Dr. Kevin Most: MS and Acute Flaccid Myelitis

Dr. Kevin Most

Recent news about nerves and viruses have played out tin the media the past few weeks, the frustrating thing about both illnesses is how little we know, how frustrating the treatment is and the lack of ideas how to prevent them

Let’s take a couple of minutes to talk about some issues that are probably going thru the minds of many parents.

Yesterday actress Selma Blair shared that she has been diagnosed with MS. We thought we would take a minute to discuss and get a basic understanding of what she is going thru. MS is multiple sclerosis, it is a disease of the nervous system. Ms. Blair shared that she has had symptoms for the past few years as she looks back she actually thinks she has had the illness for close to 15 years. Having individuals like this to step up and share her story allows us all to understand this illness that impacts over 400,000 individuals in the United States.

So, what happens in individuals who have MS. I will try to make it simple. Think about the electric cord that goes from a lamp to the wall outlet.  The cord has a rubber coating that covers the wires, as long as that rubber is intact the power goes to the lamp and allows for the lamp to work. If the rubber gets damaged the power wont flow properly and the light may flicker or not even work. Nerves in the body have the same thing. We have a material called myelin that wraps around nerves and allows for the smooth transmission of electric activity. That electric activity allows us to move smoothly, talk, vision…..the list goes on. The importance of the covering of the nerves can’t be minimized. In individuals with MS that protective covering is damaged. That damage causes the nerves to not work well. When that damage is present we see the symptoms of MS come out.

Symptoms of exacerbations of MS

  1. Vision problems
  2. Tingling or numbness
  3. Weakness or early fatigue
  4. Balance problems
  5. Dizziness
  6. In some confusion also occurs
  7. Difficulty swallowing
  8. Slurred speech

The symptoms vary in location as well as intensity as the symptoms will be based on the location in the brain where the damage is active and how bad the damage is. The unique thing about this illness is the body will repair that covering and the symptoms will resolve. Individuals with MS will have episodes that can last anywhere from a few days to a few weeks. So, the symptoms come and go based on how well the nerves are protected.  This termed Relapsing remitting MS. This is what we see in 85% of cases. Because of this the diagnosis is sometimes delayed. In Ms. Blair’s case, she looks back and sees that she probably had symptoms for close to 15 years. Often when the symptoms resolve the patient does not seek medical evaluation.

So what causes MS?  This is an interesting question. We know that the body’s immune system for some reason at various times will attack the myelin sheath and cause damage. Many think this disruption of the immune system is caused by a viral infection, but we are not sure of any specific virus. Studies are being done on many viruses in the hopes that finding the main cause may allow us to prevent MS. There is also research being done to look at genetic possibilities as well as environmental factors. We do know that MS impacts more individuals as you move away from the equator, but why that is true is still unclear. It does appear that smoking,  low levels of vitamin D and childhood obesity will increase the chance of MS.

This illness is usually affects individuals between the ages of 20 to 50. The diagnosis of MS is a bit unique, the most important thing to do is eliminate other illnesses that could cause the same symptoms but are treatable. For example, we want to rule out Lyme disease, which can cause the same symptoms and can be treated. Vitamin B12 deficiency can cause similar symptoms. So, there is no specific blood test for MS but eliminating other illnesses may be done with blood tests. The best test for MS at this point is a MRI, it can show damage in the brain or spinal cord that are seen in patients with MS.

There is no cure for MS but we do have medications that are used to reduce the number of relapses, slow the progression of MS and limit new areas of activity. More commonly steroids are used when an episode occurs, this will decrease the inflammation and shorten the time of the relapse. There are many other medications used for MS based on the symptoms and areas of the body impacted, often treating the symptoms. It is important to understand that this is a complex illness that requires a comprehensive medical plan. The plan will try to limit the episodes, treat the episodes, rehabilitation after the episodes, emotional support and modifying the disease, so you can see this is complex.

There is a lot of research going on for this frustrating and debilitating illness. Research on the cause, the treatment and how to slow episodes from occurring as well as speed on eliminating episodes

Acute Flaccid Myelitis

You cant watch the news without hearing about  Acute Flaccid Myelitis,  the breakdown for understanding the terms Acute-  immediate , Flaccid – weakness Myelitis- inflamed spinal cord. This illness has been in the news the past few weeks as the number of cases in the United States continues to grow, currently we have around 180 cases in  children in 22 states with the illness, there are many more that are being reviewed so this number will grow. Illinois alone has had 10 cases diagnosed. This is not a new illness however, a cluster of cases in 2014 in Denver brought it back to the attention of all, including the CDC and it has been tracked and monitored since. Media has brought it to the attention of all of us this year.

The frustrating thing is that we do not have a clear cause for this. Many feel it has a viral basis as it is only hitting children under the age of 18. The thought being that  this is due to a virus that the adults have been exposed to in the past and thus their immune system can protect them. The current thinking is that it may be a polio like enterovirus or possibly a West Nile like virus. However genetic and toxin exposure cannot be ruled out.

This is very rare  illness that affects the nervous system, specifically the spinal cord and causes muscles in the arms or legs in children to become weak.  Other symptoms of the illness can be facial drooping, similar to what we see with Bell’s Palsy, difficulty moving the eyes, slurred speech and difficulty swallowing. In some rare cases the condition impacts the muscles need to breath and a ventilator is needed to assist in breathing. The symptoms can vary in patients with some having minor weakness while others have profound weakness, the variation is due to the damage made to the spinal cord. Diagnosis is currently made with physical exam and possibly a MRI as there is no definitive test for AFM.

Currently we have no definitive treatment, however many treatments are being tried. These included giving the patient antiviral medications, or immunoglobulin which is essentially the foundation for immune response. The difficult part of this is that the extent of disease differs from individuals, some will recover with very minor deficits, where others will have weakness or paralysis that will remain. The damage is done in the spinal cord where we do not have the ability to regenerate cells that have been damaged. Just last week doctors at Children’s Hospital Los Angeles, are trying to treat this with surgery where they are taking nerves from the child’s ribs and diverting them, bypassing the portion of the damage. So essentially they are doing a nerve bypass. This will be closely watched as to its success.    

The CDC is working hard on trying to find the exact cause so that prevention measures and  awareness can be shared. Physicians are asked to report all of the presumed cases and send blood, spinal fluid and respiratory samples to the CDC in the hopes that they can find a common cause for this illness. With the cases so wide spread and rare it is important to have a well-orchestrated  effort to get to a common cause.

So what can we do to prevent this? Well getting back to the basics of preventing the spread of any viral illness is probably the best. Although we don’t know what the actual cause is, a viral cause is almost certain. Protect yourself by washing your hands and avoiding those who are coughing or ill. Minimize the spread of any virus by coughing into your elbow, avoid shaking hands when you are sick, wash your hands often and consider staying home when ill. This self quarantine will limit the spread. These are all good thoughts as we enter Flu season.