6 Progressive Multiple Sclerosis Theories
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- Опубликовано: 27 авг 2024
- 00:36 innate immune injury
3:09 meningeal b-cell follicles
4:49 mitochondrial failure
7:01 Oxidative injury
8:09 EBV
10:17 normal aging
Some people with MS have progressive symptoms despite stable MRI scans. But why? This video explains 6 theories as to why this occurs and potential treatments.
Selected Sources:
PET scans (18F-PBR06-PET), people with MS on highly effective disease modifying therapy still have innate immune activation: pubmed.ncbi.nl...
Is multiple sclerosis a mitochondrial disease?: www.ncbi.nlm.n...
Harding’s disease: an important MS mimic: www.ncbi.nlm.n...
Immunometabolic profiling of T cells from patients with relapsing-remitting multiple sclerosis reveals an impairment in glycolysis and mitochondrial respiration: pubmed.ncbi.nl...
Dysregulated Epstein-Barr virus infection in the multiple sclerosis brain: www.ncbi.nlm.n....
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Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
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he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information.
What do I think? I think I am so grateful for you and your videos! I love how you share a broad spectrum of thoughts and possible ways to help. I am particularly interested in the EBV connection and the aging connection. Hooray for you for encouraging us to slow down aging effects with diet and lifestyle modifications! Thanks for all you do.
One very interesting theory is that b-cell depleters are more effective than you would expect them to be (considering b cells represent a small minority of white blood cells within MS plaques) because they are destroying the reservoir of EBV. In other words, these drugs are essentially anti-EBV drugs.
Get a homeopath
@@DrBrandonBeaberfascinating!
Wow! This is one of your best videos, Dr. Beaber! Your last point, number six, was eye-opening to me. Maybe accelerated aging is just a sad fact of having MS, particularly a progressive form of MS. We already know that brain atrophy occurs at a much faster rate in pwMS. Maybe a strict adherence to OTC supplements known to benefit overall brain function is an important component of improved quality of life of those with MS, along with highly effective DMTs. I take alpha lipoic acid and N-acetyl glucosamine just because they are being studied in various MS trials, they are cheap, and are considered very safe if taken at normal levels (that's why they are OTC). Thank you for the videos! I look forward to watching and sharing them every Wednesday! 👍💛
I tend to think of MS as perhaps being a "perfect storm" of factors. A genetic predisposition towards autoimmune "overactivity" that leads to our CNS attacking EBV infected cells in the nervous system. EBV digs in to nerve cells and hides out - our immune system tries to target these proteins but sadly uses the shotgun effect, our nerve cells becoming collateral in the process. Mitochondria & oxidative stress may also be linked as oxidative stress itself can lead to mitochondria imbalance / mutations that amplify the effect. Perhaps it is all connected and like dominoes it is a chain reaction ---> Genetic susceptibility --> EBV/virus exposure --> Immune activation --> oxidative stress /cytokine storm like behavior ---> mitochondria mutations --> oxidative stress loop that causes immune activation. The system gets stuck in a positive feedback loop that is broken only by pulling the breaks on attacking cells / oxidative stress (like DMF does).
I have hope someday we can "clear" EBV from our immune systems - I would be very interested to see if this stops MS attacks completely.
facesofinvisibleillness.blogspot.com/2012/09/multiple-sclerosis-is-lyme-disease.html?fbclid=IwAR0-3_opMxXcDny0UAeH2bls8Y9duGkJj66PnyB90y8PomKXGJaoRMoUibQ&m=1
An idea for other videos:
Please, take one patient's case individually and let us know about their everyday issues. We are led to believe that if you are in remission = no issues. But I have some nerve damage that I can still feel to this day every time I exercise or get tired. It feels like mild tingling and more of this internal tremors I had during my attack.
Thanks for the suggestion, though I would have some reservation discussing a specific person. I would have to be intentionally vague.
My completely non scientific opinon is that progression is a combination of the innate immune system attacks and normal aging on top of the acquired injury. The lesions are getting bigger and the reserve is getting smaller 😬 Though it's probably not that simple x)
I love these kinds of videos. I don't like having MS but I must admit it's very interesting to listen to theories about such complex matters x)
Your videos are FANTASTIC! Keep em coming!
Thanks!
