Welcome to Stuff you Should Know from how Stuff Works dot com. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles w Chuck Bryant, Sherry's over there. Their finger on the button, and this is stuff you should know. Not the button. Okay, well it's a button. She doesn't have the nuclear suitcase. It's the button. As far as we're concerned, that's our nuclear suitcase. Yeah, because we're dropping bombs every time we drop an episode. That's right. How are you feeling pretty good? I am. I'm a little, uh, a little apprehensive about this one. Well, I've been avoiding this one for years because my uh, one of my very best friends died from complications of MS oh man just last year. You failed to tell me that when I said this one over your way as a suggestion. Well, you'd sent it before before he died, and I didn't think I could do it, and I just kind of feel like, now it's the time, you know. And weirdly, yesterday was his birthday and no would have been his birthday, and you did not know that and had sent it over and it was just kind of one of those eerie things where I was like, all right, this is this has got to happen. What's your friend's name, Billy, Well, this one's for Billy. Yeah, and this will be we'll pepper his story throughout this. It's very sad stuff. Man. Well, I'm right here with you. Man. Thank you. Just lead on me when you need it. I appreciate it. Okay. Uh. So we are talking multiple sclerosis, or m S as it's called. UM, and I knew very little about this. I guess you probably are a lot more familiar with it than I am. Then, huh yeah, I mean obviously personally his journey with it, but as we will see, UM, everyone's journey with MS is different. It is UM. Depending on what kind you have, and depending on you as an individual, it can progress in different ways, very slowly, very quickly. Can be devastating, it can be not it can be very manageable. Um. He have one of the worst kinds. So yeah, from what I understand, it's very fairly rare for someone to die from complications of MS. Right, Yeah, I mean, I don't know if rare is the word, but it's definitely not the common outcome. I got you somewhere between rare and common. I think I got you, but it's already a fairly rare disease. I think something like four hundred thousand people in the United States and I think two million worldwide have it, which I mean it's a substantial number of people, but in the context of the larger global and national population, it's not that many. It is rare, I would guess. Yeah, it's um, just a little bit of an overview. I guess, um they call it the prime of life disease. Uh, and it's very cruel in that way because, um, it most often likes people between twenty and fifty, but I think even usually in in you're like twenties. Uh, and that's when Billy was hit with it, and um, it's uh. I think more women than men get it, Yeah, by far, because it's an autoimmune disease, and more women get autoimmune diseases more, which I didn't know. More Caucasians get it, and apparently Caucasians of Northern European descent or more likely to get it. And it's really there's a lot of mystery about why people get this, Yeah, like, for example, why Caucasian people more than people with darker skin um or Also I think part of the same coin why people who live, you know, away from the equator more than people who live in the tropics. That suggests that the sun might have something to do with it. Or I think one of the things that they've been looking into lately is vitamin D, which you produce through exposed sure of this on Yeah, it's really, um a mystery in a lot of ways. Um. Some people have have brought up the idea of there are clusters of areas. Other people have said, you know that's not the case, uh clusters or bs um you're reading you know your your reverse engineering a what do you call it? A cause? I guess stop bringing up clusters basically, h environmental or um, whether it's environmental or hereditary, don't know for sure. That would that would suggest that clusters could exist, right, But the fact that they're not sure if it is environmental or not, I would think that leaves that cluster thing open to debate. Yeah, but whether or not you can it's hereditary, it's up for debate too, because I think it says the risk for people with parents, siblings, or children who are diagnoses between one and twenty and one and forty, whereas it's what one and seven fifty for the general population. UM obviously got something to do with heredity or or it could be that you tend to live with your parents and your siblings, so you would share the same environments them too. So there's a lot of mystery surrounding the underlying causes, there really is, and 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, right. So, multiple sclerosis is like you said, it's an autoimmune disease where your body's immune system attacks your own body. So there's a number of different ones, Like there's Crohn's disease is one UM, there's inflammatory bowel syndrome, and they all have in common that the body is mistaking, or the immune system is mistaking some part of some normal natural part of the body as a foreign invader and is attacking it as such. And in the case of multi pull sclerosis, UH, the body is mistaking what's called the mile in sheath, this fatty substance that protects the axons that UM neurons, that nerve cells communicate between UM. They attack that sheath, and as they attack that sheath, they start to break it down, and a basically what amounts to scar tissue and a type of plaque starts to develop and those form lesions, and it can happen anywhere on your brain or your central nervous system. Yeah, that's that's essentially what multiple sclerosis is. Yeah, those plaques, um, those are that's called the sclerosis. So literally, multiple sclerosis means you have multiple plaques this hardened tissue at places on your body. Uh. And like you said, you know you have the neurons, which are the nerve cells themselves, and the axons or the fibers that connect everything wrapped in that sheath and that sheath it's really it's very basic and cruel how it acts. You know, any autoimmune disease is just devastating because, uh, there's just something about the body making a mistake and turning on it's on an otherwise healthy self. That's just uh, I don't know, it's hard to hard to wrap your head around it. It really is, um And one of the reasons why it's so tragic it is because we have really no idea how to make the body stop doing that. And in the case of multiple scores, you you have a body that's attacking the mile in sheath, But researchers aren't quite sure exactly what part of the mile in sheath is triggering the attack, so they can't tailor drugs to stop the body from doing that. They just know it's going after milin. Yeah, and the milin can repair itself if there's damage. But um, the problem with MS is this, they call it de milonization. It's happening to too fast basically. Uh. And sometimes it can be so severe that that those nerve fibers are severed outright right exactly. It's kind of like if you clear cut a forest and then before you let the forests come back, you start cutting down saplings. It's never gonna come back. Same thing with the mile in chief. Um. It is difficult to diagnose it first because the early signs or things like you know, maybe a little dizzy and may be fatigued. Um, maybe my vision is blurry occasionally. Um. And it kind of comes and goes to where people you know think like, oh, maybe it's migraines, maybe it's some you know, something minor and um. Because it is not the most common thing, I don't think doctors immediately are like, well, we need to get you into a spinal tap, right, And because it doesn't necessarily follow a strict set of symptoms, you know, you can get those lesions anywhere, and since their nerve um, they're disrupting or affecting the nerve signals, they can present in all sorts of different