What are demyelinating disorders. How do they affect nerve function. What causes damage to the myelin sheath. What are the symptoms of demyelination. How are demyelinating disorders diagnosed and treated.

Understanding Myelin and Its Crucial Role in Nerve Function

Myelin is a fatty substance that forms a protective sheath around nerve fibers, playing a vital role in the nervous system. This insulating layer, known as the myelin sheath, enables rapid and efficient transmission of electrical impulses along nerve cells. When the myelin sheath is damaged or destroyed, a condition known as demyelination occurs, leading to various neurological problems.

The Structure and Function of Myelin

The myelin sheath is composed of multiple layers of tissue containing a lipoprotein called myelin. These layers wrap around nerve fibers in both the central nervous system (brain and spinal cord) and peripheral nervous system. The primary function of myelin is to facilitate the conduction of nerve signals, much like the insulation around an electrical wire.

How does myelin enhance nerve signal transmission? The myelin sheath allows for saltatory conduction, where the electrical impulse jumps from one node of Ranvier (gaps in the myelin sheath) to the next, significantly increasing the speed of signal propagation. This process is crucial for proper neurological function, enabling quick and accurate communication between different parts of the body.

Demyelinating Disorders: When Myelin Comes Under Attack

Demyelinating disorders are a group of conditions characterized by damage to the myelin sheath. This damage can occur in various parts of the nervous system, leading to a wide range of symptoms depending on the affected area. Understanding these disorders is crucial for proper diagnosis and treatment.

Types of Demyelinating Disorders

There are several types of demyelinating disorders, each with its unique characteristics:

• Multiple Sclerosis (MS): The most common demyelinating disorder, affecting the central nervous system
• Acute Disseminated Encephalomyelitis (ADEM): An inflammatory condition affecting the brain and spinal cord
• Neuromyelitis Optica (NMO): A disorder primarily affecting the optic nerves and spinal cord
• Transverse Myelitis: Inflammation of the spinal cord
• Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): A condition affecting peripheral nerves
• Guillain-Barré Syndrome: An acute autoimmune disorder affecting peripheral nerves

Can demyelinating disorders be classified based on their cause? Indeed, these conditions can be broadly categorized into primary and secondary demyelinating disorders. Primary disorders have no known cause and are believed to be autoimmune in nature. Secondary disorders result from known factors such as infections, toxins, or metabolic disturbances.

Causes and Risk Factors of Myelin Sheath Destruction

The causes of myelin sheath destruction are varied and can be attributed to several factors. Understanding these causes is essential for developing effective prevention and treatment strategies.

Common Causes of Demyelination

Demyelination can occur due to various reasons, including:

1. Autoimmune disorders: The body’s immune system mistakenly attacks the myelin sheath
2. Viral infections: Certain viruses can directly damage myelin or trigger an autoimmune response
3. Genetic factors: Some inherited disorders can affect myelin production or maintenance
4. Toxins and chemicals: Exposure to certain substances can lead to myelin damage
5. Nutritional deficiencies: Lack of essential nutrients, particularly vitamin B12, can affect myelin health
6. Vascular problems: Conditions affecting blood supply to nerve tissues can cause demyelination

Are there specific risk factors that increase the likelihood of developing a demyelinating disorder? While the exact causes of many demyelinating disorders remain unknown, several risk factors have been identified. These include genetic predisposition, environmental factors such as low vitamin D levels, smoking, and certain viral infections. Geographic location also plays a role, with higher rates of some demyelinating disorders observed in regions farther from the equator.

Recognizing the Symptoms of Demyelinating Disorders

The symptoms of demyelinating disorders can vary widely depending on the location and extent of myelin damage. Recognizing these symptoms is crucial for early diagnosis and treatment.

Common Symptoms Across Demyelinating Disorders

While each demyelinating disorder has its unique presentation, some common symptoms include:

• Vision problems: Blurred vision, double vision, or loss of vision
• Muscle weakness: Affecting one or more limbs
• Sensory disturbances: Numbness, tingling, or burning sensations
• Balance and coordination issues
• Fatigue
• Cognitive changes: Memory problems, difficulty concentrating
• Speech difficulties
• Bladder and bowel dysfunction

Do symptoms of demyelinating disorders always appear suddenly? The onset of symptoms can vary. Some disorders, like Guillain-Barré syndrome, can develop rapidly over days or weeks. Others, such as multiple sclerosis, may have a more gradual onset with symptoms evolving over months or years. Additionally, many demyelinating disorders are characterized by periods of relapse and remission, where symptoms may flare up and then subside.