Interesting topic, thanks for addressing it. I've also wondered why some people remain stable for decades while others progressively decline. I believe the mitochondria and EBV b-cell theories hold the most likely offenders since diet and lifestyle changes in combination with a high efficacy DMT seem to help most patients maintain function over time. I equate it to not maintaining your house or car. Over time, they will deteriorate without routine maintenance and problems will mount, eventually causing pre-mature failure of components. Unfortunately, in the case of MS, there are always exceptions out of our control.
One piece of data which would be interesting is a correlation of a particular finding (i.e. a PET scan showing high innate immune system activity in the brain/spine or EBV infected meningeal follicles) and prospective prognosis. Right now, the best predictors of prognosis are essentially clinical factors (high existing disability, evidence of significant spinal cord injury, etc.)
@@DrBrandonBeaber I'm interested as well. I read about spinal lesions being a predictor of future disability. I have several spinal lesions in the C and T spine, but thankfully (so far) they don't significantly affect my motor function. My neurologist said my prognosis is good on Ocrevus, but that's always in the back of my mind. I don't know my EDSS, but I suspect it's currently under 2.
If you started Ocravus with an EDSS of 2, your prognosis IS good. By the time I was diagnosed, I was already using a walker and at my first infusion was rated at 6.5@stonz42
Thank you Dr Beaber. Very interesting video. I contacted you a few months ago regarding my (query?) MS diagnosis. Have now started on Kesimpta and am doing very well. I have watched most of your videos and also Dr Boster’s. This is what I do to help me live my best life with MS. Take Kesimpta. Exercise six days per week - 2 x 5km run, 2 x whole body weight training and 2x yoga. Vitamin D 5000 IU per day. Sunlight exposure (Australian sun ) 15 mins per day. One probiotic, daily apple cider vinegar, B6 1000mg daily for glaucoma, occasional Fero grad C. Am on the Overcoming MS Diet. I go to bed between 8-9 and sleep for 8.5-10 hours. I also meditate every day. That’s about it! I feel great atm. Is there anything I’m missing that you would recommend?
I found this very interesting and I'm grateful that you posted a video covering all of these theories. I've been focusing on the EBV theory only because when I was in my early 20s, I was hospitalized for a few days because of the virus and dehydration. I was diagnosed with MS when I was 50 and in six short years have progressed to SPMS. I'm glad you shared your knowledge as it's prompted me to think about other possibilities, such as Dr. Wahis'' studies to which I was first exposed right after being diagnosed. Also, I like discussing various ideas with my Neurologist and he seems open to it, so more ammunition for me to pick his brain with! :) So again, thanks!
Better build as much reserve as possible through training / physical activity
This was a fantastic video!
Thanks
This time I almost understood you, perhaps because the subject is so close to my heart. FINALLY had my Ocravus infusion today, and what could my neurologist say when she stopped in, except that my neuro exam is normal and my MRI is stable? She hasn't seen encouraging outcomes with patients on BTK inhibitor studies. 😢
Great video! Also great to see Terry Wahls here, I don't follow the Wahls protocol myself, but she's been right about so many things, and was talking about mitochondria before it was cool. I think you talked about popular ms diets which don't include dairy here before, but I'd be interested in more in-depth content about dairy, ms, and oligodendrocytes. I've seen some research saying that when an immune system is activated against casein, it can be turned against oligodendrocytes.
Gavin Giovanoni has been touting subcutaneous cladribine doe PPMS
Thank-you for the video Dr Brandon, very interesting theories
No problem. I hope people would find it interesting
B cell depleters cause more infections which in turn cause more issues with symptoms. Think that is the problem. My MRI looks good but my body does not feel this way. 14 yrs with MS no dmts until October 23 started Ocrevus and everything has gone downhill kindo lost faith in Neurologist
Maybe a video about LUCID-MS would be informative. Thanks.
Thank you for always providing such in depth explanations.
I think we should focus on improving the function of our immune system. With me, I am 27 and I feel like bad diet and avoiding the sun and not supplementing at all led to my body functioning differently. I would even say that certain genes were activated or some viruses/bacteria that were successfully under control were now able to have a ball in my body :D
I did have very low blood levels of vitamin D. I wish I had taken stronger higher doses to increase my levels to where they are at now instead of the daily 5K IUs. I feel like that would have been more therapeutic and turned off any genes that might have been activated.
