In this post, I’d like to elaborate on the origins and some challenges of Multiple Sclerosis (MS). I think that my last review of MS treatment options still holds pretty much. However, many important areas were not covered. I talked about possibilities for a cure for MS development, but that will not work if MS has been misdiagnosed. I have encountered the scary option of misdiagnosing Lyme disease as MS. Worth discussing! Another interesting topic I would like to explore here is the origins of MS. Can you prevent it?  

I have mentioned earlier some bits on the Epstein-Barr virus (EBV), and its role in triggering MS. These conclusions were based on a large study involving a statistical evaluation of medical records of a very large group of people over a long period of time. This study was supported by the US military, of course. Who else could keep track of the health records of millions of patients for decades?  A statistically significant correlation between EBV infection and the development of MS has been found about ten years after EBV infection. Several other infections or other health issues followed in the study have shown no correlation with MS occurrence.

Interestingly, EBV is known to attack B-cells of the immune system. It has been suspected of having something to do with autoimmune reactions for quite some time. It is therefore not that surprising that malfunctioning B-cells are responsible for MS. These misguided B-cells are then attacking the myeline sheet covering nerves, leading to inflammation and malfunctioning nerve signaling.

 However, EBV is ubiquitous, and more than 90% of people get infected by it. Only ~0.3% of people get diagnosed with MS, though.  Hence, some additional trigger or predisposition must be required, perhaps something in our genes – DNA or other environmental factors.

Thanks for the MS, Ancient Ancestors!

An exciting scientific article was recently published in Nature. It traced the genetic origins of MS back to ancient cattle herders who migrated from Asia to Northern Europe.

Here is a map showing the prevalence of these genes, which also coincides with a higher incidence of MS. A theory has it that these MS-causing genes are remnants of ancient attempts by our bodies to develop an immune defense against animal-borne diseases. The defense was needed, obviously, due to living very closely with cattle, drinking cow’s milk, etc.

I guess there are probably other genes that cause MS besides this one. These are yet to be discovered, though. Overall, great progress was made that I believe will ultimately lead to developing a cure for MS or at least a vaccine that could decrease the incidence of MS. Vaccines against EBV should definitely achieve that if the study findings above are correct!

Misdiagnosis of MS and Lyme Disease

Based on the statistical data, I believe that one of the greatest challenges of MS is misdiagnosis. It turns out that up to 20% of people with MS might be misdiagnosed. That is a big problem, of course. How can you be cured if you are treated for the wrong disease?

There are several diseases reported as reasons for these misdiagnoses, such as migraine, radiologically isolated syndrome, and neuropathy. I will skip these here and focus on MS and Lyme disease. Lyme is likely a very rare reason for MS misdiagnosis, but it is one of the scariest. Both diseases can lead to similar symptoms; you can find a basic Lyme description from CDC here. As a result, there is confusion between Lyme and MS and what causes what. Similar is true for other neurological diseases, such as ALS.  I have even come across some reports of people diagnosed with MS who think that they were misdiagnosed and have Lyme disease instead of MS.

Here is my take on this from what I know and was able to find out. Lyme disease is a bacterial infection spread by ticks.  The symptoms of Lyme can be very similar to MS, but the causes are very different. The Lyme bacteria can be destroyed and Lyme disease cured by antibiotics, whereas MS cannot. The challenge is that the Lyme bacteria might become very good at hiding in our nervous system while taking advantage of the protection of the brain-blood barrier if not treated early after infection. The brain-blood barrier protects our CNS from anything toxic and is difficult to cross with any drugs or antibiotics. This is why it’s hard to get rid of Lyme. A special protocol needs to be implemented.

How to Fix This ?

Naturally, everyone is commonly tested for Lyme disease to rule this disease out during MS diagnosis. However, there is a possibility that Lyme disease goes undetected. Moreover, Lyme disease used to be very uncommon in the US, especially in Western parts, which results in a lack of experience with the disease among medical staff. There could also be new strains of the Lyme bacteria that cannot even be detected, and the spread of Lyme disease might be wider than expected. The environment is changing rapidly; what was true 10 years ago might not be true today.

I hope better testing to detect Lyme disease will be developed to sort this out!

The diagnostic confusion of Lyme disease with MS can have dire consequences, of course. This is because of the immunosuppressants used for MS. These treatments had tremendous success in helping people with MS. But weakening the immune system makes the Lyme bacteria thrive.   The MS treatment would, therefore, help Lyme disease and make the symptoms worse over time. Only antibiotics would temporarily stop Lyme disease and its symptoms from progressing. The problem with Lyme is that a regular dosing regimen of antibiotics would not be enough. Especially after a longer period of time after an infection. Scary!

Outlook

To finish on a positive note, I think that as MS immunosuppressive treatments become more efficacious, the confusion between MS and Lyme will become rarer. The high-efficacy treatments today work well. If they do not, it should give doctors a stronger hint that something might be off with the diagnosis. But of course, the available therapies still only modify the chronic diseases such as MS, to slow its progression and minimize negative impact on health. MS isn’t cured; it’s just about limiting collateral damage.

Based on the complicated and slow progress I described above, the ultimate cure for MS may seem far away. However, I think there is also a good reason for hope. The origins of MS are not just for history nerds but bring a better understanding of MS disease challenges. This will help both with novel treatment development and diagnosis. And with advances in gene editing, such as CRISPR, there seem to be development tools that might make an immune system correction or a reset possible!  Or at least a vaccine against EBV; that would be a good start to at least decrease the MS incidence.

And remember that there are always natural ways to limit the impact of these diseases on you. Keeping a balanced immune system, staying active, and controlling your diet and healthy lifestyle can go a long way!