Diagnostic Approaches for Demyelinating Disorders

Diagnosing demyelinating disorders often requires a combination of clinical evaluation, imaging studies, and laboratory tests. Early and accurate diagnosis is crucial for appropriate treatment and management.

Key Diagnostic Tools and Techniques

Healthcare providers use various methods to diagnose demyelinating disorders:

1. Neurological examination: Assessing reflexes, muscle strength, sensation, and coordination
2. Magnetic Resonance Imaging (MRI): Visualizing areas of demyelination in the brain and spinal cord
3. Lumbar puncture: Analyzing cerebrospinal fluid for signs of inflammation or abnormal antibodies
4. Evoked potential tests: Measuring the electrical activity of the brain in response to stimuli
5. Blood tests: Checking for specific antibodies or markers associated with certain demyelinating disorders
6. Nerve conduction studies: Assessing the speed and strength of electrical signals in peripheral nerves

How do healthcare providers differentiate between various demyelinating disorders? Distinguishing between different demyelinating disorders can be challenging due to overlapping symptoms. Doctors consider the pattern and distribution of symptoms, results of imaging studies, and specific biomarkers in blood or cerebrospinal fluid. In some cases, a combination of diagnostic tests and clinical observations over time may be necessary to reach a definitive diagnosis.

Treatment Strategies for Demyelinating Disorders

While there is no cure for most demyelinating disorders, various treatment options are available to manage symptoms, slow disease progression, and improve quality of life. Treatment approaches often involve a multidisciplinary team of healthcare professionals.

Common Treatment Modalities

Treatment strategies for demyelinating disorders may include:

• Immunomodulatory therapies: Medications that alter the immune system’s response
• Corticosteroids: To reduce inflammation during acute attacks
• Plasma exchange: Removing harmful antibodies from the blood
• Symptom-specific treatments: Addressing individual symptoms like pain, fatigue, or spasticity
• Rehabilitation: Physical therapy, occupational therapy, and speech therapy
• Lifestyle modifications: Diet, exercise, and stress management
• Complementary therapies: Such as acupuncture or mindfulness practices

Can myelin repair itself after damage? In some cases, the myelin sheath can partially repair itself through a process called remyelination. This natural repair mechanism is more effective in the early stages of demyelinating disorders. However, as the disease progresses, the body’s ability to repair myelin often diminishes. Research is ongoing to develop therapies that promote remyelination and protect existing myelin.

Living with Demyelinating Disorders: Coping Strategies and Support

Living with a demyelinating disorder can be challenging, but with proper support and management strategies, many individuals lead fulfilling lives. Developing effective coping mechanisms and accessing support resources are crucial aspects of managing these conditions.

Key Coping Strategies

Individuals with demyelinating disorders can employ various strategies to improve their quality of life:

1. Education: Learning about the condition and staying informed about new treatments
2. Stress management: Practicing relaxation techniques and mindfulness
3. Regular exercise: Engaging in appropriate physical activities to maintain strength and flexibility
4. Healthy diet: Following a balanced diet that supports overall health
5. Sleep hygiene: Ensuring adequate rest and managing sleep disorders
6. Assistive devices: Using tools to help with mobility or daily tasks
7. Support groups: Connecting with others who have similar experiences
8. Mental health support: Addressing emotional and psychological challenges

How can family members and caregivers support individuals with demyelinating disorders? Family members and caregivers play a crucial role in supporting those with demyelinating disorders. They can help by learning about the condition, assisting with daily tasks when needed, providing emotional support, and encouraging adherence to treatment plans. It’s also important for caregivers to take care of their own well-being to avoid burnout.

Research and Future Perspectives in Demyelinating Disorders

The field of demyelinating disorders is an active area of research, with scientists and clinicians working to develop new treatments and improve understanding of these conditions. Advances in medical technology and scientific knowledge are paving the way for more effective management strategies.