I am not saying that I am not okay but that is what I would do if I were to do it all over again.
I had digestive issues as well at the same time as and leading to my attacks so I do supplement with B complex and also monthly B complex shots to bypass the digestive system and ensure the medication is delivered directly into my body so it is properly absorbed.
Hope this helps someone else because honestly I am not on any MS medication and am thriving thanks to good food and good sleep and vitamins.
Had you tried any probiotics along with diet change?
What is your vitamin d blood level now?
Good on you for making changes! I started making changes after my first relapse and before my diagnosis. I believe focusing on diet and lifestyle changes really helped me a lot! I didn’t have a second relapse until 10 years later (diagnosed at that time). It is now 8 years past that one and I am still doing well. The combination of medication and even more improvements to my diet and lifestyle are keeping me well.
is it ok to take high dose of D every day for long time? and what food diet u used ps? i want to help my son 🌹🌹🌹
@@saharanights3518
I have a play-list on vitamin d.
If you want to become knowledgeable on the subject.
@@saharanights3518 vitamin D levels can vary from person to person and over time. Levels should be checked by a doctor regularly. Overall vitamin D is very safe to take and rarely gets to toxic levels. I eat a whole food plant based diet: Diet and Reduced MS Symptoms - NEW RESEARCH!
ruclips.net/video/auHHb9tpbUw/видео.html
Absolutely fantastic informative videos.
I've had MS for 20 years and I'm almost symptom free, I really can't complain.
I'm currently suffering from Lhermitte phenomenon for the past 6 days and wondered if you have any advice to ease issue.
I started on Avonex for 7 years
Gylenya 7 years
For the past 5 years I've been having Ocrevus infusions.
Thanks so much again Dr Beaber a lot of good information to think about. I will be having another spine mri on Sat , the reason being my neurologist has suggested l go on Siponimod ( lve not been on a dmt yet ) having been officially diagnosed with secondary progressive MS in March of 2023 having had over 20 years of symptoms and optic neuritis in 2008 ) . My brain mri’s have showed many lesions and two significant ones on my spine which is believed to have caused the most irreversible damage to my mobility. I furniture surf at home , use a walking stick when out and my Rollator if any significant walking is needed . Im a 54 year old female. What are your thoughts on Siponimod please 🙂
Thanks again for your information. I have a question for you: How or why did you choose MS as your specialty in neurology? Dr. Aaron Boster talks about seeing his aunt and mother weeping for his uncle, who had what I assume to be aggressive MS. Did you have a friend or family member impacted by MS that impacted your decision to specialize in this field? I think that of all the various neurological conditions, MS is the most fascinating, frustrating, and rewarding diseases to study. I often say, "MS is a fascinating disease, it just sucks that I have it" lol. Maybe you and I will be around when we cure it, or at least prevent it.
I don't have a close friend or family member with MS. I enjoy chronic care, and the advancements in the field of immunology and pharmacology are fascinating. The difference in the quality of care even over the course of my career is quite significant.
Thank you doctor for this very useful information.
Excellent video, doctor can you do a ask me anything video so that people can directly ask small questions to you and may not be a topic.
Hmm - my first relapse was painless / severe +permanent vision loss in one eye. Chance it could also be hardings? xD What differences are there between MS & hardings? Interesting video Dr. Brandon! :)
Thank you for this very informative video. I appreciate you. Things I would like to know. Is there a specific area of lesions in brain or spinal chord that has been tied into MS fatigue and where are they, same question regarding depression.
Brain lesions in general are associated with fatigue and depression. Classically, lesions in the left frontal lobe are associated with depression, but in reality there is not single anatomical region specifically associated with depression and fatigue.
@@DrBrandonBeaber Thank you so much!!!❤️❤️
Thank you Dr Beaber- very interesting and informative! I imagine it’s probably a combination of factors rather like the cause of MS.
very good video doc. Which clinical trails do you think have the highest chance of success against PIRA that are currently ongoing?
I think you missed vitamin B1 for mitochondrial funcrion.
Thank you for sharing your time and talent with us! These videos are fantastic and so helpful. Can you share your thoughts on the higher dose Ocrevus study that is ongoing (1200/1800 mg based on weight) and the conclusions from this paper "Association of Higher Ocrelizumab Exposure With Reduced Disability Progression in Multiple Sclerosis" (Hauser).