ways. Right. So, yeah, doctors are frequently stumped when you present with MS symptoms. Should we take a break and talk a little bit about the history and then get back into it. Oh yeah, sure, all right, let's do it. So historically, ms UM, although it is new on the described disease front um, obviously it's been around for a long time and people just didn't know what the heck was going on. Yeah, there's a saint that had it, they think, Yeah, back in the Middle Ages, Saint Ledwena, who's Dutch. And because she was Dutch, she was ice skating once back in the fourteen the fifteenth century, Yeah, fourteen thirties, she was ice skating and she fell, and after she fell she developed um excruciating pain, headaches, trouble walking, paralysis, UM. And apparently there would be periods where she didn't have these symptoms and then they would come back. And it would get worse and then she would not have them again, which are hallmarks of multiple sclerosis. As we'll see. Yeah, these attacks are flare ups followed by periods of remission. UM. Yeah, that's a specific type of MS. Well, yeah, which we'll get to that. But UM. King Georgia third apparently had a grandson who had a very extensive diary about his health until he died, and most people think like he clearly had ms UM and I believe that. Uh. There's a couple of decades after that that UM, a doctor Jean Martin Charcot became the first person at least it got credit with with describing the disease itself UM, identifying it and describing it. He's known as the father of modern neurology. He's popped up in some of our other stuff. He sounded familiar because he had a woman, a patient that UM had these symptoms. She eventually died. He dissected her brain, discovered these lesions and called it scleros en plaque. And then the malin was UM was discovered after that, But they didn't they didn't put two and two together at a time with the island, but it was discovered after that. So the the plaques in the effect on the milin um was really first discovered or demonstrated by Scottish doctor James Dawson, who, thanks to UM better microscopes than previous researchers that had, he could see, Oh yeah, these lines of communication between nerve cells and brain cells are basically being worn down to nothing and in some case this is broken and um, this is the basis of MS. I'm James Dawson, goodnight. Yeah, we should do one on the microscope because it seems like time and time again we've had like just literally because the being able to see things smaller has gotten more advanced, like every time that has taken a leap forward medical science as Oh, sure, it's really interesting. Plus we'll get to say Anton von leven hook that bunch. Yeah, we've talked about him before, right. Yeah. So Dawson, uh described the inflammation, but they thought it was like a virus or a toxin running through the bloodstream at the time. Um, they did for a long time. Actually well yeah, and ironically in the thirties, UM there were lab mice going hey, it's autoimmune, right, and doctors were like, oh, don't listen to the lab results from the slee mice. No, it's clearly a blood toxin that's doing that. Yeah, So they sort of were not looking at the evidence right in front of their faces for a little while until the nineteen forties, when I think at Columbia University they found that um these weird protein byproducts and their and their cerebro spinal fluid. And that was seven and that's kind of when that's kind of when the doors really opened and they said, Oh, I think we know what's going on, and I think we know how we can test for this right. Right, that established one of the big tests for for um MS, which is they're looking for so they go do a spinal tap, right, which is where they draw a sample of um cerebro spinal fluid from between your vertebrate um and when they're testing for MS, they're looking for high levels of I G G immunoglobin, G antibodies, and something called oglio clonal bands, which are another type of protein that are immunoglobins. And then they're also looking for these protein by products that are the results of myle in being broken down in the cerebro spinal fluid, which is not supposed to happen. So when they find all this stuff, they can say this is probably multiple sclerosis. And since the forties they've they've had that test, and then starting in about the eighties or nineties, they also introduced m R I. And when you compare those two things together and they both suggest MS, you've got a pretty good MS diagnosis. Yeah, but it, like you know, like I said, it's a slow process. I remember Billy, it took a while until they finally landed on MS for him, and that just kind of seems to be the way it goes. What were his initial symptoms? Do you do you remember? You know, like we didn't. He was a college roommate and we didn't. Um. He ended up moving to the Billy was. He was a very unique guy. He he lived life to the fullest and did not really follow the rules of uh modern man. Where did he move? He kind of dropped out. He went to Boone, North Carolina, which is a great place to drop out and lived in a one room shack like cabin in the middle of the woods. It's a great place to do that with the toilet just sort of in the room, a toilet or a bucket that was a toilet, had running water and electricity, but it was a one room thing and I went up there a few times and stayed with him. But um, we would like, you know, drink whiskey and shoot guns and a cross streams on the toilet probably so like Ghostbusters. So Billy kind of dropped out, and um, this was before MS. You know, he just did that. You know, as a he was like a river guide, a whitewater river guide, and live the life that those dudes live, which is to say, not being responsible for a lot and kind of spending a lot of time on the river. Yeah, it's been a lot of time on the river and hanging out. Um, so he dropped out, and you know, didn't have a phone. This was pretty cell phone, so we weren't in the best touch. This is when I was post college living in New Jersey. So the memories of his exact early diagnosis or a little foggy, but I think I remember like fogginess and uh, dizziness kind of be in his first warning signs. But he wasn't the kind of like, oh, well, you know, I need to run right out to the doctor and see what's going on. No, And it certainly wasn't the Billy way, so he you know, he didn't do himself any favors in the early years, and then when he finally did find out, he didn't do himself any favors because he didn't take care of himself and he didn't rehab and take his medication like you should have and sort of fell down into a spiral of alcohol and drug abuse and um which did not help. Like you know, they say, if you get a diagnosis, you want to you want to live as clean as you can and work out and be as physical as you can and really try and take care of your body to stave off these physical symptoms. And he didn't do any of that stuff. And plus the early thing is a really big part of it too, because again, what's happening is the mile in sheets around your entire central nervous system or subject to attack. And so if you can catch this earatly, you can kind of stave off some of those successive attacks where if you just ignore it or don't pay attention to it, it will just get worse and worse and worse. It's a it's what's called devastating progressive disease. Yeah, and there's you know, a lot of people keep it a secret at first because it can um some of the physical side effects can be embarrassing. I know that this article mentioned and at Funicello waited for years to come out, you know, former Disney Mouseketeer, And she didn't come out until I think there were reports that she was an alcoholic because they see your stumbling around. Uh, and it can be confused with things like that publicly and um and then she said, actually, tabloids, I have MS. Oh sorry and that and the same with Richard Pryor. He