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What You Should Know
About Multiple Sclerosis

with Dr. Toledo

Zuleyma
Toledo-Nieves, MD

Neurologist

Did you know that less sun exposure can increase your risk of Multiple Sclerosis? How about that 2.5 million live with MS worldwide?

March is Multiple Sclerosis Awareness Month. We sat down with Lakeland Regional Health Neurologist and MS specialist, Dr. Zuleyma Toledo to learn more about this often-misunderstood disease. She gave us an insight into the complexities of MS, with an overall perspective of hope for patients and their prognosis.

Q: Dr. Toledo, what is your patient philosophy when you first meet patients?

A: When I first meet with patients, I listen. I make sure I have plenty of time, more than the typical amount, to hear my patient’s concerns and history. I specialize in Multiple Sclerosis, but I also work with general neurology concerns, such as headaches, migraines, numbness, seizures, strokes, and more.

Q: What exactly is Multiple Sclerosis? 

A: Multiple Sclerosis is a disease that has six main factors:

  • Chronic — The disease is lifelong.
  • Autoimmune — Our body’s natural defense system is unable to differentiate between your own cells and foreign cells, causing the body to mistakenly attack normal cells.
  • Demyelinating — Causes damage to the protective covering (myelin sheath) that surrounds nerve fibers in your brain.
  • Inflammatory — The immune system attacks our body’s own tissues, resulting in inflammation.
  • Degenerative — The function of the affected tissues, organs, or nerves worsens over time due to the chronic damage.
  • Affects the Central Nervous System (CNS) — The CNS includes the brain, spinal cord, and optic nerves.
Central Nervous System

MS is a lifelong disease and does not truly go away. However, it can be managed early on to reduce the degenerative outcomes. To help patients understand the complexity of MS, I like to create a visual.

Think of your nerves as an electrical wire with a protective layer surrounding the strong, fast, and stable electricity running through. The protective layer known as the myelin sheath, helps create that fast and stable transmission from the brain to the nerves. With MS, an abnormal antibody will start to attack the protective layer (myelin sheath), causing the CNS nerves to be damaged and exposed. White matter lesions will form on the brain and spinal cord, causing the transmission to slow down and be unstable. Without proper management of MS, the antibody will continue to demyelinate the protective layer, causing degeneration and loss of nerve function over time. 

Q: Do we know what causes MS?

A: We do not know the exact cause. However, there has been incredible research done to determine the potential risk factors for MS. We do know that MS is multifactorial, meaning multiple factors contribute to the development of the disease, such as:

  • Age — While MS can occur or be diagnosed at any age, it is most commonly diagnosed in individuals between 20 and 40.
  • Sex — Women are 2-3x more likely to be diagnosed with MS.
  • Vitamin-D deficiency — Studies have shown a correlation between Vitamin-D deficiency or less sun exposure and MS, meaning White individuals are at the most risk.
  • Unhealthy lifestyle — Smoking, lack of exercise, and an unbalanced diet can contribute to MS.
  • Exposure to Epstein–Barr virus — The most common form of EBV is infectious mononucleosis (mono).

Q: What are the symptoms of MS and how can I determine if I have it?

A: Each patient is unique and their path to diagnosis is specific to their history, past symptoms, and environment. Of course, each patient experiences symptoms differently. Some common symptoms can include:

Unilateral Symptoms: Since MS affects specific nerves in the CNS, patients will experience unilateral symptoms meaning they will have symptoms in one arm, one leg, one eye, etc. rather than both. These can include:

  • Numbness
  • Weakness
  • Vision loss
  • Tremors
  • Pain
  • Muscle rigidity or spasm
  • Tingling
  • *Patients may have bilateral arm or leg weakness/numbness if the spinal cord is affected

Emotional and Mental Common Symptoms: We know MS affects certain parts of the brain causing white matter lesions that can affect our emotional and mental health. Some symptoms may be:

  • Depression
  • Mood swings
  • Anxiety
  • Fatigue

Other Common Physical Symptoms can include:

  • Constipation
  • Vertigo
  • Fatigue
  • Incontinence
  • Neuropathy

Q: How common is MS?

A: There are two main types of MS affecting nearly 1 million diagnosed individuals in the US:

  • Relapsing-Remitting MS (most common) affects 85-90% of patients. Patients will have relapses (symptoms getting worse) followed by relief (remission).
  • Primary Progressive MS (less common) affects 10-15% of patients. Symptoms are steadily occurring with no relapse and no remission.

 

Q: Is there any treatment?

A: There is no cure at this time, but we can manage the symptoms and slow the progression of the disease, which is remarkable. Currently, there are 20 medications to treat MS symptoms, including oral, injectable, and infusions. We can use a combination of different therapies and medications to fit your needs. At Lakeland Regional Health, we can diagnose and treat MS right here in our facilities. We can tailor your treatment plan to give you the best outcomes to live a strong, healthy, happy life!

Q: Is there hope?

A: Of course! Since 1993 when the first treatment medication was developed, research for MS has created more treatments, therapies, and options for symptom management. In fact, some people have such mild symptoms that no treatment is necessary. The most important thing is to talk with your doctor thoroughly at every annual exam and let them know if you experience any abnormal physical or mental symptoms. With our treatment plans implemented early on in the diagnoses, we can treat the effects of the demyelination which will in turn slow the degeneration of the nerves. This means we can give patients their lives back. They can bike, run, walk, work, and play with lessened pain and ultimately a better prognosis!

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