What types of demyelinating disease affect the central nervous system, and what can you do about them?
Answer From Jerry W. Swanson, M.D.
A demyelinating disease is any condition that causes damage to the protective covering (myelin sheath) that surrounds nerve fibers in your brain, the nerves leading to the eyes (optic nerves) and spinal cord. When the myelin sheath is damaged, nerve impulses slow or even stop, causing neurological problems.
Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. In this disorder, your immune system attacks the myelin sheath or the cells that produce and maintain it.
This attack causes inflammation and injury to the nerve sheath and ultimately to the nerve fibers that it surrounds. The process can result in multiple areas of scarring (sclerosis).
Other types of demyelinating disease and their causes include:
- Optic neuritis — inflammation of the optic nerve in one or both eyes
- Neuromyelitis optica spectrum disorder (NMOSD) — inflammation and demyelination of the central nervous system, especially of the optic nerve and spinal cord
- Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) — inflammatory disorder of the central nervous system, predominantly of the optic nerve and spinal cord.
- Transverse myelitis — inflammation of the spinal cord
- Acute disseminated encephalomyelitis — inflammation of the brain and spinal cord
MS and other demyelinating diseases most commonly cause:
- Vision loss
- Muscle weakness
- Muscle stiffness and spasms
- Loss of coordination
- Change in sensation
- Walking problems
- Changes in bladder and bowel function
There is no cure for demyelinating diseases, but disease-modifying therapies can alter the disease progression in some patients. Disease-modifying therapies can be used together with symptomatic treatment. The symptoms and progression of demyelinating diseases varies between patients. Early diagnosis and discussion of treatment options is important. The goal of treatment is to:
- Minimize the effects of the attacks
- Modify the course of the disease
- Manage the symptoms
A variety of drug therapies are recommended depending on your specific disorder. Strategies to treat symptoms include medications to improve walking, spams, bladder dysfunction and others. Physical therapy, occupational therapy and cognitive behavioral therapy can also help manage symptoms. Talk with your doctor about the best course of treatment for your specific disorder.
June 09, 2022
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See more Expert Answers
- Overview of demyelinating disorders. Merck Manual Professional Version. http://www.merckmanuals.com/professional/neurologic_disorders/demyelinating_disorders/overview_of_demyelinating_disorders.html. Accessed April 18, 2022.
- Hardy TA, et al. Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurology. 2016; doi:10.1016/S1474-4422(16)30043-6.
- Related conditions. National Multiple Sclerosis Society. http://www.nationalmssociety.org/What-is-MS/Related-Conditions. Accessed April 18, 2022.
- Signs and symptoms consistent with demyelinating disease. National Multiple Sclerosis Society. http://www.nationalmssociety.org/For-Professionals/Clinical-Care/Diagnosing-MS/Signs-and-Symptoms-Consistent-with-Demyelinating-D. Accessed April 18, 2022.
- Longo DL, et al., eds. Multiple sclerosis. In: Harrison's Principles of Internal Medicine. 21st ed. McGraw-Hill Education; 2021. http://accessmedicine.mhmedical.com. Accessed April 18, 2022.
- Olek MJ, et al. Pathogenesis and epidemiology of multiple sclerosis. https://www.uptodate.com/contents/search. Accessed April 18, 2022.
- Flanagan EP, et al. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): Clinical features and diagnosis. https://www.uptodate/contents/search. Accessed April 26, 2022.