- [Voiceover] So we know that in multiple sclerosis
the immune system is attacking the central nervous system,
but we don't really know why it's doing that.
So in other words, we don't really know
what the true cause of the disease is.
Because we don't know the true cause of the disease,
there is no known cure for it.
However, there are a lot of treatment options
available for people.
A really common class of drugs that people
take are the disease-modifying drugs.
So how do these act?
Well, remember that in multiple sclerosis,
we can really track the way that
the disease progresses over time.
So on the X axis we have time, right,
in terms of the lifespan of the individual
and on the Y axis we have the severity of the disease,
that is how much damage does the brain accumulate.
There are four different types of multiple sclerosis,
each characterized by the way
that they progress over time.
The most common type is
the relapsing-remitting form.
So you can tell here, you know,
there's a relapse over here and relapse is really
when the brain starts to accumulate a lot
of damage and the symptoms start to flare up
and the severity increases.
And you have a remission over here.
This is when the brain kind of starts
to heal itself and the symptoms go away for a bit
and the disease itself starts to improve.
This type affects about 80% to 85%
of those who have multiple sclerosis.
Because it's so common, most of the treatment
options that we have, right, those disease-modifying drugs,
address this type.
There are other types of multiple sclerosis,
but unfortunately they don't really
respond well to these drugs.
So what are these disease-modifying drugs going to do?
Well, they're actually going to modify the course
at which this disease progresses.
So what do I mean by that?
Well, if you take these drugs, then it's most likely
that the graph will probably look
something like this instead.
So you can already tell some
of the major differences, right?
One, that the severity of these relapses
is decreased and two, the remission time
has also increased so what you're doing
is you're slowing the progression of the disease.
That's why we call them disease-modifying drugs
because they modify the progression of the disease.
So what are some disease-modifying drugs?
Well, most of them are immunosuppressants
and I think this word is actually
pretty self explanatory.
These guys are going to suppress the immune system.
So one example of an immunosuppressant
are the corticosteroids.
These are steroid hormones that
are actually released by the adrenal
glands above your kidneys, but they can
also be given to a person as medication
and then you also have the beta interferons.
So an interferon is a chemical that's released
by the immune system to manage inflammation.
A beta interferon will suppress the inflammation.
So how do these work?
What's going on at the cellular level?
Well, we kind of have to understand
the pathophysiology, right?
So let's say we have a neuron over here.
As usual, this neuron will have
myelins surrounding the axon
and then next to this neuron
you may have a blood vessel.
Around this blood vessel
is kind of a wall, right, known as
the blood brain barrier.
This blood brain barrier is gonna
stop immune cells like this T-cell over here
from crossing over and entering the brain.
So this guy's ordinarily trapped
in the blood vessel, but in multiple sclerosis
this blood brain barrier becomes
pretty leaky and this guy is able
to make his way across.
This is actually one of the first points
in which these immunosuppressants can act.
They can actually stop that T-cell
from crossing the blood brain barrier
and in doing so he's not even gonna
interact with the brain at all to begin with.
So now the immune system
has limited access to the brain,
but this isn't the only site where
the immunosuppressants can act.
Maybe the T-cell actually manages
to make his way across the blood brain barrier.
The T-cell will look at that myelin
and it'll recognize it as foreign.
In doing so, this will trigger an alarm.
So this T-cell is gonna release
a whole bunch of chemicals called cytokines.
These cytokines are going to alert
a whole bunch of other immune cells
so maybe you have a B-cell over here
that responds to those cytokines
or maybe even a macrophage
and this will lead to inflammation.
The one thing your immunosuppressants can do
is it can ensure that the T-cell doesn't
react so vigorously to the myelin.
If it doesn't react as much,
it may not release so many cytokines.
If it doesn't release as many cytokines,
then those cytokines won't really
be able to recruit the other cells
of the immune system so ultimately what
we have is a dampened immune response.
The immune system isn't really able to
act as vigorously and as aggressively anymore.
So, of course, these disease-modifying drugs
will kind of relieve some of those symptoms,
but they do so by addressing
the pathophysiology.
But there are alternative ways
to really address those symptoms.
So what we want to do is we want
to think of different types of symptom management.
So instead of kind of just taking those medicines,
you can also do a number of other alternative things
to really address those symptoms directly.
So let's say we have a person over here
and let's say this person has multiple sclerosis.
What are the symptoms they may experience?
Well, one, they may have a lot of fatigue, right,
so they may just be really physically
exhausted all the time.
In addition to that, they may also have
this stiffness of their muscles where
their muscles are contracting too much
and this can lead to a lot of pain.
They may also have muscle weakness
and numbness in their arms.
So these are a lot of symptoms, right,
so how do we address them?
Well, we can have the person visit
a physical therapist.
So here we have a physical therapist
and really what they're gonna do
is they're gonna have this person
perform a number of different physical tasks.
Maybe they'll help them do
some stretching exercises.
Maybe they'll help them
walk a little bit more normally
and ultimately this will kind of
help relieve those symptoms.
But there are still other symptoms that
maybe a physical therapist might
not be able to help out with.
So remember that in multiple sclerosis,
a lot of people may actually experience
cognitive dysfunction and just as
a brief review, remember that cognition
includes functions like attention,
working memory, and decision making.
These functions can be pretty heavily
impaired in multiple sclerosis
and this can be really problematic
because cognitive dysfunction is really
one of the major reasons why
people have to leave their jobs.
So how can we address this?
Well, we can have the person undergo
what's called cognitive rehabilitation therapy.
So in cognitive rehabilitation therapy,
the primary goal is to kinda restore these functions
and the way to do that is to have the person
perform a set of mental tasks, right,
so they may play a few games
where they try to remember a few things
and all sorts of things that will really help them
kind of strengthen their cognitive abilities
and in doing so, their cognition will
start to improve, right.
So it's kinda like physical therapy,
except instead of working with your body
you're working with your mind.
So these are some of the alternative ways
to manage your symptoms without
taking those disease-modifying drugs.