kept his MS diagnosis a secret for a little while. Yeah, I remember everybody's Richard Pryor's got tremors because he used to free base. Yeah, no, turned out MS. Yeah totally. Muhamma Ali didn't have MS. But I remember people when Ali's condition got worse, We're like, oh, yeah, that you know see what that's what happens with boxing. Well, I think they might be right about that. One was by boxing. Yeah. I think he had brain plaques from too many from uh CTE. Okay, for some reason, I thought, I mean I could be mistaken, but I'm pretty sure that's why he Uh, he had Parkinson's. I think it was brought on by all the punches he took. I think, yeah, I didn't research any of this, so I'm speaking off the cuff same here, all right, That's that's what we do well. At any rate. UM people can kind of keep it a secret for a little while because it can be a diagnosis can be scary at first when you get diagnosed with MS because of the unpredictability, and you sort of have to I remember with Billy, they were kind of like, we gotta kind of see how this goes before we know what kind you have, right, which is fairly primitive as far as medicine goes. So Chuck, there's UM, there's this article has four kinds. What I saw is that it's been pared down to basically two. Yeah. Our article says that there's progressive, relapsing, relapsing, remitting UM, there is primary progressive, and then secondary progressive. And basically what I saw is that UM, there's an umbrella group called UM remitting or relapsing UH multiple sclerosis r MS, and then there's another kind that is UM, sorry, it's relapsing multiple sclerosis. And then the other kind is called primary progressive. Right, And with relapsing MS. You are, you have MS symptoms, you have basically what amounts to an attack, right where your symptoms come on and then they subside after a while. And during the time that they subside, you're in what's called um remission, right, and then they come on again, so you're in relapse phase. But during those two times, your disease is not getting worse, right, it's not progressing. That's the relapsing type of multiple sclerosis. The other kinds primary progressive, and they used to call that one UM yeah, and they kind of folded all those together. But the one that survived is primary progressive. And that's basically, like you are, your diseases getting worse pretty much constantly, and it might be happening fast, it might be happening slowly, but you have a disease progression that can be noted by the people in charge of taking care with care of you. But then during that you may have small periods where you don't have symptoms, so you've got a remission, or you have periods where they come on really strong and it gets really cute, so you have a relapse. But during this time, during like say a year or five years or ten years, your MS is getting worse, you know by the year. Yeah, which that was what Billy had got you. That's what it Yeah, that's what it sounds like. I have the impression that, um, the any kind of progressive type of of most polt clerosis is the worst of the two because you're you're you have it like basically all the time, and it's getting worse as it goes along. Yeah, and his would come together, his would come and fits and starts for the first period of years. Um, and it was that classic thing, I think where his flare ups would be like not so bad at one point and then kind of calmed down and then be really bad and then calm down. But the whole time there was a progressive thing going on to where he was. He was obviously worst case scenario, um, like couldn't walk in a wheelchair, couldn't talk, um, and that poor guy. Yeah, you know, the muscles fasticity is a big um hallmark of a kind of the worst kinds And that's when you're, um, you know, your body is just not communicating anymore, like well, no, that mile in sheath is exposed and so the the electrical impulses are going Hey, wires. So the muscles they're commanding are going hey wired too. Yeah, so he he, like I said, he walked with a cane for a little while, but eventually like just had to go, you know, lost tons of weight, eventually ended up in a wheelchair, and was his body was almost constantly in a state of muscle tension. You know. The ironic part about that is it sounds like his immune system was super healthy, which is how it was able to stage those massive attacks on on his poor mile in sheaths. Maybe you know, yeah, because you think if you had a weakish immune system, your MS wouldn't be quite as bad. Yeah, I guess I do, remember he thought about that. Yeah, it's really interesting and it's super cruel to see, um, like the body, like I said, the body turn on itself like that because Billy was very athletic and he was a good singer, and like it took away his ability to do all this stuff. Um, and it got so bad where he would um and it mentions it in this article about like even when you're eating, you have to be really careful because you can choke on your tongue or choke on food. Um. When he would get cracked up and laugh at us. It would like it would be you know, it would be good for him, but it would also be a little bit scary because he would his laugh would get out of control such where you had to worry about if you know, he had taken a sip of water or something, you could choke on it. Yeah, apparently that's one of the ways that people do die from complications of MS is choking because they have swallowing problems. Yeah, that was definitely, I mean, I don't remember the exact like literal cause of death at the end, but um you know, it just ravaged his body basically, so the other ones I saw where that your lung function, weakend. Muscle activity is one of the other main ways um uh, like an infection from a sore due to immobility can if not treated correctly, those things can lead to say like a blood infection and you can die from sepsis and then sadly, suicide is another leading cause of death among people who have MS. Something like six percent of fourteen percent of people with MS commit suicide. And one of the reasons why that's much higher than the population at large um is because one of the comorbidity ease of multiple sclerosis is depression, and it's apparently, from what I saw in my research, one of those things that's not widely recognized and therefore not widely treated enough as far as m S goes. That it's a it's apparently a big problem with it, and it can come from just being depressed that you have MS, because again the strikes you in the prime of your life, so you think about all the stuff you're missing out on because you have debilitating MS, or just the the mile in sheath coding regions of your brain. If you get legion lesions in the parts of your brain that regulate your mood, you can become Um, the physiology of your brain can lead to depression because of the changes there. Well yeah, I mean it does originate in the central nervous system, but um, it can in some cases affect like your memory, uh, your speech, your problem solving, and your higher brain function. I think it's it says in here like five have severe impairment of higher brain functions. So yeah, of course depression is gonna go along with that, you know, so we should we should say that for the most part, it's from what I saw, the vast majority of patients with multiple sclerosis don't die from it, they don't suffer major cognitive impairment as a result of it, and um, a lot of them don't even exhibit major symptoms for the most part. Yeah, I don't want to freak people out with Billy's story because he had the worst case scenario. But the diagnosis doesn't mean you're headed towards that. No. No, I just wanted to make sure that we were saying that. You know, I don't want to scare anybody, but we gotta get information out there, right because I mean, if there's one thing that would be really great if we could do with this episode, is if there's somebody out there