Promising Areas of Research

Current research in demyelinating disorders focuses on several key areas:

• Remyelination therapies: Developing treatments to promote myelin repair
• Neuroprotective strategies: Finding ways to prevent nerve damage
• Stem cell therapies: Exploring the potential of stem cells to replace damaged cells
• Biomarkers: Identifying specific markers for early diagnosis and treatment monitoring
• Personalized medicine: Tailoring treatments to individual genetic and molecular profiles
• Novel drug delivery systems: Improving the effectiveness of existing treatments
• Neuroimaging advancements: Developing more sensitive and specific imaging techniques

What are the potential implications of these research areas for patients with demyelinating disorders? The ongoing research holds promise for more effective treatments, earlier diagnosis, and potentially even prevention of demyelinating disorders. As our understanding of these conditions grows, patients may benefit from more targeted therapies with fewer side effects, improved quality of life, and potentially slowed disease progression. However, it’s important to note that translating research findings into clinical practice often takes time, and patients should work closely with their healthcare providers to stay informed about the latest treatment options.

Overview of Demyelinating Disorders – Brain, Spinal Cord, and Nerve Disorders

By

Michael C. Levin

, MD, College of Medicine, University of Saskatchewan

Reviewed/Revised May 2023

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Most nerve fibers inside and outside the brain are wrapped with many layers of tissue composed of a fat (lipoprotein) called myelin. These layers form the myelin sheath. Much like the insulation around an electrical wire, the myelin sheath enables nerve signals (electrical impulses) to be conducted along the nerve fiber with speed and accuracy. When the myelin sheath is damaged, nerves do not conduct electrical impulses normally. Sometimes the nerve fibers are also damaged.

If the sheath is able to repair and regenerate itself, normal nerve function may return. However, if the sheath is severely damaged, the underlying nerve fiber can die. Nerve fibers in the central nervous system (brain and spinal cord) cannot fully regenerate themselves. Thus, these nerve cells are permanently damaged.

Insulating a Nerve Fiber

Some disorders that cause demyelination affect mainly the central nervous system. Others, such as chronic inflammatory demyelinating polyneuropathy Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Chronic inflammatory demyelinating polyneuropathy is a form of polyneuropathy that, like Guillain-Barré syndrome, causes increasing muscle weakness, but the weakness progresses for more than. .. read more , affect mainly nerves in other parts of the body.

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When babies are born, many of their nerves lack mature myelin sheaths. As a result, their movements are jerky, uncoordinated, and awkward. As myelin sheaths develop, movements become smoother, more purposeful, and more coordinated.

Myelin sheaths do not develop normally in children with certain rare hereditary diseases, such as Tay-Sachs disease Tay-Sachs Disease and Sandhoff Disease Tay-Sachs disease and Sandhoff disease are types of lysosomal storage disorder called sphingolipidoses and are caused by a buildup of gangliosides in the tissues in the brain. These diseases… read more , Niemann-Pick disease Niemann-Pick Disease Niemann-Pick disease is type of lysosomal storage disorder. Types A and B are sphingolipidoses and are caused by a buildup of sphingomyelin in the tissues. Type C is a lipidosis that is caused… read more , Gaucher disease Gaucher Disease Gaucher disease is a type of lysosomal storage disorder called a sphingolipidosis. It is caused by a buildup of glucocerebrosides in tissues. Children who have the infantile form usually die… read more , and Hurler syndrome. Children with such disorders may have permanent, often extensive, neurologic problems.

In adults, the myelin sheath can be damaged or destroyed by the following:

• Stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly… read more

• Infections

• Immune disorders

• Metabolic disorders

• Nutritional deficiencies (such as a lack of vitamin B12 Vitamin B12 Deficiency Vitamin B12 deficiency can occur in vegans who do not take supplements or as a result of an absorption disorder. Anemia develops, causing paleness, weakness, fatigue, and, if severe, shortness… read more )

• Poisons (such as carbon monoxide Carbon Monoxide Poisoning Carbon monoxide is a colorless, odorless gas that is produced when many materials are burned and can be toxic when breathed in large amounts Carbon monoxide poisoning is common. Symptoms may… read more )

• Drugs or medications (such as the antibiotic ethambutol)

• Excessive use of alcohol Alcohol Use Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning). Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma,… read more

Destruction of the myelin sheath is called demyelination.

