Description of Pathology

Multiple sclerosis (MS) is a chronic, long-lasting disease of the central nervous system. It is considered
an autoimmune disease, a disorder in which the body mistakenly attacks itself. MS is an individualized
unpredictable disease. Moderate symptoms affect many individuals with MS. While, communication
between the brain and other parts of the body might become disrupted causing some to lose their
ability to see clearly or even write out a sentence; for others it can be that they cannot speak at all
properly when trying to say something or may also loose control over walking. Myelin is the protein/fat
sheath that encompasses our nerve fibers. In MS, the immune system targets and attacks the myelin,
which eventually gets damaged in multiple regions. The loss of myelin leads to the formation hard scar
tissue, known as sclerosis. These areas are also called plaques or lesions. Due to this damage, the nerves
cannot function properly to carry electrical signals back and forth between the brain. If there are
repeated attacks of MS, it is called relapsing-remitting (RR) MS, and if the symptoms evolve over time
with no clear attack-defining events, this type is known as primary progressive (PP) MS.

Multiple sclerosis (MS) is one of the most widespread disabling neurological conditions of young adults
around the world. One can develop MS at any age, but most people receive diagnoses between 20 and
50 years old with a higher prevalence in women than in men. There are relapsing-remitting and
progressive types of MS, but the course is rarely predictable. Researchers still do not fully understand
the cause of MS or why the rate of progression is so difficult to determine. Many people living with MS
do not develop severe disabilities. Most have an average or near-average lifespan. Recent findings from
the National MS Society estimate that nearly 1 million people in the United States are living with MS.
This is more than double the last reported number and the first national research on MS prevalence
since 1975. An estimated 2.5 million people live with MS worldwide. An estimated 200 new cases are
diagnosed each week in the United States, according to the MS Discovery Forum. Rates of MS are
usually higher further from the equator. Some researchers consider vitamin D deficiency as a possible
explanation for this. According to the National Institute of Neurological Disorders and Stroke (NINDS),
people with relatively higher levels of vitamin D are less likely to develop MS. Those that do develop MS
may be more likely to have a less severe case.

Multiple sclerosis (MS) is the most common disabling neurological disorder affecting young adults all
over the world. MS can be experienced by anyone regardless of age, but the diagnosis is usually given
between 20-50 years old, with a higher incidence in women than men. The course of MS is often
unpredictable, and disease progression may fall into one of two major categories: relapsing-remitting or
progressive. The cause of MS is not yet known, and why the course can be so hard to predict also evades
researchers. By and large, relatively few people with MS become significantly disabled. Some of these
individuals have a lifespan close to the average. A new study for the National MS Society (Society)
estimates nearly 1 million people are living with multiple sclerosis in the United States. This number far
exceeds previous studies and is the first to provide a national estimate of prevalence since 1975. MS
affects an estimated 2.5 million people worldwide. According to the MS Discovery Forum, approximately
200 new cases are reported across the United States every week. The further north you go, the higher
the rates of MS. Vitamin D deficiency was implicated by some investigators. The National Institute of
Neurological Disorders and Stroke (NINDS) states that people with higher vitamin D levels are less likely
to get MS, while those who do develop it may experience a milder case.

Normal Anatomy of the Major Body System

The major body system affected is the central nervous system (CNS). The CNS consists of the brain,
spinal cord, and optic nerves, which are responsible for processing sensory information, coordinating
movement, and regulating various body functions. The normal anatomy of the CNS includes neurons,
which are the primary nerve cells responsible for transmitting electrical signals throughout the body,
and glial cells, which provide structural support and insulation for neurons. Myelin, a fatty substance
produced by oligodendrocytes in the CNS, forms a protective sheath around the axons of neurons,
facilitating the rapid transmission of nerve impulses.

In a healthy CNS, the myelin sheath ensures that electrical signals are conducted efficiently between
neurons, enabling smooth and coordinated communication between different parts of the brain and
body. The brain itself is divided into several regions, each with specific functions. For example, the
cerebrum is responsible for higher cognitive functions, such as reasoning and memory, while the
cerebellum coordinates movement and balance. The spinal cord acts as a conduit for signals between
the brain and the rest of the body, allowing for reflex actions and voluntary movement. The blood-brain
barrier (BBB) is another critical component of the CNS. It is a selective barrier that protects the brain
from potentially harmful substances in the blood while allowing essential nutrients to pass through. The
integrity of the BBB is crucial for maintaining the brain's environment. In MS, however, this barrier can
become compromised, allowing immune cells to infiltrate the CNS, which leads to the autoimmune
response that characterizes the disease. The normal anatomy of the CNS, with its complex network of
neurons, myelin, and protective barriers, is essential for maintaining the body's overall function and
coordination.

