Stuff You Should Know — How Multiple Sclerosis Works

Hosted by Josh Clark & Charles W. "Chuck" Bryant
Date: April 27, 2017
Episode Summary by an Expert Podcast Summarizer

Overview:

This episode of "Stuff You Should Know" dives deep into Multiple Sclerosis (MS): what it is, its causes, its varied symptoms and trajectories, the challenging diagnostic journey, hopes for treatment, and the human side of the disease, seen through Chuck’s personal reflections on his friend Billy’s MS journey. The discussion is compassionate, candid, and humanizes MS as much as it explains the biology and the current state of research.

Personal Connection & Emotional Introduction

[01:45 - 02:40]

• Chuck shares his apprehension and emotional reasons for delaying the episode:

  “I’ve been avoiding this one for years because one of my very best friends died from complications of MS...And weirdly, yesterday would have been his birthday...this has got to happen.” — Chuck [01:46, 02:19]

• Josh recognizes the significance and assures his support, stating “This one’s for Billy.” [02:29]

What Is Multiple Sclerosis?

[03:17 - 06:36]

• MS as an Autoimmune Disease:
  • The immune system mistakenly attacks the body’s own myelin sheath (the fatty layer encasing nerve fibers), causing lesions/plaque in the brain and central nervous system.
• Who Gets MS?
  • About 400,000 in the US, 2 million globally (relatively rare).
  • Strikes most often between ages 20-50; more common in women and in people of Northern European descent.
• The Big Unknowns:
  • The causes are mysterious—hereditary, environmental, and other factors may combine.
  • Vitamin D/sun exposure may play a role; “clusters” of cases are debated as a real pattern or coincidence.

Notable quote:

“So much so that they don’t even know what is going on. Well, they do know generally what’s going on on the biological level, but not specifically.” — Josh [06:23]

How MS Damages the Body

[06:36 - 09:19]

• Body attacks the myelin, forming scar tissue (“sclerosis”) and lesions.
• This blocks nerve signals, which can manifest almost anywhere depending on lesion location—symptoms are highly variable.
• Regeneration can’t keep up with damage, leading to “devastating progressive disease” if left unchecked.

Notable Metaphor:

“It’s kind of like if you clear cut a forest and then before you let the forest come back, you start cutting down saplings, it’s never going to come back.” — Josh [09:07]

Diagnosis Challenges

[09:19 - 10:14]

• Early symptoms (dizziness, fatigue, blurry vision) are vague and can come/go, making MS hard to diagnose quickly.
• It's often mistaken for migraines or minor issues; diagnosis requires advanced testing like spinal tap and MRI to spot immune markers and lesions.

Brief History of MS and Its Discovery

[12:13 - 14:47]

• Old cases suspected (Saint Lydwina, King George III’s grandson).
• Jean-Martin Charcot identified MS as a distinct disease (“father of modern neurology”).
• Discovery of myelin plaque and clarification that MS is autoimmune, not viral/blood toxin.
• Diagnostic spinal taps looking for IgG, oligoclonal bands, and myelin breakdown products; routine MRIs in diagnosis since the ‘80s.

Notable Moment:

“Ironically, in the 30s, there were lab mice going, hey, it’s autoimmune. And doctors were like, oh, don’t listen to the lab results from those silly mice.” — Chuck [15:22]

Chuck’s Friend Billy: A Real-Life MS Story

[17:05 - 21:10]

• Billy, an adventurous outdoorsman, had early vague symptoms (dizziness, fogginess) but delayed medical care.
• Lifestyle and lack of early intervention worsened his outcome:

  “He didn’t do himself any favors...he didn’t rehab and take his medication like he should have and sort of fell down into a spiral of alcohol and drug abuse...which did not help.” — Chuck [19:01]

• Social stigma discussed; celebrities (Annette Funicello, Richard Pryor) concealed MS due to misperceptions.

Notable reflection:

“Some of the physical side effects can be embarrassing...it can be confused with things like [alcoholism] publicly.” — Chuck [20:03]

Types of Multiple Sclerosis

[21:45 - 24:40]

• Main Types:

  • Relapsing-Remitting MS: Flare-ups followed by remission, non-progressive between attacks.
  • Primary Progressive MS: Constant progression, possibly with remissions; more severe.