Some disorders that cause demyelination have no known cause. These disorders are called primary demyelinating disorders. The most common of these disorders is

• Multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause… read more

Other primary demyelinating disorders include

• Acute disseminated encephalomyelitis Acute Disseminated Encephalomyelitis (ADEM) Disorders that cause demyelination and have no known cause are called primary demyelinating disorders. Demyelination is the destruction of the tissues that wrap around nerves, called the myelin… read more

• Adrenoleukodystrophy and adrenomyeloneuropathy Adrenoleukodystrophy and Adrenomyeloneuropathy Disorders that cause demyelination and have no known cause are called primary demyelinating disorders. Demyelination is the destruction of the tissues that wrap around nerves, called the myelin… read more

• Leber hereditary optic neuropathy Leber Hereditary Optic Neuropathy Disorders that cause demyelination and have no known cause are called primary demyelinating disorders. Demyelination is the destruction of the tissues that wrap around nerves, called the myelin… read more

• Neuromyelitis optica spectrum disorder Neuromyelitis Optica Spectrum Disorder (NMOSD) Neuromyelitis optica spectrum disorder affects mainly the nerves in the eyes and spinal cord, causing patches of myelin (the substance that covers most nerve fibers) and the nerve fibers under. .. read more (neuromyelitis optica)

Sometimes primary demyelinating disorders develop after a viral infection or vaccination against a viral infection. A likely explanation is that the virus or another substance somehow triggers the immune system to attack the body’s own tissues (autoimmune reaction Autoimmune Disorders An autoimmune disorder is a malfunction of the body’s immune system that causes the body to attack its own tissues. What triggers an autoimmune disorder is not known. Symptoms vary depending… read more ). The autoimmune reaction results in inflammation, which damages the myelin sheath and the nerve fiber under it.

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Types, Causes, Symptoms, and Treatments

Myelin is an insulating layer of lipids and proteins surrounding nerves. Myelin damage can cause problems with the nerves’ ability to send and receive electrical messages. Inflammatory disorders often cause myelin damage, but there are other causes.

When you think of myelin, imagine the insulation around an electrical wire.

Damage to myelin can make it harder for you to move around, perform ordinary tasks, and even see what you’re doing sometimes. Fatigue is also common.

Inflammation is one common cause of damage to myelin, but other things can cause demyelination, including:

• viral infections
• loss of oxygen
• physical compression
• metabolic problems

Discover what disorders that can develop when your nerves experience damage to the myelin sheath around them.

There are two main categories of demyelinating disease: demyelinating disease of the central nervous system (CNS) and demyelinating disease of the peripheral nervous system (PNS).

CNS demyelinating disease

This category of disease includes conditions such as:

• Multiple sclerosis (MS): MS is the most common type of demyelinating disease of the central nervous system, and affects about 1 million people in the United States.
• Optic neuritis: Optic neuritis is inflammation of the optic nerves. It affects about half of all people with MS.
• Transverse myelitis: Transverse myelitis is inflammation of both sides of a section of the spinal cord. About 1,400 new cases are diagnosed each year in the United States, with about 33,000 people experiencing symptoms or disability as a result of this condition.
• Acute disseminated encephalomyelitis (ADEM): ADEM is a severe bout of inflammation in which swelling damages the myelin on cells in the brain, spinal cord, and sometimes the optic nerves.
• Neuromyelitis optica (NMO): Neuromyelitis optica affects the eyes and the spinal cord first, and eventually also may affect the brain. Also known as Devic’s disease, it’s a rare disease that affects only about 4,000 people in the United States.
• Adrenoleukodystrophy: There are three different kinds of adrenoleukodystrophy: childhood cerebral ALD, adrenomyelopathy, and Addison’s disease. It affects about 1 in every 20,000 to 50,000 people.

PNS demyelinating disease

This category includes conditions such as:

• Chronic inflammatory demyelinating polyneuropathy: Also known as chronic relapsing polyneuropathy, CIDP causes progressive muscle weakness and affects roughly 5 to 7 out of every 100,000 people.
• Guillain Barré-syndrome (GBS): GBS is an autoimmune disorder in which your immune system attacks the cells of your peripheral nervous system. It’s considered rare, as it affects only about 1 in 100,000 people in the United States.