Normal Physiology of the Major Body System

The central nervous system's (CNS) normal physiology plays a crucial role in maintaining the body's
functionality. The CNS, which includes the brain, spinal cord, and optic nerves, is responsible for
processing and transmitting information throughout the body via electrical and chemical signals.
Neurons, the primary cells of the CNS, transmit these signals through their axons, which are coated with
a protective layer called myelin. Myelin, produced by oligodendrocytes in the CNS, enhances the speed
and efficiency of nerve impulse conduction, ensuring rapid communication between different parts of
the nervous system. This efficient communication is vital for coordinated muscle movements, sensory
perception, cognitive functions, and overall body homeostasis.

The normal physiology of the CNS relies heavily on the integrity of the myelin sheath and the proper
functioning of synapses, where neurons communicate with each other. In a healthy CNS, nerve impulses
travel along the myelinated axons, jumping from one node of Ranvier (gaps in the myelin sheath) to the
next in a process called saltatory conduction. This process allows for quick and efficient transmission of
signals across long distances within the nervous system, which is essential for tasks such as voluntary
muscle control, reflex actions, and the integration of sensory information. Additionally,
neurotransmitters released at synapses enable the transmission of signals between neurons, allowing
for the complex processing of information that underlies all cognitive and motor functions.

The blood-brain barrier (BBB) is another critical component of the CNS's normal physiology, protecting
the brain from harmful substances in the bloodstream while allowing essential nutrients to pass
through. The BBB maintains the stable environment necessary for proper neuronal function. In MS,
however, this normal physiology is disrupted when the immune system mistakenly targets and damages
the myelin sheath. This demyelination impairs the efficient conduction of nerve impulses, leading to the
wide range of neurological symptoms seen in MS patients. The breakdown of the BBB also allows
immune cells to enter the CNS, exacerbating the autoimmune response and further damaging the
nervous tissue.

Mechanism of Pathophysiology

The pathophysiology of multiple sclerosis primarily involves the central nervous system and is
characterized by inflammation and neurodegenerative changes. Inflammatory lesions also called
plaques develop in the white matter of the central nervous system due to myelin destruction and axonal
injury by the immune cells. Demyelination disrupts the transmission of nerve impulses thereby resulting
in impaired neuronal signalling. The chronic inflammation and demyelination in multiple sclerosis cause
neuronal injury and loss (Tobore, 2020). In a healthy individual, the immune system typically protects
the body from foreign invaders while maintaining a balance that prevents it from attacking the body's
own tissues. However, in MS, this balance is disrupted due to a combination of genetic susceptibility and
environmental factors, such as viral infections or vitamin D deficiency, which trigger an autoimmune
response. According to Van Langelaar et al. (2020), this response involves the activation of T cells, which
normally help protect the body by identifying and attacking pathogens. In MS, these T cells mistakenly
recognize the myelin sheath—a fatty layer that insulates nerve fibers in the CNS—as a foreign invader.

Once activated, these autoreactive T cells cross the blood-brain barrier (BBB), a critical structure that
typically prevents harmful substances from entering the CNS. The breach of the BBB in MS allows these
immune cells to infiltrate the CNS, where they release pro-inflammatory cytokines that attract other
immune cells, such as B cells and macrophages, to the site of inflammation. B cells produce antibodies
against myelin, further amplifying the immune attack. Macrophages, which are cells that normally engulf
and destroy pathogens, begin to attack and degrade the myelin sheath (Van Langelaar et al., 2020). The
resulting loss of myelin, known as demyelination, disrupts the ability of neurons to conduct electrical
signals efficiently, leading to the various neurological symptoms seen in MS, such as muscle weakness,
visual disturbances, and coordination problems.