right now who is starting to have migraines are tinkling in their arm, that they'll go to the doctor and catch it early. You know, absolutely, So let's talk about a treatment and stuff after your break. Huh, okay, alright. One of the things you can do one to you are diagnosed is get on drugs. Um. They've come a long way to do drugs, that's right. Uh. The drugs that they use to help treat them as have come a long way over the years. They're called disease modifying agents, and um, you know, they don't cure anything. But what they're trying to do is slow the progression or alter or suppress that immune system in such a way that it helps. Yeah. Yeah, and um, there's a lot of ways out there to actually treat the symptoms that are drug based and non drug based, but those disease modifying agents are the ones that actually alter the course of the multiple sclerosis. But like you said, they don't actually cure it. Although it is possible that there is a cure for it out right now, but it's new enough, it was just started in the late nineties, and it's so not so radical, um that it just hasn't been proven as a cure, but it's kind of looking like it might be. Yes, should we go ahead and talk about that. Yeah, So it's based on stem cells. Yeah, I mean, it's basically what they're doing is completely replacing your immune system, right, it's nuts. So back in the nineties, two doctors from Ottawa, Um, what provinces Ottawa in do you remember the Ontario, Well, let's just say Ottawa, Canada like Atlanta, USA. Uh. These doctors, Mark Friedman and Henry Atkins. They had this idea of basically reducing your immune system to nothing, so that when they managed to keep you alive, if they managed to keep you alive, when they restarted your immune system again by reintroducing some of your stem cells your hemeo poetic I want to say, stem cells, ye your own right, um, that it would build your immune system up again, and then they could watch the immune system restart MS and they'd be able to watch the disease progression from square one. But as one of them said in an interview, they failed miserably. But it's great that they did, because what they found was that when they devastated the immune system, brought it to zero, wiped it out, and then reintroduced your blood stem cells to the patient again, the MS didn't come back. In most of the people they tried this on. Yeh six remained relapse free for three years after three years and counting, and almost showed no sign of progression of the disease. Which is and then in that original I think UM study that Friedman and Atkins carried out, something like twenty three of the twenty four UM the disease was stopped in its tracks. And apparently these people had like a pretty bad bad cases of MS. This wasn't it wasn't a lightweight case of MS. Yeah. There's something called the Expanded Disability Status Scale, which basically kind of ranks how bad they are in terms of walking, dexterity, cognition. And they all had to rate between a three and a five point five on that scale, which is, you know, fairly severe, right, And so some people for twenty three out of twenty four in the original study, and I think, like you said, six and later studies, Um, the disease just stopped, that did not get any worse, even though these were progressive cases of MS. And in something like six of the twenty four they actually there the disease was walked back. So like the permanent damage apparently there's a rule of thumb among people with multiple sclerosis or doctors that if you have a symptom that doesn't get better or go away after a year, you can consider it permanent damage. That permanent damage was actually reversed in six of the twenty four patients by this incredibly radical procedure that seems to work. Yeah, like that they one of the doctors is, like, 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. Yeah, some of these people have been in remission for four teen years and for all intents and purposes, that's that's cured. It's amazing, it is. It's pretty great. But again it's also a very very risky procedure. What they're using in UM and I think the most current incarnation, i think it's called halt MS is the process, but it's based on those Autawa doctors discovery that you use five different kinds of chemotherapy to kill your immune system. And so obviously you have to be kept in isolation and everyone has to wear a crazy bio hazard suit around you, and they have you on anti microbials and it kills everything UM and they are trying to fight off any infection in Anyone who's ever stayed in the hospital knows the best place to get an infection is a hospital. So it's extraordinarily dangerous. But if you can survive, and if you have like a pretty bad case of MS, I'm guessing you'd be willing to try this UM it can cure you. Yeah, Billy would have tried this in a second. I guarantee it. Uh. They had twenty four volunteers initially between two thousand and six and two thousand and ten. For the first study, I think, oh no, no, this one was um, this was in Denver, So I guess are they doing follow up research? Yeah, this is a difference. So the one that you're talking about, that's the Halt study. UM. I'm not sure exactly what Freedman and Atkins called their technique, but as far as I know, they're the pioneers of wiping out your immune system and then replacing it to get rid of MS. Yeah. So I think I might have mixed together some of the stats for these two studies. But let's just say they're both very promising. Um. And you know who knows, like I don't. I don't know the procedure. I know we've talked about doing shows on medical testing and stuff, and the procedure like the stepping stones from here to like all right now, when is this going to be a thing? Um? But I mean it's so kind of dangerous and frought with complications. I don't know if they this can be super widespread, you know, I from what I'm seeing in the research, though, it has such positive backing. I think kind of across the spectrum that it's I think people are gung hollo about it, Like people should be able to decide if they want to take that risk, Like Billy was certainly in a position where he's like, it's not gonna get any worse for me, right, Yeah, Like I'm willing to take this chance and maybe die. Right. Uh. It's basically I guess what these volunteers are saying to make my life better. Yeah. I think one of the things that's probably staying in most people like that's way is the cost associated because I supposedly there's really just stupid loopholes that you have that regarding um stem cell therapies. Like like the article I sent you UM talked about a guy named Dave Bexfield and he was UM accepted to the study, willing to take the risks, and UM his insurance company was like, yeah, that's great, it's a stem cell um study, but we only cover stem cells that are that come from donors, and this study has stem cells that come from you, So you're gonna have to pay the two thousand dollars yourself. And he did. This guy got together, he's scraped together like a hundred and eighties six grand, which is what it costs to to carry out this trial for him specifically, And um, I guess afterward he went after his insurance company and got not only that money back, but like another two thousand dollars or something in interest and he's cured. So boom, I should say, and he's c worded. That's right. Uh. There are UM some other diseases that are sort of like MS, and there is debate in the medical community whether or not they want to actually classify them. There's something called clinically isolated syndrome, which means you can have an attack or a flare up or an episode UM from this de milonization. But it's just like one lesion. And sometimes you might develop MS, but not always. Sometimes it's just c I D. Yeah. I thought that was weird, and to me it is kind of suggests how incomplete and understanding science has of MS. Well, yeah, and