In many of these disorders, the exact cause isn’t known. Scientists are learning more about them, as research is ongoing, but here’s what they know now:

Condition	Cause
Multiple sclerosis	The exact cause is still unknown, although experts believe that genetic and environmental factors may be at work. Women are two to three times more likely to develop MS.
Optic neuritis	You are at increased risk for developing optic neuritis if you already have MS or NMO. Infections and other diseases sometimes give rise to inflammation of the optic nerve, too. But the exact cause is not yet completely understood.
Transverse myelitis	Experts speculate that it could be immune-mediated, or it could be the result of an infection. It sometimes develops as an early symptom of MS. But it’s estimated that in 16-60 percent of cases, the exact cause isn’t known.
Acute disseminated encephalomyelitis	Again, while scientists still hope to pinpoint an exact cause, the general thinking is that a viral or bacterial infection may cause the inflammation that’s the hallmark of this condition. It tends to affect more children than adults.
Neuromyelitis optica	It often strikes in childhood, but it can also affect adults and is more common in women than in men. In fact, more than 80 percent of diagnosed cases of NMO occur in women.
Adrenoleukodystrophy	This disorder affects the nervous system and the adrenal glands. It’s an X-linked recessive inherited condition, which means that it’s caused by a mutation on a gene on the X chromosome. So it tends to affect more men than women.
Chronic inflammatory demyelinating polyneuropathy	Some experts suspect that this may be a chronic version of a common form of Guillain-Barré syndrome (GBS) known as acute inflammatory demyelinating polyneuropathy (AIDP), which appears to be an autoimmune disorder.
Guillain-Barré syndrome	Research suggests that there are four subtypes of GBS, and the causes can vary. Infection may be one notable culprit. For example, a recent infection with Campylobacter jejuni bacteria seems to cause GBS in about a quarter of people who are diagnosed.

Sometimes the symptoms will be similar to various conditions that cause damage to the myelin of your nerve cells. Here’s more detailed information about symptoms you might expect from these disorders.

Multiple sclerosis

MS causes a wide variety of symptoms that can range from mild to severe. Some people experience:

• severe fatigue
• numbness or tingling in the extremities
• difficulty walking and balancing
• vision problems
• speech difficulties known as dysarthria
• muscle spasticity
• tremors
• pain
• difficulty concentrating
• bowel and bladder dysfunction
• as many as 50 percent of people with MS also experience depression at some point in their lifetime

Optic neuritis

The most common symptoms include vision loss in one eye, pain around your eye that’s exacerbated by eye movement, and difficulty distinguishing between colors.

Transverse myelitis

Symptoms of transverse myelitis can include:

• weakness of the legs and arms
• pain in the lower back, arms, legs, or torso
• abnormal sensory feelings or even sensory loss
• bowel and bladder dysfunction

Acute disseminated encephalomyelitis

You may develop a number of symptoms, including:

• fever
• stiff neck
• fatigue
• balance issues
• weakness or tingling in your extremities
• blurred or double vision
• confusion

Neuromyelitis optica

Some people experience a single long-lasting attack, while others have a relapsing form of NMO.

Symptoms of NMO include:

• vision loss and eye pain in one or both eyes
• numbness, weakness, or even paralysis in arms or legs
• loss of bladder and bowel control

Adrenoleukodystrophy

Symptoms can vary, depending on what type of ALD you have.

Someone with childhood cerebral ALD may develop:

• muscle spasms
• seizures
• hearing problems
• vision deficits
• trouble with language comprehension

Someone with Addison’s disease may:

• lose their appetite
• experience weight loss
• develop weakness
• experience vomiting

Chronic inflammatory demyelinating polyneuropathy

With this condition, you may develop:

• progressive and symmetrical weakness, often around the muscles around your hips and shoulders, and also your hands and feet
• numbness, tingling, or prickling sensations
• fatigue
• double vision
• trouble swallowing

Guillain-Barré syndrome

GBS causes symptoms that can range from relatively mild weakness to paralysis. Some people might not even be able to breathe on their own without assistance. As many as 20 percent of people are left with significant disability.

Once a diagnosis is made, your doctor can begin discussing the most appropriate treatment for you.

Multiple sclerosis

There are a number of different FDA-approved preventive treatments for reducing the frequency and severity of MS symptoms, including:

• interferon beta-1a
• interferon beta-1b
• glatiramer acetate
• a monoclonal antibody known as natalizumab
• the chemotherapy agent mitoxantrone

Steroids are also prescribed for flare-ups or exacerbations. Recent research also suggests that it may be possible to repair the myelin if people have enough surviving oligodendrocyte cells, which wrap around the nerve cells, to begin making new myelin.

