Multiple Sclerosis: Mirror, Mirror

Aliases: multiple sclerosis, MS

With the presidential campaign season officially underway in the US, I decided to profile a disease that afflicts the world’s most beloved fictional POTUS (President of the United States). At the end of The West Wing’s second season, President Josiah “Jed” Bartlet, reveals that he suffers from a relapsing-remitting course of multiple sclerosis (MS), shocking the nation and his staffers. But for all its drama, The West Wing’s MS storyline doesn’t overblow the effects of the disease. Instead, it (dare I say artfully?) manages to present an optimistic view1 of the condition while still addressing some of its many challenges.

Although the course of President Bartlet’s illness is extremely mild, with little progression of symptoms and next to no cognitive impact (although this is one of the disease’s most common symptoms; see below), he is subject to its fluctuations, emphasizing the brutal cycle of relapse and remission5. The show highlights both the overt costs of the disease, like the fatigue that afflicts most people with the condition5, and its more subtle effects. President Bartlet divulging his diagnosis is the climax of season 2, and while his admission takes place on a larger stage than most, it accurately depicts the anxiety that can plague MS sufferers when discussing their condition1,5. Perhaps most importantly, while MS significantly affects the lives of President Bartlet and those closest to him, the disease doesn’t derail his life5. He remains capable and competent, handily tackling one crisis after another for the next 5 seasons.

Fiction can be more powerful than fact. An estimated 2.3 million people worldwide suffer from MS4, yet none of these very real people have as enduring a public presence as the fictional President Bartlet. At the show’s height in season 3, The West Wing commanded a massive audience, with about 17.2 million viewers2. Now that the show is available on Netflix (oops, there goes your weekend/month; you’re welcome), its audience has expanded to an untold number. With such an enormous reach, The West Wing’s empowering MS storyline has certainly raised awareness about the disease1, but it could also hugely affect the way both the public and those diagnosed with the condition view MS. Oscar Wilde famously wrote, “Life imitates Art far more than Art imitates Life”. In this case, let’s hope he’s right.

MS
What’s next?

Cause: MS is an autoimmune disorder where the body’s immune system targets the central nervous system (CNS, the brain, spinal cord, and optic nerves), specifically the myelin (the fatty substance covering nerves) and the nerves themselves. The disease is triggered in people who are genetically predisposed (have genes related to the disease) by a combination of environmental factors; gender, geography, age, genetics, and ethnic background all influence disease development. Women are at least 2-3 times as likely to develop the disease as men, and while the average person has a 0.1% chance of developing MS, first degree relatives of MS sufferers have a 2.5-5% chance, and identical twins of MS sufferers have a 25% chance of contracting the disease4.

Consequence: MS results in nerve damage; the attacked myelin forms scar tissue, called sclerosis (this is where the disease gets its name), and impedes nervous system function. Because the nervous system affects all other bodily systems, the damage caused by MS results in a wide array of symptoms that are unpredictable and change over time. The first signs of the disease are usually numbness or tingling and vision problems. The most common symptoms include fatigue (80% of patients), pain (55% of patients experience clinically significant pain, nearly half have chronic pain), bladder dysfunction (at least 80% of patients), and cognitive changes (such as a decrease in the ability to organize and problem-solve, occurs in about 50% of patients). Confusingly, MS symptoms are commonly caused by several other conditions as well, making it very difficult to diagnosis the disease. Diagnosis requires physicians to find evidence of damage in at least two separate areas of the CNS, to find evidence that the damage occurred at least a month apart, and to rule out all other possible diagnoses4.

If the symptoms were not complex enough, the progression of the disease adds to the mix. MS can follow 4 different courses, any of which can be mild, moderate or severe:

  1. Relapsing-remitting: the most common course (85% of patients, including President Bartlet) with clearly defined attacks, followed by complete or partial recovery periods.
  2. Secondary-progressive: most people initially diagnosed with relapsing-remitting will eventually develop this form, where the disease progresses more steadily, though not necessarily more quickly.
  3. Primary-progressive: fairly rare (10% of patients) with steadily worsening neurological function from diagnosis onward. No distinct relapses or remissions.
  4. Progressive-relapsing: least common course (~5% of patients) with steadily worsening disease from diagnosis onward with relapses of exacerbated symptoms. Patients may experience a recovery period after these relapses, but the disease progresses without remissions4.

Cure: Unfortunately, there is no cure for MS. However, there are a wide range of treatment options. Most treatments address relapsing forms of MS (scientists are searching for effective treatments for progressive forms); medications are used to modify the disease course, treat relapses, and manage symptoms. Patients undergo rehabilitation to improve movement function4. While there is no cure, MS is not a fatal illness; MS sufferers generally have about the same life expectancy as the average population3.

References

  1. Dotinga, R. MS Goes West. HealthScoutNews. 26 November 2001. Web. 11 August 2015.
  1. How did your favorite show rate? USA Today. 28 May 2002. Web. 11 August 2015.
  1. Learn about Multiple Sclerosis. Multiple Sclerosis Foundation. July 2009. Web. 11 August 2015.
  1. Multiple Sclerosis FAQ. National Multiple Sclerosis Society. Web. 7 August 2015.
  1. Vancheri, B. ‘The West Wing’ lauded for accurately portraying MS story line. Pittsburgh Post-Gazette. 16 May 2001. 11 August 2015.

Image source: https://en.wikipedia.org/wiki/File:Josiah_Bartlett_with_chair.jpg , Copyright NBC

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Suzi Claflin

I am a postdoctoral fellow studying chronic disease epidemiology.

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