multiple sclerosis

Posted on Multiple Sclerosis

Brain lesions associated with memory loss in multiple sclerosis linked to common brain circuit

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Between 30 to 50 percent of people living with multiple sclerosis (MS) will experience memory problems but the cause is uncertain. Brain lesions are the hallmark imaging sign used to diagnose MS and are often associated with memory dysfunction. However, increased MS brain lesions are not specific to memory problems and are also associated with fatigue, walking difficulty and other common MS symptoms. Previous studies that attempted to align the anatomy of lesions associated with memory problems in MS led to conflicting results.

Researchers from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, conducted a study to figure out which MS lesion locations are associated with memory issues. The team, led by Isaiah Kletenik, MD, analyzed imaging and cognitive data from 431 people with MS enrolled in the Comprehensive Longitudinal Investigation of MS at Brigham and Women’s Hospital, or CLIMB study. Researchers mapped white matter lesion locations from each person and tested associations between memory dysfunction and a memory circuit previously derived from strokes causing memory problems. They found that MS lesions that were associated with memory problems intersected with this memory circuit centered on the hippocampus. The researchers also analyzed the MS lesion locations compared to large functional and structural brain atlases to identify unique MS memory circuits.

“In many neurologic diseases, we know what brain function will be disrupted based on the location of lesions, but in MS, the lesions are widespread making localization challenging,” Kletenik said. “By applying a circuit-based approach, we show that lesions associated with MS memory dysfunction connect to a memory circuit.”

Posted on Multiple Sclerosis

Life stressors may contribute to multiple sclerosis flares, disability.

The findings highlight the importance of analyzing the impact of life stressors on those with MS
The findings highlight the importance of analyzing the impact of life stressors on those with MS

A Michigan Medicine-led study finds that stressors across the lifespan — including poverty, abuse and divorce — are associated with worsening health and functional outcomes for people with multiple sclerosis.

Using survey data from more than 700 people with MS, researchers discovered that stressful events occurring both in childhood and adulthood contributed significantly to participants’ level of disability.

The results are published in Brain and Behavior.

“MS is the leading cause of non-traumatic disability among young adults, and additional research is needed to identify these external drivers of disability that can be addressed or prevented, including stress, to improve functional outcomes,” said co-author Tiffany Braley, M.D., M.S., director of the Multiple Sclerosis/Neuroimmunology Division and Multidisciplinary MS Fatigue and Sleep Clinic at University of Michigan Health.

“This knowledge is needed to inform MS research as well as clinical care. Referrals to resources, such as mental health or substance use support could help reduce the impact of stress and enhance wellbeing,” Braley said.

More than 2.8 million people in the world have MS, an autoimmune condition that affects the brain and spinal cord, in which the protective layer of nerve cells is attacked by the body’s immune system. People with MS can experience unique, often painful, exacerbations of their symptoms known as a relapses, exacerbations or “flares”.

Initially in the study, both childhood and adult stressors were significantly associated with worse burden caused by relapse after the onset of the COVID-19 pandemic. However, the association between childhood stressors and disease burden lost significance when further accounting for experiences in adulthood. 

Studies focused on stress and MS that don’t account for the full lifespan, researchers say, could miss vital information or overestimate the relationship between childhood stressors and health outcomes.

“Adverse Childhood Experiences, which we call ACEs, and other childhood stressors could impact immune, inflammatory and behavioral processes throughout life, and reduce resilience to adult stress,” said first author Carri Polick, Ph.D., R.N., who completed this work while at the U-M School of Nursing and is now a postdoctoral fellow in the National Clinician Scholars Program at Duke University.

“It is important to use a lifespan approach in future work to better understand patterns and inform symptom management. For example, we are expanding upon this work to investigate mechanistic pathways through sleep, smoking and mental health, through which stressors may lead to worse MS outcomes including increased disability, pain and fatigue.”

Posted on Multiple Sclerosis

A new study explains how a common virus can cause multiple sclerosis.

Epstein–Barr virus. (2023, April 19). In Wikipedia. https://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus

Researchers at Karolinska Institutet in Sweden have found further evidence for how the Epstein-Barr virus can trigger multiple sclerosis or drive disease progression. A study published in Science Advances shows that some individuals have antibodies against the virus that mistakenly attack a protein in the brain and spinal cord.

The Epstein-Barr virus (EBV) infects most people early in life and then remains in the body, usually without causing symptoms. The link between EBV and the neurological disease multiple sclerosis (MS) was discovered many years ago and has puzzled researchers ever since. Increasing evidence, including two papers published in Science and Nature last year, suggests that EBV infection precedes MS and that antibodies against the virus may be involved. However, the molecular mechanisms seem to vary between patients and remain largely unknown.

“MS is an incredibly complex disease, but our study provides an important piece in the puzzle and could explain why some people develop the disease,” says Olivia Thomas, postdoctoral researcher at the Department of Clinical Neuroscience, Karolinska Institutet and shared first author of the paper. “We have discovered that certain antibodies against the Epstein-Barr virus, which would normally fight the infection, can mistakenly target the brain and spinal cord and cause damage.”