Optic neuritis

Sometimes optic neuritis symptoms will improve on their own, but your doctor may prescribe steroids to address the inflammation.

Transverse myelitis

Treatment may be given to address symptoms and reduce inflammation, and to address any infections that might be present. Possible treatments include:

• intravenous corticosteroid therapy
• plasma exchange therapy
• intravenous immunoglobin (IVIG)
• antivirals for any infections in the spinal cord
• pain medications to address both muscle and nerve pain

Neuromyelitis optica

Your doctor may prescribe corticosteroids or immunosuppressants to reduce symptoms. Another possible option is a process called plasmapheresis, which removes certain antibodies from your blood that may be contributing to the symptoms.

Acute disseminated encephalomyelitis

Intravenous steroids like methylprednisolone or oral steroids can help reduce the inflammation caused by ADEM. Plasmapheresis may also be an option with severe cases of this condition.

Adrenoleukodystrophy

One effective treatment for childhood ALD is hematopoietic stem cell transplant, which is a bone marrow transplant. People with Addison’s disease may experience some benefit from taking steroids. Some people may also take seizure medications or go to physical therapy to help with muscle spasms and weakness.

Chronic inflammatory demyelinating polyneuropathy

The most commonly used treatments include glucocorticoids, intravenous immunoglobulin (IVIg), and plasma exchange therapy to help modulate the immune system. Physiotherapy might help you build or maintain muscle strength and function, so you can be as mobile as possible.

Guillain-Barré syndrome

There’s no cure for GBS, but doctors may offer treatment such as high-dose immunoglobulin therapy (IVIg) or plasma exchange to ward off nerve damage. In the past, corticosteroid therapy was offered, but eventually research found it wasn’t effective.

10 tips for living well with a myelin sheath disorder

Living a normal life with a demyelinating disease can be challenging. You may encounter trouble seeing well and moving independently at times. These strategies for managing MS and other neurological diseases can help you live your life as fully as possible:

1. Use voice-to-text software. If you’re struggling with numbness, tingling, or muscle weakness in your hands and arms, don’t stress yourself even more by trying to write or type. This software can also be useful for anyone who’s having trouble seeing, due to inflammation of their optic nerves.
2. Use assistive devices or tools. There are devices that can make it easier to open jars or retrieve an item off a high shelf, or use a shower chair to sit upon if it’s too hard to stand.
3. Choose attire that’s easy to put on and take off. Velcro shoes aren’t just for little kids who can’t tie their shoes. They’re also useful for adults whose hands are weak or shaky. You might also appreciate elastic-waist pants or gadgets that help you pull up a zipper or fasten buttons. Stick with shoes with a sturdy tread so you’ll be less likely to slip.
4. See a little more clearly. You might try using a vision aid like a magnifying lens if your vision has been affected. Or if you’re experiencing double vision, or diplopia, talk to your doctor about prism glasses, which can help refract the light coming into your eyes to help you see better.
5. Use a cane. If you’re not as steady on your feet as you’d like to be, try using a cane to give you extra support. Supportive braces might also help. A motorized scooter or wheelchair might be another option to help you get around safely and confidently.
6. Rearrange your environment. Make your home work for you, rather than against you. Get rid of throw rugs that could trip you, and use non-skid bathmats in the bathroom. Store items that you use regularly within easy reach.
7. Practice good sleep hygiene. One of the best things you can do for yourself if you have a condition like MS is get a good night’s sleep. Simple strategies like going to bed each night at the same time, keeping your bedroom cool and dark, and taking time to wind down trying to sleep may help.
8. Eat a healthy diet. A 2016 randomized controlled trial found that people with MS who ate a low-fat, plant-based diet experienced lower levels of fatigue. Ask your doctor about making dietary changes to see if they improve your energy levels.
9. Seek out occupational therapy. If you’re experiencing muscle weakness, especially in your arms or hands, an occupational therapist may help with strategies.
10. Join a support group. You aren’t the only one with this disease. Finding a support group, either in person or online, can be a lifeline. You can talk about your challenges, listen to others, and learn strategies to make it easier to live with your disorder.

