Nerve Damage in Multiple Sclerosis

Multiple Sclerosis (MS) is known to be a complex and often debilitating autoimmune condition. Its detrimental effect on nerve cells, specifically the neurons and their protective myelin sheath, also classifies the condition as neurodegenerative. Let’s examine the intricacies of MS nerve damage, and explore how the disease attacks nerve cell fibres and disrupts the myelin sheath.

Understanding Multiple Sclerosis

Multiple Sclerosis is a chronic inflammatory condition of the central nervous system. It is an autoimmune demyelinating disease, which means the immune system mistakenly attacks normal tissues — in this case, the myelin or protective covering around nerve fibers. This leaves scarred tissues or lesions in multiple areas, disrupting electrical impulses throughout the body. When the myelin sheath is damaged, nerve impulses slow down or even stop, causing neurological problems.

Neurons and Myelin Sheath: The Difference

When trying to understand the specifics of MS nerve damage, it is important to be aware of the fundamental components that are involved in MS.

Neurons

They are responsible for transmitting electrical signals from the central nervous system to the rest of the body. These signals impact movement, cognition, and senses. Essentially, neurons are the building blocks of the nervous system. Their structure comprises signal-receiving dendrites, a cell body that processes them, as well as an axon that transmits signals to other neurons.

The space between the axon of one neuron and the dendrite of another is known as the synapse.

When the central nervous system needs to convey information to a certain part of the body, it comes into the neuron through the dendrites and travels through the axon to the synapse.

Neurotransmitters are then released by the neuron and accepted by the receptors of the adjacent neuron, and this enables the information to cross the synapse.

Myelin Sheath

It is a protective layer that surrounds and insulates axons, the long projections of neurons. It acts like the insulation on an electrical wire, speeding up the transmission of electrical signals along the axon and ensuring efficient communication between nerve cells.

Surrounding the nerve cells are glial cells, which are special support cells containing oligodendrocytes that produce a fatty protein called myelin. Myelin sheaths the axon and serves as a protective layer, much like the insulative coating around an electrical wire, while also enabling information to pass smoothly through the nerve cells.

Multiple sclerosis and myelin sheath

When a patient suffers an MS attack, an immune system response is triggered that leads to inflammation of the nerve cells and the glial cells. This damages the oligodendrocytes, which in turn means that myelin cannot be produced at the normal rate, which causes the myelin sheath to be stripped away. This process is known as demyelination, and a demyelinated nerve cannot transmit messages properly. As a result, depending on where the nerve damage has occurred, the patient will experience difficulties with voluntary movement.

Post the MS attack, the body is able to heal the damage to some extent – known as remyelination. The new myelin tends to be thinner, however, which means that messages cannot be transmitted as efficiently as before. As the disease progresses, the oligodendrocytes may be unable to produce myelin altogether. As more and more of the axon remains exposed, scars form on the nerve cells that affect their ability to be regenerated. A tell-tale sign of Multiple Sclerosis, therefore, is the white lesions that show up on MRI scans from the scarring.

MS Nerve Damage: What Happens

In MS, the immune system primarily attacks the myelin sheath. Immune cells, such as T cells and B cells, infiltrate the central nervous system. This results in lesions and inflammation. This further damages and disrupts the myelin sheath’s integrity, and impairs its ability to insulate the axons properly.

Demyelination

As the condition advances, the myelin sheath is gradually stripped away from the axon. This is known as demyelination. Without the protective myelin sheath, nerve impulses slow down or get blocked, causing several neurological symptoms.

Axonal Damage

Axonal damage is the result of prolonged inflammation and demyelination. It is known to impair the neuron’s ability to transmit signals effectively. In some cases, axonal damage can also lead to degeneration of neurons.

Types of MS Nerve Damage

The type of multiple sclerosis is known to determine the progression of MS nerve damage. There are several types of MS, and each exhibits different patterns of nerve damage. Let’s look at them below:

Relapsing-Remitting MS (RRMS)

RRMS involves periodic relapses or flare-ups of symptoms followed by periods of partial or complete recovery. New areas of myelin are damaged during relapses. This leads to temporary neurological deficits.

Secondary Progressive MS (SPMS)

As RRMS advances, most patients transition to SPMS. This type of MS is marked by a gradual accumulation of disability and nerve damage, often with fewer relapses.

Primary Progressive MS (PPMS)

PPMS can be characterised by a gradual and steady progression of symptoms from the onset. It may not have distinct relapses or remissions. Nerve damage is persistent in PPMS, and more often than not leads to severe disability.

Progressive-Relapsing MS (PRMS)

This type of MS is less common and can be characterised by a gradual decline in function. It can involce occasional acute relapses.

Implications of Nerve Damage in MS

Nerve damage in MS can seriously impact a person’s daily life and overall well-being. Below are the consequences of MS nerve damage:

Motor Function Impairment: Muscle weakness, spasticity, and impaired coordination
Sensory Abnormalities: Numbness, tingling, or pain in various parts of the body, hindering sense of touch and ability to perceive temperature and pain
Cognitive Dysfunction: Poor memory, inability to focus, short attention span, inability to problem-solve
Bowel and Bladder Dysfunction: Urinary incontinence, constipation, or difficulty emptying the bladder
Fatigue: Read more about fatigue in multiple sclerosis here
Vision Problems: Read more about vision problems in multiple sclerosis here

Managing MS Nerve Damage at Plexus

Managing multiple sclerosis and MS nerve damage involves a combination of approaches that aim to manage the symptoms, as well as slow the progression of nerve damage. These may include:

Stem Cell Therapy: Autologous mesenchymal cells are injected into the patient’s body in a painless and non-surgical procedure to regenerate or replace damaged neurons, and slow the progression of the condition.
Disease-Modifying Therapies: DMTs are medications designed to reduce the frequency and severity of MS relapses, potentially slowing down the damage to nerve cells.
Symptomatic Treatment: Medications and therapies are available to manage specific symptoms such as muscle spasticity, pain, and fatigue.
Physical and Occupational Therapy: Rehabilitation programs can help individuals with MS improve their strength, balance, and mobility, as well as learn adaptive strategies to maintain independence.
Cognitive Rehabilitation: This involves cognitive therapy and training to manage memory and cognitive impairments.
Supportive Care: This includes emotional support, lifestyle modifications, and adaptive aids to enhance the quality of life for individuals with MS.

At Plexus, we also devise customised MS rehabilitation programs that are a combination of the above approaches, and also comprise the following:

Functional strengthening
Gait training
Motor relearning
Balance training
Coordination training
Hand function training
Splinting for weak muscles
Fall prevention training
Activities for daily living training
Emotional counseling
Speech therapy

In short, Multiple Sclerosis gradually breaks down the ability of the nerve cells to heal and operate efficiently, which is what causes problems with voluntary movement. There are, however, several treatments that slow down the rate of damage and improve remyelination so that the patient can be more functional. Early diagnosis, access to appropriate medical care, and a comprehensive management plan tailored to the individual’s needs are key factors in minimizing the impact of MS nerve damage and helping those affected lead fulfilling lives.

Reach out to Team Plexus today to know more about our rehabilitation program for MS.

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