Almost 1 million people in the U.S. are living with multiple sclerosis (MS). In MS, the immune system attacks the myelin coverings of the body’s nerve fibers, exposing and damaging the nerve cells. This autoimmune disease can affect the central nervous system (CNS), causing nerve damage and severe neurological symptoms that impact quality of life.
Environmental factors play a part in the development of MS disease activity. However, the risks of developing MS are particularly worrying for people who have one or more relatives with MS. The medical condition has genetic elements — more than 200 genes are linked to MS — and some people with MS have a family history of the condition. Finding a way to prevent MS development in children is a major concern for parents who are living with MS. One MyMSTeam member wrote, “Both my mom and myself have MS. Her aunt and cousin both have MS as well. I worry that someday one of my three children will get it.” Another member said, “I'm just worried about my daughter and sons now. My future has been decided.”
MyMSTeam recently had an in-depth conversation about the possibility of MS prevention with neurologist and MS expert Dr. Michael Kornberg. Dr. Kornberg is an assistant professor of neurology at Johns Hopkins University, where he researches the processes behind the progression of the disease. In 2015, Dr. Kornberg received the Clinician-Scientist Development Award in Multiple Sclerosis from the National Multiple Sclerosis Society and the American Academy of Neurology.
This is a very common question. People obviously are very concerned, especially if they have a medical history of MS and are worried about their children developing MS. I think it's worth putting the risks into perspective. If you have MS, your child's risk is about 10 times higher than the general population. This sounds like a lot, but only 1 to 3 of every 1,000 people in the general population develop MS. So if you are a person with MS, your child has about a 3 percent to 5 percent chance of developing MS. That’s definitely not trivial, but the odds are much greater that your child is not going to have MS. I think it's important for people to understand that.
The bottom line is that doctors don’t know of anything that prevents MS. People will often ask if their child should be getting routine magnetic resonance imaging (MRI) scans. This is a matter of opinion, but I generally don't suggest that in the absence of symptoms. There are cases in which people will have MS-like changes on MRI scans but don’t experience symptoms of MS, and I wouldn’t want to expose these people to medications just for the sake of it. First and foremost, it’s important to be vigilant about symptoms. Don't put new symptoms on the back burner. Get them evaluated.
There are some factors that are at least associated with a lower risk of developing MS. The biggest one is not smoking, because we know that people who smoke have an increased risk of developing MS versus those who don't.
The other big risk factor is vitamin D. We know that individuals with lower vitamin D levels have a greater risk of developing MS. I generally recommend vitamin D supplements, although you have to remember that there’s a difference between correlation and causation. We know that people with lower vitamin D levels have a higher risk of getting MS, but we don’t know yet whether taking vitamin D supplements makes a difference in preventing MS. There’s actually a lot of evidence that people with MS just are genetically predisposed to having lower vitamin D, so a lack of Vitamin D might not actually be a cause of MS. However, supplementing with normal amounts of vitamin D is so low risk that I think people should do it. So if you don't smoke and you take vitamin D, I think you're well on your way.
Obesity is also associated with a higher risk of MS, so you can lower your risk with the same kind of regimen for healthy living that we all should be following — moderate exercise focusing on aerobic exercise and a generally healthy diet. There's no particular diet that has clearly been shown to be magical in this respect, so just focusing on a generally healthy diet that's low in processed foods and high in fruits and vegetables is a good idea. If people want to follow a specific diet, I recommend the Mediterranean diet, which has clearly been shown to have cardiovascular benefits.
Aside from these risks, I generally tell people that they can take a little bit of the burden off themselves because the risk of developing MS is still overall low. Again, just take symptoms seriously if they occur.
I wouldn’t be honest if I said that I think there is research on the immediate horizon that's going to be a game changer in terms of risk of developing MS. Unfortunately, I don't think we're there yet. MS is a very complex problem, with causes that are distinct based on the person.
Having said that, I think it is a very exciting time in MS research and in the care of people with MS. There are things we can do to limit MS consequences and effects. This is the era of MS treatment, with excellent disease-modifying therapies for relapsing-remitting MS. The next frontier is how we can slow the progression of MS and repair damage caused by it. There's a lot of very exciting research in the pipeline there.
Our goal should be to target both prevention and treatment in parallel, but that may not be possible in a short interval of time. What I try to convey to some of my patients is to think about other conditions that are chronic, such as diabetes or high blood pressure. We can't necessarily make the condition go away, but we can treat it with the goal that it becomes part of the background of your life rather than a driving force, limiting the long-term consequences. I think that MS treatment is an equally important goal as prevention and there's a lot of exciting research and a lot of advancement going on in that area.
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