like I said that, some people say, well, you shouldn't even call this MS, and some people say no, it's like maybe the mildest form you can get. Uh. What else, There's something called Marburg m s H shoulders diffuse sclerosis Belo concentric sclerosis and devits disease. They are all sort of in that UM range of what's called ideopathic inflammatory demylinating diseases. And children can get it too, even though it's pretty rare. Yeah, eight thousand cases in the US. And remember there's like four dred thousand of MS, but of pediatric multiple sclerosis UM, there's eight thousand of them, which is I mean talk about prime of life disease. Yeah, and I think it's even harder to diagnose in kids because that's certainly not something they're looking for, right, And we're like the drugs that they're using, it's it's like what we don't know what effects are going to have on kids. You know, it is the career worse than the disease because there's you know, we said that there's some disease altering drugs. There's a new one called O Crivous that is UM pending approval from the FDA but looks like it's going to go through, which is I think the first UH disease modifying agent that is shown to treat both progressive and relapsing forms of multiple sclerosis UM. And it goes after the immune system. I think it tries to suppress your B cells in the immune system. Um So, there's there's plenty of treatments that go after the disease, but there's also a lot of treatments that treat symptoms, right, and um one of the ones that are used are antidepressants and anti convulsants. And so there's a lot of questions like, should we be giving those two kids even though they have MS. What's the long term effect of giving antidepressants to a child whose brain chemistry is still in the beginning stages of development. Yeah, I mean, drugs can be wonderful, but there there's not a drug you can take that doesn't have some sort of other effect. And um, the benefits outweighing the side effects, Like you gotta take all this into consideration for anything, you know. One of the other things I saw about antidepressants, Chuck, was, um, they have figured out that they can use it to treat chronic pain. And one of the outcroppings from m S. So again, MS is like your body going haywire and really unique ways for each person with multiple sclerosis. Um So, it kind of in a way provides researchers ways to whenever the body does something it is not supposed to. It's a great place for researchers to go study the normal processes of the body. And one of the things they figured out is that in treating chronic pain with multiple sclerosis, um, you can use antidepressants. And the reason why is because apparently chronic pain and depression use a lot of the same neural pathways and create a lot of the same changes to the plasticity of the brain as one another, and that chronic pain and depression maybe in a lot of ways more related at least neurologically than chronic pain and acute pain, which seemed to be kind of different animals. Yeah, fascinating, I think so too. Have you got anything else? Uh? Yeah, you know, I think I would just advise anyone. And it's not just MSS, but like if you got a I wasn't the friend to Billy that I should have been towards the end, and it's fraught with regret, uh. And part of that is because life gets in the way, uh. And part of it is just you know, it's not the easiest thing to face as a friend. And I think what I did was I let myself off the hook too easily. For that stuff, which I feel really crappy about now, like try to overcome that. If you have something like this going on. That's good advice, man, That's what I will say. I swore I wasn't gonna do this. Are you missing? Yeah, it's it's It was very hard and I wasn't the friend I should have been. And my friend Eddie was great and stood by Billy, and uh, I went and saw him at the end in the hospital, but it was you know, I had a lot of regret about the final years and not going to see him. You should have and it's understandable. Man. Yeah, I think you just did some sort of absolution though. Well we'll see. Well, if you want to know more about multiple sclerosis, you could type those words into the search part how stuff works dot com and it will bring up this article. Um. And since I said that and Chuck is missing, it's time for listening mail. That means it's Wednesday. Uh, this is on empathy a little bit too. Um. Hey, guys listening to empathy right now. I had a pause to say thank you when you were talking about the study relating to autism and alex athemia. Uh, you listed four groups studied as individuals with autism and alexothemia, individuals with autism, um uh without alexithemia, individuals with alexithemia but not autism, and then people who didn't have either one. Growing up as a sister of a guy with autism, I can tell you how many times I've heard people describe individuals without autism as normal people. It's such a lazy way to describe a group who doesn't exhibit just one of a multitude of other characteristics, and frankly, it's demeaning and rude. So thank you for not being those guys. You're always careful in your wording, so I shouldn't be surprised, But having thirty years plus experience hearing normal people condition me to brace myself when you started the list inclusive language for the wind keep up the great work. That is from Megan is isgin in Indianapolis? And she said, psh, Indianapolis is no Seattle, but maybe come to the Circle City sometime. Oh nice, up uh, and we I think we have been batting around the idea of in Indianapolis show, so yeah, hopefully it will happen. Thanks a lot, Megan. That was very nice of you. We appreciate the kudos. Um And if you want to get in touch with this, like Megan and tell us to come to your city, you can tweet to us We're at s Y s K podcast or josh um Clark Uh. You can hang out with us on Facebook dot com slash stuff you Should Know or Facebook dot com slash Charles W. Chuck Bryant. You can send us an email stuff podcast at how stuff Works dot com, and as always, join us at our home on the web, stuff you Should Know dot com For more on this and thousands of other topics. Is it how stuff Works dot com

Welcome to Stuff you Should Know from how Stuff Works dot com. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles w Chuck Bryant, Sherry's over there. Their finger on the button, and this is stuff you should know. Not the button. Okay, well it's a button. She doesn't have the nuclear suitcase. It's the button. As far as we're concerned, that's our nuclear suitcase. Yeah, because we're dropping bombs every time we drop an episode. That's right. How are you feeling pretty good? I am. I'm a little, uh, a little apprehensive about this one. Well, I've been avoiding this one for years because my uh, one of my very best friends died from complications of MS oh man just last year. You failed to tell me that when I said this one over your way as a suggestion. Well, you'd sent it before before he died, and I didn't think I could do it, and I just kind of feel like, now it's the time, you know. And weirdly, yesterday was his birthday and no would have been his birthday, and you did not know that and had sent it over and it was just kind of one of those eerie things where I was like, all right, this is this has got to happen. What's your friend's name, Billy, Well, this one's for Billy. Yeah, and this will be we'll pepper his story throughout this. It's very sad stuff. Man. Well, I'm right here with you. Man. Thank you. Just lead on me when you need it. I appreciate it. Okay. Uh. So we are talking multiple sclerosis, or m S as it's called. UM, and I knew very little about this. I guess you probably are a lot more familiar with it than I am. Then, huh yeah, I mean obviously personally his journey with it, but as we will see, UM, everyone's journey with MS is different. It is UM. Depending on what kind you have, and