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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 71 HOW DO THESE TWO SCENARIOS CONNECT? We have suspected for a long time that the pathogen in the first scenario, Epstein-Barr virus (EBV ), which causes mononucleosis, might have something to do with the disease in the second scenario, multiple sclerosis (MS). But a recent large-scale study points out a much closer connection than we knew—this virus might actually cause MS. This discovery may change future strategies and outlooks for people with either or both of these situations. MULTIPLE SCLEROSIS: AN OVERVIEW In 1868, a French neurologist named Jean-Martin Charcot, a pioneer in neuroanatomy, described what he labeled la sclérose en plaques. He distinguished what we now call multiple sclerosis from other CNS conditions, especially Parkinson's disease. Charcot identified three common symptoms of MS—nystagmus, intention tremor, and disrupted speech patterns. This presentation is now called the Charcot triad. MS affects about 400,000 people in the US, and about 2.1 million people worldwide. It is usually diagnosed in young adults between the ages of 20 and 40. Women are diagnosed about twice as often as men. This disease is most common among people who spend the first part of their lives at latitudes far from the equator, which has led to some speculation about contributing factors and treatment options. TAKEAWAY: Growing evidence supports a connection between Epstein-Barr virus and multiple sclerosis. MS Pathophysiology To talk about MS, we must briefly review the role of myelin. Myelin is an insulating layer of proteins and fats that wraps around neuron fibers. Myelin helps speed nerve transmission and insulate electrical impulses within tightly packed bundles of neurons. In the CNS, it is light-colored, so myelin-wrapped brain and spinal cord tissue is referred to as white matter. MS involves an attack with elements of both innate and adaptive immunity turned against myelin sheaths within the CNS. When myelin breaks down, a few bad things happen: Function is lost at the affected neurons, so impulses cannot carry through to their destinations; local inflammation can damage tissues all around the affected area; and scar tissue plaques develop at the sites of attack. Ultimately, the damage may penetrate beyond the myelin-producing cells to affect the axons. MS has several different presentations, but the most common form, relapse/remitting MS, involves clear cycles of flare and remission. Sometimes patients can begin with one type, and then go on to develop a different form of the disease. For more on types of MS and what it's like to live with it, see the video that accompanies this article. Signs and Symptoms of MS MS is sometimes called "the great imitator" because during flares it can look like a myriad of other diseases or conditions. Symptoms may become severe during episodes of flare, and then subside during remission. In early stages, remission may bring about a full restoration of function. But as the disease progresses, some loss of function may be permanent. Signs and symptoms of MS are sometimes discussed as primary issues related directly to the destruction of myelin, and secondary problems that are complications of the primary ones. Primary issues include debilitating fatigue, weakness, numbness, paresthesia, trouble swallowing, tremors, vision problems, loss of balance, pain, paralysis, and bladder and bowel problems. All of these are brought about by myelin damage to the associated motor and sensory neurons.