• Chuck’s friend Billy had primary progressive MS.

• Progressive types lead more rapidly to disability:

  “His body was almost constantly in a state of muscle tension.” — Chuck [25:03]

Progression, Severity, and Consequences

[24:41 - 28:41]

• Rapid physical decline: loss of mobility, speech, muscle control.
• Advanced complications: choking (swallowing difficulties), infections, and—tragically—high suicide rates due to depression.
• Depression may be biological (lesions in mood-regulating areas of the brain), not just reactionary.

Notable quote:

“One of the comorbidities of multiple sclerosis is depression... it can come from just being depressed that you have MS...or just the myelin sheath coating regions of your brain.” — Josh [27:13]

Clinical Outlook: Most Do Not Get the Worst

[28:22 - 29:12]

• Majority of MS patients do not die from MS, nor suffer severe cognitive impairment. Many have mild disease.
• Early intervention is critical—“don’t ignore tingling or migraines, see a doctor.”

Treatment: From Modern Drugs to Experimental Cures

[31:13 - 36:45]

• Current Drugs:
  • Disease-modifying agents (not cures) slow progression or suppress the immune attack.
• Radical New Approach: Stem Cell Immune Reset (HALT-MS):
  • Wipe out immune system with chemo, re-seed with patient's own blood stem cells.
  • Astonishing results in trials: up to 86% relapse-free for years, some saw disease reversed.

“The permanent damage was actually reversed in six of the 24 patients by this incredibly radical procedure.” — Josh [34:56]

• Risky (life-threatening infections), expensive, but potentially a “cure” for severe cases.

Notable Moment:

“Billy would have tried this in a second, I guarantee it.” — Chuck [36:15]

Classification Nuances & Pediatric MS

[39:05 - 41:36]

• Related/in-between diseases: clinically isolated syndrome, Marburg MS, Devic’s Disease, etc.
• Pediatric MS is rare (~8,000 US cases), tough to diagnose/treat due to unknown drug impacts on developing brains.

Symptom Management & Future Drugs

[41:36 - 43:09]

• New drugs (like Ocrevus) target both major MS forms.
• Additional treatments: antidepressants and anticonvulsants, also shown to help with chronic pain due to overlapping neural circuits with depression.

Final Reflections: Advice and Regrets

[43:13 - 44:30]

• Chuck’s heartfelt advice to anyone with a friend/family member with a serious illness:

  “Try to overcome that if you have something like this going on...I wasn’t the friend to Billy that I should have been toward the end. And it’s fraught with regret.” — Chuck [43:15]

• Josh offers comfort and understanding.

Notable Quotes & Moments

• “There’s just something about the body making a mistake and turning on its otherwise healthy self that’s just...it’s hard to wrap your head around it.” — Chuck [07:43]
• “I just wanted to make sure that we were saying that...if there’s one thing...go to the doctor and catch it early.” — Josh [28:49]
• “No one likes using the C word. And he was like. But I’m gonna go ahead and say it, like, these people are cured.” — Chuck [35:03]
• Billy’s health journey, from living in a one-room shack to battling constant muscle tension, powerfully illustrates the individualized impact of MS.

Key Timestamps

• [01:45] — Emotional introduction/dedication to Billy
• [03:17] — What is MS, who gets it, and why
• [06:36] — MS pathology: attack on myelin
• [09:19] — Early symptoms & why diagnosis is hard
• [12:13] — Historical cases and discovery
• [17:05] — Chuck recounts Billy’s story
• [21:45] — Types of MS explained
• [24:41] — Prognosis, symptoms, and how MS can kill
• [31:13] — Treatment, immune reset stem cell therapy
• [39:05] — MS spectrum and pediatric cases
• [41:36] — Symptom treatment & research
• [43:13] — Chuck’s candid regrets and listener encouragement

Conclusion

This episode balances clear, accurate medical info about MS with deeply personal storytelling. It explores what MS does to the body, why it’s so confusing to diagnose and treat, cutting-edge therapies, and, most resonantly, what it feels like to watch a friend suffer from a disease that can be random, cruel, and—sometimes, though not always—devastating.

For more:
See the Stuff You Should Know website and search “multiple sclerosis,” or consult reputable medical resources and MS advocacy groups.