depending on you as an individual, it can progress in different ways, very slowly, very quickly. Can be devastating, it can be not it can be very manageable. Um. He have one of the worst kinds. So yeah, from what I understand, it's very fairly rare for someone to die from complications of MS. Right, Yeah, I mean, I don't know if rare is the word, but it's definitely not the common outcome. I got you somewhere between rare and common. I think I got you, but it's already a fairly rare disease. I think something like four hundred thousand people in the United States and I think two million worldwide have it, which I mean it's a substantial number of people, but in the context of the larger global and national population, it's not that many. It is rare, I would guess. Yeah, it's um, just a little bit of an overview. I guess, um they call it the prime of life disease. Uh, and it's very cruel in that way because, um, it most often likes people between twenty and fifty, but I think even usually in in you're like twenties. Uh, and that's when Billy was hit with it, and um, it's uh. I think more women than men get it, Yeah, by far, because it's an autoimmune disease, and more women get autoimmune diseases more, which I didn't know. More Caucasians get it, and apparently Caucasians of Northern European descent or more likely to get it. And it's really there's a lot of mystery about why people get this, Yeah, like, for example, why Caucasian people more than people with darker skin um or Also I think part of the same coin why people who live, you know, away from the equator more than people who live in the tropics. That suggests that the sun might have something to do with it. Or I think one of the things that they've been looking into lately is vitamin D, which you produce through exposed sure of this on Yeah, it's really, um a mystery in a lot of ways. Um. Some people have have brought up the idea of there are clusters of areas. Other people have said, you know that's not the case, uh clusters or bs um you're reading you know your your reverse engineering a what do you call it? A cause? I guess stop bringing up clusters basically, h environmental or um, whether it's environmental or hereditary, don't know for sure. That would that would suggest that clusters could exist, right, But the fact that they're not sure if it is environmental or not, I would think that leaves that cluster thing open to debate. Yeah, but whether or not you can it's hereditary, it's up for debate too, because I think it says the risk for people with parents, siblings, or children who are diagnoses between one and twenty and one and forty, whereas it's what one and seven fifty for the general population. UM obviously got something to do with heredity or or it could be that you tend to live with your parents and your siblings, so you would share the same environments them too. So there's a lot of mystery surrounding the underlying causes, there really is, and 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, right. So, multiple sclerosis is like you said, it's an autoimmune disease where your body's immune system attacks your own body. So there's a number of different ones, Like there's Crohn's disease is one UM, there's inflammatory bowel syndrome, and they all have in common that the body is mistaking, or the immune system is mistaking some part of some normal natural part of the body as a foreign invader and is attacking it as such. And in the case of multi pull sclerosis, UH, the body is mistaking what's called the mile in sheath, this fatty substance that protects the axons that UM neurons, that nerve cells communicate between UM. They attack that sheath, and as they attack that sheath, they start to break it down, and a basically what amounts to scar tissue and a type of plaque starts to develop and those form lesions, and it can happen anywhere on your brain or your central nervous system. Yeah, that's that's essentially what multiple sclerosis is. Yeah, those plaques, um, those are that's called the sclerosis. So literally, multiple sclerosis means you have multiple plaques this hardened tissue at places on your body. Uh. And like you said, you know you have the neurons, which are the nerve cells themselves, and the axons or the fibers that connect everything wrapped in that sheath and that sheath it's really it's very basic and cruel how it acts. You know, any autoimmune disease is just devastating because, uh, there's just something about the body making a mistake and turning on it's on an otherwise healthy self. That's just uh, I don't know, it's hard to hard to wrap your head around it. It really is, um And one of the reasons why it's so tragic it is because we have really no idea how to make the body stop doing that. And in the case of multiple scores, you you have a body that's attacking the mile in sheath, But researchers aren't quite sure exactly what part of the mile in sheath is triggering the attack, so they can't tailor drugs to stop the body from doing that. They just know it's going after milin. Yeah, and the milin can repair itself if there's damage. But um, the problem with MS is this, they call it de milonization. It's happening to too fast basically. Uh. And sometimes it can be so severe that that those nerve fibers are severed outright right exactly. It's kind of like if you clear cut a forest and then before you let the forests come back, you start cutting down saplings. It's never gonna come back. Same thing with the mile in chief. Um. It is difficult to diagnose it first because the early signs or things like you know, maybe a little dizzy and may be fatigued. Um, maybe my vision is blurry occasionally. Um. And it kind of comes and goes to where people you know think like, oh, maybe it's migraines, maybe it's some you know, something minor and um. Because it is not the most common thing, I don't think doctors immediately are like, well, we need to get you into a spinal tap, right, And because it doesn't necessarily follow a strict set of symptoms, you know, you can get those lesions anywhere, and since their nerve um, they're disrupting or affecting the nerve signals, they can present in all sorts of different ways. Right. So, yeah, doctors are frequently stumped when you present with MS symptoms. Should we take a break and talk a little bit about the history and then get back into it. Oh yeah, sure, all right, let's do it. So historically, ms UM, although it is new on the described disease front um, obviously it's been around for a long time and people just didn't know what the heck was going on. Yeah, there's a saint that had it, they think, Yeah, back in the Middle Ages, Saint Ledwena, who's Dutch. And because she was Dutch, she was ice skating once back in the fourteen the fifteenth century, Yeah, fourteen thirties, she was ice skating and she fell, and after she fell she developed um excruciating pain, headaches, trouble walking, paralysis, UM. And apparently there would be periods where she didn't have these symptoms and then they would come back. And it would get worse and then she would not have them again, which are hallmarks of multiple sclerosis. As we'll see. Yeah, these attacks are flare ups followed by periods of remission. UM. Yeah, that's a specific type of MS. Well, yeah, which we'll get to that. But UM. King Georgia third apparently had a grandson who had a very extensive diary about his health until he died, and most people think like he clearly had ms UM and I believe that. Uh. There's a couple of decades after that that UM, a doctor Jean Martin Charcot became the first person at least it got credit with with describing the disease itself UM, identifying it and describing it. He's known as the father of modern neurology. He's popped up in some of our other stuff. He sounded familiar because he had a woman, a patient that UM had these symptoms. She eventually died. He dissected her brain, discovered