Multiple sclerosis(MS) is an inflammatory disease of the nervous system resulting from breakdown of myelin in the brain and spinal cord. The most commonly recognized symptoms of MS include weakness, sensory loss, fatigue, spasticity, pain, as well as cognitive complaints including depression. Diagnosis is primarily based upon clinical findings and brain imaging studies such as MRI scans. There are different subtypes of multiple sclerosis the most common being relapsing and remitting forms.
The cause of multiple sclerosis is still unknown but most neurologists believe that genetic and environmental factors play a major role. As the immune system is known to be a primary factor in multiple sclerosis, infectious processes are being more closely examined as a causative factor in eliciting a hyper-immune response.
Infectious diseases, such as Lyme, Epstein Barr and Herpes infections have all been previously proposed as potential causal triggers of multiple sclerosis. Lyme disease is a common bacterial infection caused by tick bites that can result in pain, fatigue, sensory abnormalities and other neurological symptoms that may resemble multiple sclerosis. Brain MRI findings in Lyme disease can include abnormalities in the white matter of the brain and spinal cord but more commonly Lyme disease produces symptoms that involve the peripheral not central nervous system. Confirmatory diagnosis of Lyme disease involving the brain may require testing for anti-Borrelia antibodies in the spinal fluid as both false positive and false negative blood tests may lead to an incorrect diagnosis.
Viruses including Epstein–Barr virus (EBV) and certain members of the herpes family have been suspected as risk factors for MS. But given the prevalence of antibodies to these viruses in unaffected individuals, the connection between multiple sclerosis and viruses may also lead to confusion regarding the connection.
Bacterial infections in the GI tract has been proposed as playing a role in MS. Among these, Clostridium perfringens is an anaerobic gut bacterium that usually causes foodborne illness but has been suggested as a potential causal agent in MS. Clostridium bacteria can bind to myelin or the white matter in the brain through a toxin that has been shown to cause demyelination. Further evidence of the potential role of Clostridium perfringens in MS has been supported by the identification of the bacterial toxin in stool samples of patients with clinical symptoms of MS. As clostridium has been recognized as producing food borne illness the surprising connection between this bacteria and MS- a disease of the central nervous system, supports the connection between disturbances in the balance of bacteria in the gut and brain disease. Further evidence of this connection includes the finding of antibodies to the clostridium toxin in blood and spinal fluid from patients with MS.
The encouraging news in all of this is that we are now capable of identifying low grade infections in MS clinically. Confirmation of occult clostridial infection can be treated with specific antibiotics, probiotics and other alternative non immunosuppressive therapies