My experience with Multiple Sclerosis

As a final assignment during the course “The Neurobiology of everday life”, we were required to submit an essay on a topic that was covered by the course. Here is my final assignment…

This essay is an account of my experience of Multiple Sclerosis (MS) and the explanations for my condition and various symptoms that were introduced in the course “The Neurobiology of Everyday Life”. Every symptom that I exhibit has an explanation in terms of neurobiological processes and I now have a clearer understanding of what the underlying causes of the symptoms I experience.

Multiple sclerosis is classified in this course, as a demyelinating disease because myelin which assists in the transfer of information along an axon, becomes damaged[1]. Other researchers refer to it as an autoimmune disease because the body attacks itself by damaging myelin around its own axons(Giampaolo et al., 2013). This damage causes a wide variety of symptoms, depending on which axon has been affected (different axons have different roles – for example, some such as those found in motor neurons, are tasked with body movement, while others deal with visual input). MS when it is described as a central demyelinating disease describes the underlying problem in the interaction between oligodendrocytes (a type of glial cell which is responsible for the myelination of axons) and the axon[2]. The association between oligidendrocytes are often the targets for MS therapies (Deshmukh et al., 2013).

My encounter with MS started about 32 years ago when I experienced a sudden onset of double vision. The double vision, as I now understand it after having followed this course (and which was not recognised at the time), can be explained as follows: Visual information from the retina of each eye enters the thalamus via the optic nerve. Both eyes need to be aligned to obtain clear vision. If the eyes are misaligned, the visual information will be blurry. Motor neurons control the position of the eye by way of six muscles called the extraocular muscles[3]. In my case, the axons carrying information to these eye muscles had their myelin sheaths compromised which meant that signals reached their respective destinations (the extraocular muscles) at different times, resulting in a horizontal misalignment leading to double vision. Luckily, this condition rectified itself after a few months, though I was not diagnosed with MS at the time.

A few years later, whilst out jogging, I experienced weakness of my right leg and was unable to continue running. Initially diagnosed with myasthenia gravis and then stroke (both diseases which have a profound effect on the neurobiology of the brain). I was eventually diagnosed with MS after a Magnetic Resonance Imaging (MRI) scan revealed several lesions. An excerpt from the MRI scan can be found in Figure 1. The report that was generated from my MRI scan indicated among other things:

“Multiple MS plaques are seen at the callosal-septal interface as well as involving the corpus callosum / peri-callosal white matter. Lesions also seen in the cerebellum bilaterally”. (an extract from the MRI scans is shown at the end of this essay).

These lesions explained why I have speech problems (dysarthia) as the cerebellum (which is contained in the brain stem)[4] contains motor neurons which are responsible for muscles that control speech[5]. The callosal-septal interface links the right and left hemispheres and lesions here explain why I have difficulty with my fine motor skills for writing as well as balance.

MS is not the only condition I have which was explained in this Coursera course – though it is by far the most serious. Recently, I have been suffering back pains. Fortunately, an MRI scan did not reveal any new lesions but, as I am getting on in age, it seems that I have some degeneration of the lumbar/sacral spine (specifically in segments L5/S1) which is affecting the exiting nerve roots[6] (cauda equina) from my spinal column. As explained in Lesson 3 as you age the “intervertebral foramens” become smaller leading to a possible compression of the cauda equina.

In addition to back aches, age has thrown me another curve ball in terms of vasomotor disorder[7] For several years I experienced hot flushes (also called hot flashes in some countries) as I was going through menopause[8]. The symptoms I have experienced are commonly know to be associated with menopause (Stuenkel, 2018). I have learnt from this Coursera course, that I may not have a thermoneutral zone. The hypothesis of a lack of a thermoneutral zone being the cause of hot flushes has been corroborated in other research (Mallhi, Khan, Khan, & Mahmood, 2018). In other words, in ‘normal’ people, the core temperature can stray from the set point temperature of 37⁰c by 0,5⁰c with no metabolic reaction occurring. In my case, because I do not have this 0,5⁰c leeway. The body’s reaction to an imperceptible rise in temperature is to try and cool down the body by sending blood to the surface of the skin where it can cool down. The result is a feeling of heat which triggers a subsequent feeling of cold and a vicious cycle of feelings of heat and cold are created.

In conclusion, this course has been extremely valuable to me personally. It has enabled me to understand the MRI report that was generated from my neurologist and has given me a deeper understanding of MS and its effect on me. Age-related changes to my body are now more understandable and in consequence, are more acceptable because I can understand the neural dynamics behind them.

REFERENCES

Deshmukh, V. A., Tardif, V., Lyssiotis, C. A., Green, C. C., Kerman, B., Kim, H. J., … Lairson, L. L. (2013). A regenerative approach to the treatment of multiple sclerosis. Nature, 502(7471), 327–332.

Giampaolo, D. L., Bhigjee, A., Retief, C., Isaacs, M., Britz, M., Opperman, D., … van Rensburg, M. (2013). Guideline for the diagnosis and management of multiple sclerosis: A Southern African perspective. South African Medical Journal, 103(9), 670–691.

Mallhi, T. H., Khan, Y. H., Khan, A. H., & Mahmood, Q. (2018). Managing Hot Flushes in Menopausal Women : A Review. Journal of the College of Physicians and Surgeons Pakistan, 28(6), 460–465.

Miller, V. M., Kling, J. M., Files, J. A., Joyner, M. J., Kapoor, E., Moyer, A. M., … Faubion, S. S. (2018). What’s in a name: are menopausal ‘“ hot flashes ”’ a symptom of menopause or a manifestation of neurovascular dysregulation? Journal of the North American Menopause Society, 25(6), 700–703.

Stuenkel, C. A. (2018). Vasomotor and related menopause symptoms. Clinical Obstetrics and Gynecology, Published ahead of print.

Figure 1: Excerpt from a series of MRI scans

[1] Source: Lesson 1: Neurons: Myelin

[2] Source: Lesson 1: Neurons: Myelin

[3] Source: Lesson 6: The vestibular sense & gaze:Horizontal VOR circuitry

[4] Source: Lesson 1: The nervous system: Central anatomy:

[5] Source: Lesson 1: The nervous system: Central anatomy:

[6] Source: Lesson 3: Neuroanatomy : Neuroanatomy labs : Spinal cord

[7] Source: Lesson 9: Thermoregulation: Fever and hot flashes

[8] Though there has been a suggestionthat hot flushes are not merely signs of menopause, but could be indications of underlying pathosphysiological processes which are hidden by the hormonal changes that occur with menopause(Miller et al., 2018)