Misdirected antibodies

The researchers analysed blood samples from more than 700 patients with MS and 700 healthy individuals. They found that antibodies that bind to a certain protein in the Epstein-Barr virus, EBNA1, can also bind to a similar protein in the brain and spinal cord called CRYAB, whose role is to prevent protein aggregation during conditions of cellular stress such as inflammation. These misdirected, cross-reactive antibodies may damage the nervous system and cause severe symptoms in MS patients, including problems with balance, mobility and fatigue. The antibodies were present in about 23 percent of MS patients and 7 percent of control individuals.

“This shows that, whilst these antibody responses are not required for disease development, they may be involved in disease in up to a quarter of MS patients,” says Olivia Thomas. “This also demonstrates the high variation between patients, highlighting the need for personalised therapies. Current therapies are effective at reducing relapses in MS but unfortunately, none can prevent disease progression.”

T cells may also be involved

The researchers also found that there is likely a similar cross-reactivity among T cells of the immune system.

“We are now expanding our research to investigate how T cells fight EBV infection and how these immune cells may damage the nervous system in multiple sclerosis and contribute to disease progression,” says Mattias Bronge, affiliated researcher at the Department of Clinical Neuroscience, Karolinska Institutet and shared first author of the paper.

Posted on A to Z of Medical Conditions

Neuromyelitis optica spectrum disorder, Causes, Signs and Symptoms, Diagnosis and Treatment.

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Neuromyelitis optica spectrum disorders (NMOSD) is an etiologically heterogeneous syndrome predominantly characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord (myelitis).[ Episodes of ON and myelitis can be simultaneous or successive. A relapsing disease course is common, especially in untreated patients. In more than 80% of cases, NMO is caused by immunoglobulin G autoantibodies to aquaporin 4 (anti-AQP4), the most abundant water channel protein in the central nervous system. A subset of anti-AQP4-negative cases is associated with antibodies to myelin oligodendrocyte glycoprotein (anti-MOG). Rarely, NMO may occur in the context of other autoimmune diseases (e.g. connective tissue disorders, paraneoplastic syndromes) or infectious diseases. In some cases, the etiology remains unknown (idiopathic NMO).

Multiple sclerosis (MS) and NMO can be similar in clinical and radiological presentation, and MS may very rarely present with an NMO-like phenotype (e.g. in patients with long-standing MS resulting in confluent spinal cord lesions mimicking the long spinal cord lesions typically seen in MS). In consequence, NMO was wrongly considered a clinical variant of MS in the past. However, NMO is not caused by MS in the vast majority of cases but differs from MS substantially in terms of pathogenesis, clinical presentation, magnetic resonance imaging, cerebrospinal fluid findings, disease course and prognosis.

Posted on autoimmune conditions

Autoimmune Disease: A Food-based Approach

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An estimated 23.5 million people in the United States are living with an autoimmune disease, such as type 1 diabetes, Crohn’s disease, multiple sclerosis, rheumatoid arthritis, or myasthenia gravis. These diseases afflict women more than men and are among the leading causes of death for young and middle-aged women.

Collectively, these diseases are becoming more common around the world. Side effects from some of the medications to treat them can be harsh, so those living with these conditions may look for natural and less invasive ways to manage these diseases. But can the right diet help tame an autoimmune disease?

Learn how nutrition and your diet may help to manage some of these conditions during this free online webinar on Autoimmune Disease: A Food-based Approach.

The expert panel is comprised of:

Leigh Frame, PhD, MHS, is an assistant professor, Department of Clinical Research and Leadership, program director, Integrative Medicine Programs, and executive director, Office of Integrative Medicine and Health. Dr. Frame brings nutrition and immunity together through clinical/translational research. She has used her wide-ranging experience in biomedical research (from wet bench to clinical research) to oversee research programs, including the National Institute of Neurological Disorders and Stroke (NINDS) Parkinson’s Disease Biomarkers Program.

Susan LeLacheur, DrPH, MPH, PA-C, BS, is a professor in the Department of Physician Assistant Studies at the GW School of Medicine and Health Sciences. Dr. LeLacheur has more than 35 years of clinical experience in primary care, HIV/AIDS, and infectious disease. She is the section director for the GW PA Program’s Foundations of Medicine Gastroenterology Section. Her ongoing clinical practice at Whitman Walker Health in Washington, D.C. includes both primary and HIV care.


Lara Zakaria, RPh, MS CNS IFMCP, is an Institute for Functional Medicine Certified Practitioner, nutritionist, pharmacist and public health professional based in New York City. She combines evidence-based nutrition and complementary medicine, including positive psychology, to inspire patients to use whole food, herbs and lifestyle modification to optimize their health. Her training in drug-drug and drug-nutrient interactions also gives her a unique perspective on helping patients optimize their medication and supplement programs.