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Ongoing research, including research into stem cell therapies, may eventually bear fruit in the form of new effective treatments for a variety of disorders that affect the myelin covering of nerve cells.

In the meantime, communicating with your doctor about your symptoms, using strategies to help with your daily activities, and reaching out for support are good ways to manage your needs.

Nerve cells are restored. Petersburg neurologist told how it happens › Articles and news › DoctorPeter.ru

• Health

American media reported today that scientists have found a way to restore nerve cells after damage that leads to impaired motor functions. They did experiments on mice. Gleb Makshakov, Head of the Rehabilitation Department of the Multiple Sclerosis Center of City Hospital No. 31, told Doctor Peter about how physical activity can change the life of a person with disabilities.

May 20, 2020

American scientists have described the ability to regenerate nerve cells and the myelin sheath that protects them in patients after strokes, brain injuries and diseases such as multiple sclerosis. Studies in mice have shown that they can be restored with exercise. It is reported by the University of Colorado Anschutz Medical Campus.

Gleb Makshakov told Dr. Peter how physical activity works by restoring neural connections and myelin sheath in people with multiple sclerosis.

In animals, the symptoms disappear completely. In humans – for a long time

– If we talk about the complete disappearance of symptoms caused by the destruction of the myelin sheaths surrounding the nerve fibers, and the nerves themselves, which are responsible for transmitting impulses from the brain to the organs and vice versa, then, indeed, only animal studies are known. When mice are challenged with autoimmune encephalitis, a disease that mimics multiple sclerosis, the neurological symptoms disappear completely due to the physical activity that is forced on them. In animals, the regeneration of nervous tissue, including the myelin sheath, occurs in such a way that they are restored almost completely.

People are a little more difficult. In multiple sclerosis, myelin can repair itself. When there is no active inflammation in the plaques, two constant processes occur: both demyelination and remyelination. But the problem is that it is impossible to measure the myelin in the head of a living person. The baseline MRI, which is done to diagnose MS, shows signal impairment, which indicates both damage to the myelin sheath and damage to the neurons themselves. But there are studies that are called “MRI with magnetization transfer.” They measure the density of the myelin fraction (thickness of the myelin sheath) and allow you to see how well the myelin covers the nerve fiber. There is nothing new in the fact that during exercise in patients with multiple sclerosis, it is restored – functional studies have long shown this.

How does the brain restore the ability to move?

Why this happens is also already clear: physical activity, including aerobic activity, reduces the level of inflammation in the head, which acts destructively on the nervous tissue – the less inflammation, the better myelin sheath and neurons feel. And if a person leads a sedentary lifestyle, and even smokes, suffers from diabetes, then his inflammation is more pronounced.

Functional recovery is more difficult: the brain is built on, so to speak, a network feature. One nerve center is more or less responsible for a specific function, such as the movement of an arm or leg. He needs other centers to work. The main center is connected with them in the process of mastering the motor (motor) skills of a person. That is, one part of the cortex is connected to different parts of the brain. When a person in whom these structural connections are destroyed undergoes physical rehabilitation, they are restored, so he feels better. But the symptoms can completely go away only in those who have the disease caught on time, when the neural connections still have a sufficient reserve.

In our rehabilitation department, we see a significant regression of symptoms in patients who are recently ill and are doing well. Sometimes it happens almost immediately. But those who have already expressed disability and have developed secondary changes (muscle atrophy, joint contracture) cannot fully recover, although their functional state improves: they can walk more and longer, physical endurance grows.

Read also

What to do and how to stay on the go

In order to achieve a recovery effect, physical activity must be tailored to the extent of the patient’s loss of function. If he is young and has no movement restrictions, then physical activity should be like that of a healthy person. Aerobic – 10 thousand steps a day (brisk walking, running) – daily. Intense physical activity – 2-3 times a week for 30-45 minutes (so as not to get very tired): in the gym, on the sports ground, if it’s difficult on your own – with a trainer. Even weight training, strength training is possible, if the condition allows. You can organize it in different ways, for example, after work, walk or climb the stairs without an elevator, get a dog and walk with it.

