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What is multiple sclerosis?

Multiple sclerosis (MS) is a nervous system condition that affects the brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between the brain and the body. While MS can sometimes cause disabilities for those diagnosed with it, advances in treatment and patient care have made it possible for most people with MS to enjoy a normal life expectancy.

There are four general classes of MS including:
  • Relapsing-Remitting MS – The most common form of MS, patients experience a period of active symptoms, which is known as relapsing, followed by symptom-free periods, which are known as remitting.
  • Secondary-Progressive MS – Patients can develop secondary-progressive MS 10-15 years after their initial diagnosis of relapsing-remitting MS. In these instances, some acute attacks and remission may occur, but with more chronic symptoms and less complete recoveries.
  • Primary-Progressive MS – A more serious—and rare—form of multiple sclerosis. In these instances, MS symptoms gradually worsen over time, leading to disability.
  • Progressive-Relapsing MS – Progressive-relapsing MS is the least common form of the condition. Patients experience symptoms that gradually worsen over time, as well as periods of active symptoms and remissions. However, patients with progressive-relapsing MS typically to not regain all of their function after a relapse.

What causes multiple sclerosis?

The ultimate cause of MS is damage to myelin, nerve fibers, and neurons in the brain and spinal cord, which together make up the central nervous system (CNS). But how that happens, and why, remain challenging questions. Evidence suggests that MS is a condition caused by genetic vulnerabilities combined with environmental factors.

There is little doubt that the immune system contributes to the brain and spinal cord tissue destruction of MS, however the exact target the immune system attacks and which immune system cells cause destruction isn’t fully understood.

The immune system plays a contributing role in the onset and progression of MS, however what the immune system is targeting and the specific immune system cells involved is not fully-understood. Researchers have several possible explanations for what might be going on.

The immune system could be:
  • Destroying brain cells because they are unhealthy
  • Genetic Susceptibility – Susceptibility to MS may be inherited. Studies of families indicate that relatives of an individual with MS have an increased risk for developing the disease. Experts estimate that about 15 percent of individuals with MS have one or more family members or relatives who also have MS. But even identical twins, whose DNA is exactly the same, have only a 1 in 3 chance of both having the disease. This suggests that MS is not entirely controlled by genes.
  • Sunlight and Vitamin D – A number of studies have suggested that people who spend more time in the sun and those with relatively high levels of vitamin D are less likely to develop MS. Bright sunlight helps human skin produce vitamin D. Researchers believe that vitamin D may help regulate the immune system in ways that reduce the risk of MS.
  • Smoking – A number of studies have found that people who smoke are more likely to develop MS. People who smoke also tend to have more brain lesions and brain shrinkage than non-smokers.
  • Infectious Factors and Viruses – A number of viruses have been found in people with MS, but the virus most consistently linked to the development of MS is Epstein Barr virus (EBV), the virus that causes mononucleosis. Only about 5 percent of the population has not been infected by EBV. These individuals are at a lower risk for developing MS than those who have been infected.

What to expect?

The course of MS is different for each individual, which makes it difficult to predict. For most people, it starts with a first attack, usually (but not always) followed by a full to almost-full recovery. Weeks, months, or even years may pass before another attack occurs, followed again by a period of relief from symptoms. For others, symptoms may gradually worsen with less complete recoveries during remission periods.

To help patients cope, adapt and enhance their quality of life, drug therapies and overall treatment programs (including diet, exercise and overall health and wellness management, and support systems) are often planned, coordinated and managed proactively among patients and their healthcare teams.

How is multiple sclerosis treated?

There is still no cure for MS, but there are treatments for initial attacks, medications and therapies to improve symptoms, and recently developed drugs to slow the worsening of the disease. These new drugs have been shown to reduce the number and severity of relapses and to delay the long-term progression of MS.

Treatments for Attacks

These treatments may include injectable steroids, oral steroids and plasma exchanges as a secondary option in certain types of MS.

Treatments to Help Reduce Disease Activity and Progression

During the past 20 years, researchers have made major breakthroughs in MS treatment due to new knowledge about the immune system and the ability to use MRI to monitor MS in patients. As a result, a number of medical therapies have been found to reduce relapses in patients with relapsing MS by altering the course of the condition. These drugs are called disease modulating drugs. In addition, immunomodulator medications, or drugs that impact the immune system, are being used to treat patients with relapsing MS.

How can a specialty pharmacy help?

Kroger Specialty Pharmacy sets a clear path to caring, compassionate multiple sclerosis therapy management and support. We are able to provide MS patients, providers and partners with the necessary coordination of care vital to achieving successful treatment outcomes. By utilizing our expert patient care team comprised of Doctors of Pharmacy, registered pharmacists and nurses, reimbursement specialists and dedicated Patient Care Coordinators (PCCs), we are able to offer each and every patient and partner with high-quality, personalized care, ongoing patient evaluation and clinical support including frequent patient follow-up and continual education about their MS treatment.

What are some support resources?