Multiple sclerosis is a disease that still intrigues medicine. Scientists from different parts of the world are trying to develop innovative treatments that can lead to a cure for the condition that affects the lives of approximately 2.8 million people. However, one of the main challenges is still to fully understand what triggers it.
“It’s difficult to talk about a cure for a disease when we don’t fully know the cause. We know that several factors can cause the condition, but not what gives the start”, explains Priscilla Proveti, coordinator of the neurology outpatient clinic at the University Hospital of Brasília (HUB) and physician at Sirio-Libanes and DF Star hospitals.
Multiple sclerosis is a heterogeneous disease that involves hyperactivation of the immune system and neurodegeneration of the central nervous system. It causes the body’s defense cells to attack the myelin sheath, a kind of insulation layer that protects neurons.
These injuries can occur in the brain, spinal cord or optic nerves, causing symptoms such as intense fatigue, muscle weakness, numbness, bowel and bladder dysfunction and changes in motor coordination, for example.
“To a certain extent, we know today how to control inflammation in the central nervous system, but not how to stop neurodegeneration completely and how to regenerate what was lost”, says neurologist Felipe Ghlen, a physician at Hospital Sírio-Libanês and professor at the University of Brasília. (UnB).
There are a number of treatments approved by drug regulatory agencies that try to prevent the progression of the condition through different strategies, such as application pens – similar to those used in the control of diabetes –, infusion therapies, autologous bone marrow transplantation and oral pills. .
Multiple sclerosis is an autoimmune, neurological and chronic disease that generates changes in the immune system of those who have it. The condition causes the human body’s defense cells to attack the central nervous system and, as a result, cause muscle and brain damage.Getty Images
****Ilustracao-links-rompidos.jpgIn other words, the condition results in permanent damage by destroying the nerves, which leads to problems with communication between the brain and the rest of the body. The initial signs of the disease depend on which nerves are affected.koto_feja/ Getty Images
*****Photo-man-holding-his-own-wrist.jpgMuscle weakness, numbness or tingling sensations in arms and legs, extreme tiredness, and memory lapses are common. In addition to these, slowed speech, hesitant pronunciation of words or syllables, blurred or double vision, tremors and difficulty swallowing are some of the main symptoms. LaylaBird/ Getty Images
****Photo-person-holding-own-wrist.jpgThese symptoms arise throughout life with the progression of multiple sclerosis, being more evident during periods known as crisis or outbreaks of the disease. In addition, they can be aggravated when there is exposure to heat or fever.Peter Dazeley/Getty Images
*****Photo-woman-in-wheelchair.jpgThe causes of the disease are still unknown. However, it is known that the symptoms are related to immunological alterations. Studies indicate that being between 20 and 40 years old, being a woman, having cases of the disease in the family, having low levels of vitamin D and an autoimmune disease are some of the factors associated with the condition.eyecrave productions/ Getty Images
*****x-ray-of-a-brain.jpgBecause it has an unknown origin so far, there is no cure for multiple sclerosis. However, there are treatments that help alleviate symptoms and slow down the progression of the disease.Paul Biris/Getty Images
*****Colorful-picture-pills.jpgThe treatment of multiple sclerosis is done with medications indicated by the doctor that help to prevent progression, reduce the time and intensity of crises, in addition to controlling symptoms. Tanja Ivanova/ Getty Images
*****Photo-physiotherapy-person-with-multiple-sclerosis.jpgPhysical therapy is also important to control symptoms, as it allows the muscles to be activated, preventing weakness in the legs and muscle atrophy. It is done through stretching and muscle strengthening exercises.Alvis Upitis/ Getty Images
****Photo-person-sitting-in-wheelchair-in-front-of-a-doctor.jpgContrary to what you might think, multiple sclerosis is not such a rare disease. According to the Brazilian Association of Multiple Sclerosis (ABEM), it is estimated that 40,000 people have the disease in Brazil alone. Worldwide, according to the Ministry of Health, this number rises to 2.8 millionFatCamera/ Getty Images
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studies in progress
In parallel to the drugs available, the scientific community is advancing in studies with the use of stem cells at an early stage.
“Following the logic, if a set of genetic defects result in a dysfunctional immune system that attacks itself, we could transplant stem cells from healthy people. But this is not so simple, as they can induce rejection. The problem with autologous stem cell transplantation is that, over time, as the genetic defect is there, there is a possibility that the disease will return”, explains the doctor at Hospital Sírio-Libanês.
THE Nature magazineone of the most respected in the scientific world, released last January 13th the preliminary results of a clinical study on the use of neural stem cells to treat progressive multiple sclerosis – the most aggressive form of the disease – in an attempt to regenerate the central nervous system by lumbar puncture.
In phase 1 of the clinical study, scientists from The New York Stem Cell Foundation, in the United States, and the University of Cambridge, in England, managed to show that patients tolerate the approach well, but its effectiveness has not yet been proven.
Priscilla, who did not participate in the study, points out as a positive point the fact that the research shows that, apparently, the patients had a lower degree of cerebral atrophy and a lower dosage of some cytokines in the cerebrospinal fluid. But she claims that the results are still preliminary and it is necessary to continue with the research.
Although it is a breakthrough, experts still see many limitations in the study, such as the limited number of patients – common in phase 1 studies. In addition, the picture of all participants continued to progress. “All this demonstrates how complex the treatment of diseases that affect the central nervous system is”, says Ghlen.
Vaccine
Vaccination against the Epstein–Barr virus was recently identified as a promising form of treatment. A large study of US military personnel showed that all those diagnosed with multiple sclerosis also had a history of infection with the virus.
Previous research has already shown a possible relationship between viral infection and the development of the disease. Epstein–Barr is a very common virus: it is estimated that nine out of ten people come into contact with it at some point in their lives, but not everyone develops multiple sclerosis. Vaccinating the population could then be a way to prevent the disease.
approved treatments
While these studies do not advance, patients have at their disposal drugs called highly effective, stronger, approved by the National Health Surveillance Agency (Anvisa). The oral use options are considered an important advance: in addition to working well, they manage to provide more well-being to patients who do not adapt to the needles of applicator pens.
“The neurologist chooses the treatment according to risk factor, age and desire for pregnancy, for example. Normally, we choose highly effective medications”, explains Priscilla.
Doctors tend to be more aggressive in treating the disease, indicating highly effective drugs as the first option, especially in patients with better prognostic factors, says the neurologist at the HUB.
“The community that treats multiple sclerosis has been trying to change the treatment protocol because studies show that the more aggressive the approach, the better the patient responds over time”, says Priscilla.
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