If the patient is disabled (greater than 4 on the EDSS scale), does not walk well, or is confined to a wheelchair, they need to be recommended physical activity by a qualified rehabilitation specialist (physical therapist, occupational therapist or exercise therapy instructor). These should be special adapted exercises that the patient can perform at home. In addition, it is important for a patient with disabilities to independently do what an ordinary person does not perceive as a burden. This includes brushing your teeth, such as cleaning the house, cooking, getting up, moving from chair to bed or vice versa. For him, this requires more strength than for a healthy one, which means it can be considered physical activity and a way to keep the nervous system “in good shape”. Therefore, it is important, for example, that the patient’s family support his independence and physical activity, not isolate him in the “golden cage” of care.

Physical activity is important for any person, but for an MS sufferer its importance can hardly be overestimated – if he does not move, his condition will worsen. The main rule of the brain: you either use a function, or it gradually atrophies in you. And one more thing: classes should be constant. We often see how in our rehabilitation department the patient’s motor abilities improve, and then he comes home and stops exercising. Six months later – a rollback back to the state in which he came to rehabilitation for the first time. Relatives, support groups, blogging or a diary in which he would talk about his successes can motivate the patient. Fitness bracelets or trackers also help.

© DoktorPiter

A fundamentally new way to treat multiple sclerosis has been proposed

Scientists are investigating a new drug that helps restore the myelin sheaths of nerve cells, which could theoretically be a cure for multiple sclerosis.

Multiple sclerosis is an autoimmune disease in which nerve fibers lose their insulating myelin sheath and with it the ability to transmit signals effectively. Patients complain of fatigue, their limbs, vision and memory weaken, speech becomes slurred, and depression develops. Currently, multiple sclerosis is treated with immunosuppressive drugs, mainly interferon-beta and fingolimod, but these drugs are not very effective and have unwanted side effects.

American researchers led by Luke Leirson , professor at the Scripps Research Institute , proposed a different approach, cell regenerative. In an article published in Nature , they described the action of a drug that stimulates the differentiation of progenitor cells of those cells that should ensure the restoration of destroyed myelin sheaths.

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More than 2.5 million people worldwide suffer from multiple sclerosis, mostly women. Its cause is unknown, but certain infections and a lack of vitamin D contribute to the disease. myelin sheath.

Myelin is produced by special cells called oligodendrocytes (a long word, but you have to remember it). They must restore damaged membranes, but they cannot do this, because in multiple sclerosis their number is sharply reduced: for reasons that have not yet been clarified, precursor cells stop turning into oligodendrocytes.

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The researchers tried to find a substance that would stimulate the differentiation of progenitor cells. To do this, they tested the effect of approximately 100,000 molecules on a culture of progenitor cells of rat optic nerve neurons. Among several selected substances with unexplored properties was the familiar drug benztropine, a drug prescribed for Parkinson’s disease. Since many of the properties of benztropine were already known, scientists continued to work with it.

Further studies were performed on mice. A small amount of the demyelination-inducing drug cuprizone was added to their diet, and a mouse model of multiple sclerosis was obtained.

It turned out that benztropine does not affect the inflammatory response, but helps mice restore a population of mature oligodendrocytes, which, in turn, rebuild the myelin sheath of damaged nerves, despite ongoing T-cell attacks.

Moreover, myelin restoration probably occurs at the same rate as its destruction. Benztropine is known for its multiple effects on brain neurons, but it induces differentiation of oligodendrocyte precursors by binding to certain muscarinic (acetylcholine) receptors. Its mechanism of action remains to be studied in more detail.

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Benztropine has another extremely valuable property: it is a wonderful addition to the traditional treatment of multiple sclerosis. Its reception allows almost 90% to reduce the doses of immunosuppressants without loss of effectiveness. Since these drugs have undesirable side effects, the ability to reduce the dosage is very important. So

drug relieves the symptoms of multiple sclerosis by enhancing the action of immunosuppressants and at the same time activating the restoration of myelin.

Researchers plan to learn more about the mechanisms of this process and possibly modify the structure of benztropine to increase its effect. They will also study the action of other molecules that stimulate the differentiation of oligodendrocyte progenitor cells. It is possible that they will act more effectively than benztropine.

Benztropine is a drug prescribed for Parkinson’s disease, it is sold in pharmacies under a different name, but is not registered in Russia. Its research as a cure for multiple sclerosis is just beginning, and long preclinical and clinical trials are ahead. Scientists warn that benztropine also has unwanted dose-dependent side effects, neurological and psychiatric, and could harm multiple sclerosis patients if they read this note and self-medicate.