Nicoletta: Rebecca asks, I have had MS for two and a half years and have had three big relapses. Why do relapses take months and months to show any sign of remission and why do I never recover that much?
Dr David Rog, Neurologist: So I’m sorry to hear that Rebecca’s had as many relapses as she has in such a short time. What happens biologically are that cells, lymphocytes, white cells, punch a hole through the barrier that normally exists between the blood vessels and the brain. So the lymphocytes get into the brain and/or the spinal cord and then they cause a cascade of inflammation, so swelling, if you like. And it’s the swelling and the inflammation that cause the symptoms. The body tries to repair itself and obviously switch off the inflammation as best it can and sometimes that process can be helped by high dose corticosteroids, which if you like, seal up that hole in the blood-brain barrier, the barrier between the blood and the brain, and then try to promote repair. And there is, or there are, innate mechanisms, in other words, mechanisms within the body itself that promote repair.
Unfortunately, the repair sometimes doesn’t work as well as we would like and I use the analogy of a DIY job, if you like, compared to a professional job when we were originally put together, and so it’s not as good as the original. Some people’s symptoms completely settle after a relapse, but under conditions of, shall we call it stress, so that might be poor sleep, infection, over-exercising and so on, then those symptoms can temporarily recur. And that’s, if you like, demonstrating the fact that the repair hasn’t been perfect. In answer to the last part of the question, Rebecca’s question, why some people recover better than others and why some people recover better from some relapses than others, is not fully understood and that’s one of the key questions in multiple sclerosis and of course one of the most frustrating things, both for patients and for the neurologist and the nurses that care for them.
Nicoletta: Could you tell me a little bit more about how the body does try and repair itself?
Dr David Rog, Neurologist: So in multiple sclerosis one of the things that happens is the lagging, the myelin around nerves becomes disrupted and the myelin in the central nervous system, the brain and the spinal cord, is made by these support cells called oligodendrocytes, and each oligodendrocyte, you can think of it like an octopus, if you like, with sort of 40 different legs, and these legs all go out, wrap themselves around the nerve and then curve, so the tentacle, if you like, curves around the nerve. So if you cut it in cross-section it looks a little bit like an onion, if you like, and that’s the myelin. And increasingly now, we’re understanding that there are certain barriers to repair the natural repair mechanisms that operate actually occurring. One of those barriers is actually getting the cells into areas of damage, the oligodendrocytes into the areas of damage and getting the right factors that are made by cells, again, into that area in order to promote repair and growth. And those mechanisms now are being unpicked gradually, but it obviously is a complicated process. But that’s how, that’s the biology in very simple terms, as I understand it, that comes back then to why people say, for example, why don’t I recover fully from an attack.
Nicoletta: Thank you.
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Dr David Rog is a consultant neurologist at the Salford Royal NHS Trust. He gained his MD in liverpool and he completed his neurological training between 2002 and 2006 on the North West rotation at Lancashire Teaching Hospitals Trust and Greater Manchester Neuroscience Centre. Dr Rog is the Chairman of the Clinical Research Steering Group at Salford Royal and the Nervous System Theme lead for Greater Manchester Comprehensive Local Research Network.