these lesions and called it scleros en plaque. And then the malin was UM was discovered after that, But they didn't they didn't put two and two together at a time with the island, but it was discovered after that. So the the plaques in the effect on the milin um was really first discovered or demonstrated by Scottish doctor James Dawson, who, thanks to UM better microscopes than previous researchers that had, he could see, Oh yeah, these lines of communication between nerve cells and brain cells are basically being worn down to nothing and in some case this is broken and um, this is the basis of MS. I'm James Dawson, goodnight. Yeah, we should do one on the microscope because it seems like time and time again we've had like just literally because the being able to see things smaller has gotten more advanced, like every time that has taken a leap forward medical science as Oh, sure, it's really interesting. Plus we'll get to say Anton von leven hook that bunch. Yeah, we've talked about him before, right. Yeah. So Dawson, uh described the inflammation, but they thought it was like a virus or a toxin running through the bloodstream at the time. Um, they did for a long time. Actually well yeah, and ironically in the thirties, UM there were lab mice going hey, it's autoimmune, right, and doctors were like, oh, don't listen to the lab results from the slee mice. No, it's clearly a blood toxin that's doing that. Yeah, So they sort of were not looking at the evidence right in front of their faces for a little while until the nineteen forties, when I think at Columbia University they found that um these weird protein byproducts and their and their cerebro spinal fluid. And that was seven and that's kind of when that's kind of when the doors really opened and they said, Oh, I think we know what's going on, and I think we know how we can test for this right. Right, that established one of the big tests for for um MS, which is they're looking for so they go do a spinal tap, right, which is where they draw a sample of um cerebro spinal fluid from between your vertebrate um and when they're testing for MS, they're looking for high levels of I G G immunoglobin, G antibodies, and something called oglio clonal bands, which are another type of protein that are immunoglobins. And then they're also looking for these protein by products that are the results of myle in being broken down in the cerebro spinal fluid, which is not supposed to happen. So when they find all this stuff, they can say this is probably multiple sclerosis. And since the forties they've they've had that test, and then starting in about the eighties or nineties, they also introduced m R I. And when you compare those two things together and they both suggest MS, you've got a pretty good MS diagnosis. Yeah, but it, like you know, like I said, it's a slow process. I remember Billy, it took a while until they finally landed on MS for him, and that just kind of seems to be the way it goes. What were his initial symptoms? Do you do you remember? You know, like we didn't. He was a college roommate and we didn't. Um. He ended up moving to the Billy was. He was a very unique guy. He he lived life to the fullest and did not really follow the rules of uh modern man. Where did he move? He kind of dropped out. He went to Boone, North Carolina, which is a great place to drop out and lived in a one room shack like cabin in the middle of the woods. It's a great place to do that with the toilet just sort of in the room, a toilet or a bucket that was a toilet, had running water and electricity, but it was a one room thing and I went up there a few times and stayed with him. But um, we would like, you know, drink whiskey and shoot guns and a cross streams on the toilet probably so like Ghostbusters. So Billy kind of dropped out, and um, this was before MS. You know, he just did that. You know, as a he was like a river guide, a whitewater river guide, and live the life that those dudes live, which is to say, not being responsible for a lot and kind of spending a lot of time on the river. Yeah, it's been a lot of time on the river and hanging out. Um, so he dropped out, and you know, didn't have a phone. This was pretty cell phone, so we weren't in the best touch. This is when I was post college living in New Jersey. So the memories of his exact early diagnosis or a little foggy, but I think I remember like fogginess and uh, dizziness kind of be in his first warning signs. But he wasn't the kind of like, oh, well, you know, I need to run right out to the doctor and see what's going on. No, And it certainly wasn't the Billy way, so he you know, he didn't do himself any favors in the early years, and then when he finally did find out, he didn't do himself any favors because he didn't take care of himself and he didn't rehab and take his medication like you should have and sort of fell down into a spiral of alcohol and drug abuse and um which did not help. Like you know, they say, if you get a diagnosis, you want to you want to live as clean as you can and work out and be as physical as you can and really try and take care of your body to stave off these physical symptoms. And he didn't do any of that stuff. And plus the early thing is a really big part of it too, because again, what's happening is the mile in sheets around your entire central nervous system or subject to attack. And so if you can catch this earatly, you can kind of stave off some of those successive attacks where if you just ignore it or don't pay attention to it, it will just get worse and worse and worse. It's a it's what's called devastating progressive disease. Yeah, and there's you know, a lot of people keep it a secret at first because it can um some of the physical side effects can be embarrassing. I know that this article mentioned and at Funicello waited for years to come out, you know, former Disney Mouseketeer, And she didn't come out until I think there were reports that she was an alcoholic because they see your stumbling around. Uh, and it can be confused with things like that publicly and um and then she said, actually, tabloids, I have MS. Oh sorry and that and the same with Richard Pryor. He kept his MS diagnosis a secret for a little while. Yeah, I remember everybody's Richard Pryor's got tremors because he used to free base. Yeah, no, turned out MS. Yeah totally. Muhamma Ali didn't have MS. But I remember people when Ali's condition got worse, We're like, oh, yeah, that you know see what that's what happens with boxing. Well, I think they might be right about that. One was by boxing. Yeah. I think he had brain plaques from too many from uh CTE. Okay, for some reason, I thought, I mean I could be mistaken, but I'm pretty sure that's why he Uh, he had Parkinson's. I think it was brought on by all the punches he took. I think, yeah, I didn't research any of this, so I'm speaking off the cuff same here, all right, That's that's what we do well. At any rate. UM people can kind of keep it a secret for a little while because it can be a diagnosis can be scary at first when you get diagnosed with MS because of the unpredictability, and you sort of have to I remember with Billy, they were kind of like, we gotta kind of see how this goes before we know what kind you have, right, which is fairly primitive as far as medicine goes. So Chuck, there's UM, there's this article has four kinds. What I saw is that it's been pared down to basically two. Yeah. Our article says that there's progressive, relapsing, relapsing, remitting UM, there is primary progressive, and then secondary progressive. And basically what I saw is that UM, there's an umbrella group called UM remitting or relapsing UH multiple sclerosis r MS, and then there's another kind that is UM, sorry, it's relapsing multiple sclerosis. And then the other kind is called primary progressive. Right, And with relapsing MS. You are, you have MS