Over time, the continuous cycle of inflammation, demyelination, and attempted repair leads to the
formation of scar tissue or plaques in the CNS, primarily in the white matter of the brain and spinal cord.
These plaques are areas where the myelin has been destroyed and replaced with hardened tissue,
further impeding nerve signal transmission. Additionally, the ongoing immune attack can also damage
the underlying axons of neurons, leading to irreversible neuronal loss and contributing to the
progression of disability in MS patients (Haki et al., 2024). The combination of demyelination, axonal
damage, and the formation of sclerotic plaques are the hallmarks of MS pathology, reflecting the severe
disruption of normal CNS anatomy and physiology that underpins the disease.

Prevention

Multiple sclerosis cannot be completely prevented and certain risk factors — such as age, sex, and
family history — cannot be modified. However, research done by Baskaran et al. (2023) show that
changing diet and lifestyle may help reduce the risk of developing MS. Though MS cannot be totally
prevented, quitting smoking (if applicable), maintaining moderate body weight, and getting enough
vitamin D through diet or sun exposure could help reduce the risk. Staying active, minimizing stress
levels, and following a healthy, well-rounded diet may also be beneficial (Baskaran et al., 2023).
Treatment

Although there is currently no cure for multiple sclerosis (MS), current treatments focus on limiting
further damage, easing symptoms, and avoiding complications. Individuals with a type of multiple
sclerosis called relapsing-remitting MS, the doctor may first treat them with a disease-modifying drug.
These multiple sclerosis treatments slow down the advance of the disease and prevent flare-ups. The
drugs work by curbing the immune system — the body's main defense against germs — so that it does
not attack the protective coating called myelin that surrounds the nerves (McGinley et al., 2021).
Therefore, the primary approach involves disease-modifying therapies (DMTs) that aim to reduce the
frequency and severity of relapses, delay the progression of disability, and limit the accumulation of new
lesions as seen on MRI scans. Common DMTs include injectable medications like interferon beta and
glatiramer acetate, oral medications such as fingolimod and dimethyl fumarate, and intravenous
infusion therapies like natalizumab and ocrelizumab. In addition to DMTs, corticosteroids like
methylprednisolone are often used to manage acute MS relapses by reducing inflammation and
speeding up recovery (McGinley et al., 2021). Symptomatic treatments are also crucial, addressing issues
such as muscle spasticity, fatigue, pain, and bladder or bowel dysfunction. Physical therapy and
occupational therapy play an essential role in helping patients maintain mobility, strength, and
independence.

Conclusion

In conclusion, Multiple Sclerosis (MS) is a chronic and unpredictable autoimmune disease that primarily
targets the central nervous system, leading to the progressive destruction of the myelin sheath and the
disruption of normal neurological function. Despite the complexities in its pathophysiology and the
variability in its presentation, advancements in understanding MS have led to treatments that can slow
disease progression and manage symptoms, although a cure remains elusive. Preventative strategies,
such as maintaining a healthy lifestyle and ensuring adequate vitamin D levels, may help reduce the risk
of developing MS. Ongoing research continues to explore the causes, mechanisms, and potential
therapies to better manage and ultimately find a cure for this debilitating condition.

References
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diagnosis and management of multiple sclerosis for the general neurologist. Journal of Clinical Neurology
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Haki, M., Al-Biati, H. A., Al-Tameemi, Z. S., Ali, I. S., & Al-Hussaniy, H. A. (2024). Review of multiple
sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine, 103(8), e37297.

Kuhlmann, T., Moccia, M., Coetzee, T., Cohen, J. A., Correale, J., Graves, J., ... & Waubant, E. (2023).
Multiple sclerosis progression: time for a new mechanism-driven framework. The Lancet
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McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis and treatment of multiple
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Papiri, G., D’Andreamatteo, G., Cacchiò, G., Alia, S., Silvestrini, M., Paci, C., ... & Vignini, A. (2023).
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Tobore, T. O. (2020). Towards a comprehensive etiopathogenetic and pathophysiological theory of
multiple sclerosis. International journal of neuroscience, 130(3), 279-300.

Van Langelaar, J., Rijvers, L., Smolders, J., & Van Luijn, M. M. (2020). B and T cells driving multiple
sclerosis: identity, mechanisms and potential triggers. Frontiers in immunology, 11, 760.