Progressive Impact of
There is building evidence that the
levels of disability (mild, moderate or
severe) across all MS sub-types are
related to the progressive nature of
underlying bloodflow disorders and the
consequences thereof. In this context
the identification of CCSVI conditions
could be seen as a
red light signaling a
dangerous escalation of an insidious
process that includes
breakdown, the formation of
iron laden lesions
more rapidly where (potentially
treatable} vascular irregularities are
also present. In
of MS is
At the 20
year mark population studies show that
35% of people living with MS are
significantly to severely impaired.
Lifetime Continuous Care programs
multi-disciplinary teams are
identified as essential for those with
more advanced forms of MS.
the course of MS and prognosis.
genetic linkages can increase an individual's risk of
developing MS. A
study published on 30 September 2013
identified 110 genetic variants associated with MS – previously thought to be 57.
Although each of these variants individually confers only a very small risk
of developing multiple sclerosis, collectively they explain approximately 20
percent of the genetic component of the disease. The genes implicated show substantial overlap with genes known to
be involved in other autoimmune diseases
such as inflammatory bowel disease,
Crohn's disease and celiac disease.
ongoing genetic issues and MS.
Demographics - In
What Geographic Areas is MS most Prevalent
MS is more
prevalent and progresses more rapidly in
further away from the equator. Access to
sunshine is a very significant
Research indicates that sunlight may
protect against a wide range conditions,
including multiple sclerosis. When our
skin is exposed to the sun a compound -
nitric oxide - is released in our
blood vessels which causes blood vessels
to widen. Associated
as promoting vascular regeneration after vascular injury whereby it acts directly on
endothelial cells to prevent vascular leak. Researchers said "these findings may help explain the clinical correlations between low serum vitamin D levels and the many human diseases with well-described vascular dysfunction phenotypes''.
Australia it is
reported that in excess of 1000 people
are newly diagnosed each year, which
exceeds the annual population growth rate.
The 2015 population nationally is thought to be around 26,000.
to find out about MS populations and
prevalence rates in each area across Australia.
Quality of Life
when Living with MS -
and Value Systems have Changed
The World Health Organisation
defines Quality of Life as
individual’s perception of their position in life in the context of the
culture and value systems in which they live and in relation to their goals,
expectations, standards and concerns".
This is typified
by Kerri Cassidy's selection as the
winner of Australia's National Award for
Excellence in Justice and Rights
Protection. This is a reflection of her
determination and commitment to
raising awareness about the need for
justice and rights protection of people
with Multiple Sclerosis (MS) through the
equitable access to Chronic Cerebro
Spinal Venous Insufficiency (CCSVI)
QoL Background Research
In health services generally and medical
practice in particular, QoL tends to be
equated to physical health, despite that
fact that it has been well demonstrated
that quality of life and health status
are quite distinct concepts.
In reality, this “health-related”
approach to QoL underestimates the
challenges faced by pwMS with activities
of daily living and basic social
recent research suggests that it has
stronger associations with psychological
Role of Stress and Hope - Potentially Potent
doctors suggesting stress plays no part in the development and course of MS,
there is a large and coherent medical literature showing that stress can
precipitate MS and trigger relapses. A study (March 2014) from preventive
medicine researchers in Chicago is the first to examine MRIs of PwMS and
correlate stressful life events with appearance of lesions on MRI. As part
of a study on stress management therapy in 121 PwMS, the researchers asked
participants about stressful life events, categorising them as negative or
surprising part of the study was
that positive stressful life events
had a protective effect; those with
a positive event had 47% fewer new
contrast-enhancing lesions on MRI -
More about this study. |
Aspects of this research echo
findings by Australian researchers
''those with high
hope had more positive state of
mind, greater life satisfaction and less
depression. Interestingly hope buffered
the effects of high stress, so that
under high stress, there was an even
greater difference in favour of those
with high hope, and they were
considerably less anxious''. They went
on to say "confirmation of the
stress-buffering effects of hope in the
context of chronic illness is noteworthy
- hope is a potent protective resource
for pwMS''. -
all about stress and MS|
Decision Making - It's Your Choice
as a Basic Human Right|
The literature emphasises the importance
of ensuring that decisions relating
to MS management, including potential
treatment options, are the
responsibility of the person diagnosed
with MS in consultation with their
medical advisors. Implicit in this
expectation is a need to ensure, during
the diagnostic processes and
subsequently, that such persons have
ready and appropriate access to
impartial, independent and unbiased
information on all of the aforementioned
topics. To do otherwise is in
basic human rights.
Adapting to Change is Not Always
The rapidly increasing
understandings regarding the very
significant involvement of the vascular
system in MS progression, simple as it
is, brings with an immediate and steep
learning curve for many.
Adapting to change is not always
All too often there are reports about a
significant lack of such information
- at times from otherwise seemingly
here. Better education, including for GP's,
is identified as one of a
range of issues designed to better
support this right of individual choice.
An Open Letter on this topic to the
Australian Health Minister is at
Protecting the Vulnerable