I am interested in the study (I mention it in some of my other videos), but just like you, I will have to wait for the results. With rituximab, the observational evidence suggests giving it at a lower dose or less often retains similar efficacy. Many people receive Ocrevus have sustain b-cell depletion, and people who have b-cell repletion do not necessarily experience lower drug efficacy.
I always watch your RUclips videos 👍
Thanks
Thank you for this information. I am leaning towards the EBV theory, since C*vid reactives EBV. I have been in a horrible state since getting C*vid 20 months ago… MRIs have been stable, yet, symptoms unchanged. So, seems to be the Long C*vid/EBV theory that’s causing all this havoc. Have you seen this in your MS patients who have long c*vid?
Thank you!
You're very welcome
I recently had a spinal tap can you please help me understand my results the anxiety is taking over and I’m not scheduled to see my neurologist for a month..
CSF - Glucose - Normal - 64mg/dl
CSF - RBC - High - 61 CMM
CSF - WBC - Normal - 4 CMM
CSF - mononuclear cell - 4 CMM
CSF - IgG - High - 5.30mg/dl
CSF - Albumin - Low -
Sorry but I can't give you personal advice. In CIDP spinal fluid protein is typically elevated. I have a video explaining oligoclonal bands (typically used to diagnose MS) here: ruclips.net/video/jyLnT6liw9k/видео.html
very interesting content.
Thanks
PLEASE GET A HOMEOPATH
hello Doc. First, thank you for the video! Second, do you do Telemedicine? I'm from Bulgaria and want your opinion on my MS.
Sorry but I would not be able to help you personally. I wish you good luck.
@@DrBrandonBeaber it's not about prescriptions etc. I just want to know why my body reacts this way. My doctors have classic explanations. But my main symptom is not so classic. Thanks anyway.
Hi from Israel always waiting to hear your video thanks dear doctor
Dr, isn't it because common drugs like anti-CD20 are only targeting B cells and therefore T cells are still there and can enter into the CNS. In particular T CD4 can activate other cells like microglia.
What you are describing is possible, but the exact sequence of events leading to innate immune system inflammation is unclear. People undergoing hematopoietic stem cells transplant who receive lymphocyte depleting chemotherapy (including t cells) can still develop progressive MS. The risk of depleting all lymphocytes for a prolonged period is very high.
2:08 and how does this not look like neurocysticercosis?
are there any studies on those whose progression slow naturally?! (i was surprised not to find any, and again wonder if our focus should be on promoting the bodies potentialities rather than try to attack its rogue processes). If I want to teach a tennid player to have a better serve I would encourage a more positive approach not simply say just serve underhand...
Is the rate od EBV in autopsies in pw without MS any different?!?!?
re #3 mitochondrial 'failure' .... I must say that treatments tend to focus on stopping bad processes, and I wonder if our best and brightest tilt the focus might more on getting the system to work right than stopping it from going wrong by promoting the body's inherent but forgotten ability.. Possibly Wahls is attempting and somewhat succeeding in this I wonder..
Are there any MS DMTs or supplements that you know of that slow down smouldering MS? There has to be something that slows it down. For instance, dimethyl fumarate should slow it down based on the oxidative stress theory, no?
This is unclear. Some dmts have evidence in preventing progression independent of relapse activity.
@@DrBrandonBeaber Thank you. Can you please make a video (if you haven't already) on those DMTs that have evidence in preventing PIRA? Would DMF be one of them, at least in theory?
how many paticipants had b cell depletor/ ritux direct in spinal fluid? As they used to say in cowboy movies 'let's cut them of at the pass' haha
how might it b inate IS if not all identical twins get MS. epigenetics?
re EBV if a generation of kids got EBV vaxxed and had lower MS rates that'd be a big deal. Is that on the table ofhypothesies?
It seems like it's all of them
Could be
I have ms but have 100% never had ebv
Have you actually have negative antibody testing. Most EBV infections do not cause symptoms.
@@DrBrandonBeaber yes. I have had the negative testing
@@stupud818 You are a rare exception.
@@DrBrandonBeaber I guess I won the crappy lotto then 🙃
I personally think sarcoidosis causes it
Fab ta.