I assume everyone that follows the National Hockey League has heard that Minnesota goalie Josh Harding was diagnosed with multiple sclerosis (MS) in September while the lockout shenanigans were going on, so here’s an overview of MS and how it may impact Harding.
MS is an autoimmune disease. This means that the body’s immune system doesn’t recognize something as it’s own and attacks it. Basically, the body attacks it’s own cells. Autoimmune diseases may impact certain organs, such as the thyroid, or certain types of cells. MS affects the nervous system (brain, spinal cord, nerves) by attacking the cells that comprise the protective sheath that covers the nerves.
This covering over nerves is called myelin and in addition to protection, the myelin helps with conducting impulses, or electrical signals, from the brain. When the myelin is attacked by the body, the myelin is damaged and what is left behind is essentially scar tissue. Multiple sclerosis means “multiple scars”. The scar tissue is not able to help with conduction of impulses and as a result, the areas that have scar plaques do not transmit signals to the brain very well. Imagine a television cable that has been damaged and is missing some of the insulation that covers the cable. Instead of a clear picture, there may be static and possibly transmission from a different channel or a few different channels. When a nerve has damaged myelin, the impulses that are sent from the brain to perform an activity, like contracting a muscle to move an arm, do not get through clearly and the body cannot do what the brain tells it to do.
Since MS can affect any part of the central nervous system, it’s symptoms can vary and the attacks or “flare-ups” are unpredictable. Symptoms can be numbness, tingling, or weakness in one or more limbs, partial or complete loss of vision usually accompanied by pain with eye movement, double vision or blurred vision, tremor, lack of coordination, unsteady gait, slurred speech, bladder or bowel problems, fatigue and/or dizziness. Symptoms may come and go and can even disappear for months. For this reason, MS often is not diagnosed when symptoms first occur. MS doesn’t follow a typical pattern, either and different areas of the body are affected at random. With Josh Harding, there was a tweak in his neck, then dizziness, black spots in his vision and numbness in his right leg.
There are four subtypes of MS and they are:
Relapsing-remitting MS (RRMS) Flare ups, or relapses, followed by periods of remission that can last for days to months. Most people with have RRMS when initially diagnosed.
Secondary-progressive MS (SPMS) SPMS RRMS often progresses to SPMS where there are relapses and only partial recoveries from symptoms. There is no remission in symptoms and the disease progressively worsens until there is a steady progression of disability.
Primary-progressive MS (PPMS) PPMS progresses slowly and steadily from its onset. There is no remission in symptoms, only progression of disability.
Progressive-relapsing MS (PRMS) PRMS progresses with steady worsening of symptoms along with flare ups or exacerbations. This is the least common of the four types.
There are several things that may increase risk for developing MS, however it isn’t yet understood why it develops in some people and not others. We do know that MS most commonly affects people between the ages 20-40 and more commonly occurs in women. MS is more likely to develop if a parent or sibling has MS, however MS isn’t only determined by genetics. Certain viruses, like Epstein Barr virus may be associated with MS. Caucasians of northern European descent have a higher risk of MS. MS is more common in Europe, southern Canada, northern United States, New Zealand and southeastern Australia. Interestingly, if a child moves from one of these higher risk areas to a low risk area, the risk is reduced and vice versa. However if the move occurs after puberty, the risk level associated with the area that the child moved from is retained.
Unfortunately, there is no single blood test that can be done to diagnose multiple sclerosis. Tests to diagnose MS include blood tests to rule out other causes of symptoms, thorough physical exam, lumbar puncture (spinal tap), magnetic resonance imaging (MRI) of the brain and/or spinal cord, and nerve tests to measure the speed of transmission of nerve signals from the eyes, spinal cord and brainstem to the brain.
While there is no cure for MS, the life expectancy for those with MS is no different than people who do not have MS. Multiple sclerosis may significantly reduce quality of life but it does not usually cause death. Treatment is targeted at modifying the course of the disease by reducing the frequency and severity of flare-ups. Corticosteroids are used to reduce inflammation during flare-ups. Sometimes therapeutic plasma exchange, or plasmapheresis, is used during flare-ups for people who do not respond to treatment with corticosteroids. During therapeutic plasma exchange, blood is taken from the patient and the plasma is separated from the blood and replaced, then the blood and replacement plasma are transfused back to the patient. Other medications that may be used are muscle relaxers for spasms, medications to treat fatigue and medications to treat depression.
I hope for the best for Harding and that he can continue to overcome the challenges that lie ahead.