symptoms, you have basically what amounts to an attack, right where your symptoms come on and then they subside after a while. And during the time that they subside, you're in what's called um remission, right, and then they come on again, so you're in relapse phase. But during those two times, your disease is not getting worse, right, it's not progressing. That's the relapsing type of multiple sclerosis. The other kinds primary progressive, and they used to call that one UM yeah, and they kind of folded all those together. But the one that survived is primary progressive. And that's basically, like you are, your diseases getting worse pretty much constantly, and it might be happening fast, it might be happening slowly, but you have a disease progression that can be noted by the people in charge of taking care with care of you. But then during that you may have small periods where you don't have symptoms, so you've got a remission, or you have periods where they come on really strong and it gets really cute, so you have a relapse. But during this time, during like say a year or five years or ten years, your MS is getting worse, you know by the year. Yeah, which that was what Billy had got you. That's what it Yeah, that's what it sounds like. I have the impression that, um, the any kind of progressive type of of most polt clerosis is the worst of the two because you're you're you have it like basically all the time, and it's getting worse as it goes along. Yeah, and his would come together, his would come and fits and starts for the first period of years. Um, and it was that classic thing, I think where his flare ups would be like not so bad at one point and then kind of calmed down and then be really bad and then calm down. But the whole time there was a progressive thing going on to where he was. He was obviously worst case scenario, um, like couldn't walk in a wheelchair, couldn't talk, um, and that poor guy. Yeah, you know, the muscles fasticity is a big um hallmark of a kind of the worst kinds And that's when you're, um, you know, your body is just not communicating anymore, like well, no, that mile in sheath is exposed and so the the electrical impulses are going Hey, wires. So the muscles they're commanding are going hey wired too. Yeah, so he he, like I said, he walked with a cane for a little while, but eventually like just had to go, you know, lost tons of weight, eventually ended up in a wheelchair, and was his body was almost constantly in a state of muscle tension. You know. The ironic part about that is it sounds like his immune system was super healthy, which is how it was able to stage those massive attacks on on his poor mile in sheaths. Maybe you know, yeah, because you think if you had a weakish immune system, your MS wouldn't be quite as bad. Yeah, I guess I do, remember he thought about that. Yeah, it's really interesting and it's super cruel to see, um, like the body, like I said, the body turn on itself like that because Billy was very athletic and he was a good singer, and like it took away his ability to do all this stuff. Um, and it got so bad where he would um and it mentions it in this article about like even when you're eating, you have to be really careful because you can choke on your tongue or choke on food. Um. When he would get cracked up and laugh at us. It would like it would be you know, it would be good for him, but it would also be a little bit scary because he would his laugh would get out of control such where you had to worry about if you know, he had taken a sip of water or something, you could choke on it. Yeah, apparently that's one of the ways that people do die from complications of MS is choking because they have swallowing problems. Yeah, that was definitely, I mean, I don't remember the exact like literal cause of death at the end, but um you know, it just ravaged his body basically, so the other ones I saw where that your lung function, weakend. Muscle activity is one of the other main ways um uh, like an infection from a sore due to immobility can if not treated correctly, those things can lead to say like a blood infection and you can die from sepsis and then sadly, suicide is another leading cause of death among people who have MS. Something like six percent of fourteen percent of people with MS commit suicide. And one of the reasons why that's much higher than the population at large um is because one of the comorbidity ease of multiple sclerosis is depression, and it's apparently, from what I saw in my research, one of those things that's not widely recognized and therefore not widely treated enough as far as m S goes. That it's a it's apparently a big problem with it, and it can come from just being depressed that you have MS, because again the strikes you in the prime of your life, so you think about all the stuff you're missing out on because you have debilitating MS, or just the the mile in sheath coding regions of your brain. If you get legion lesions in the parts of your brain that regulate your mood, you can become Um, the physiology of your brain can lead to depression because of the changes there. Well yeah, I mean it does originate in the central nervous system, but um, it can in some cases affect like your memory, uh, your speech, your problem solving, and your higher brain function. I think it's it says in here like five have severe impairment of higher brain functions. So yeah, of course depression is gonna go along with that, you know, so we should we should say that for the most part, it's from what I saw, the vast majority of patients with multiple sclerosis don't die from it, they don't suffer major cognitive impairment as a result of it, and um, a lot of them don't even exhibit major symptoms for the most part. Yeah, I don't want to freak people out with Billy's story because he had the worst case scenario. But the diagnosis doesn't mean you're headed towards that. No. No, I just wanted to make sure that we were saying that. You know, I don't want to scare anybody, but we gotta get information out there, right because I mean, if there's one thing that would be really great if we could do with this episode, is if there's somebody out there right now who is starting to have migraines are tinkling in their arm, that they'll go to the doctor and catch it early. You know, absolutely, So let's talk about a treatment and stuff after your break. Huh, okay, alright. One of the things you can do one to you are diagnosed is get on drugs. Um. They've come a long way to do drugs, that's right. Uh. The drugs that they use to help treat them as have come a long way over the years. They're called disease modifying agents, and um, you know, they don't cure anything. But what they're trying to do is slow the progression or alter or suppress that immune system in such a way that it helps. Yeah. Yeah, and um, there's a lot of ways out there to actually treat the symptoms that are drug based and non drug based, but those disease modifying agents are the ones that actually alter the course of the multiple sclerosis. But like you said, they don't actually cure it. Although it is possible that there is a cure for it out right now, but it's new enough, it was just started in the late nineties, and it's so not so radical, um that it just hasn't been proven as a cure, but it's kind of looking like it might be. Yes, should we go ahead and talk about that. Yeah, So it's based on stem cells. Yeah, I mean, it's basically what they're doing is completely replacing your immune system, right, it's nuts. So back in the nineties, two doctors from Ottawa, Um, what provinces Ottawa in do you remember the Ontario, Well, let's just say Ottawa, Canada like Atlanta, USA. Uh. These doctors, Mark Friedman and Henry Atkins. They had this idea of basically reducing your immune system to nothing, so that when they managed to keep you alive, if they managed to keep you alive, when they restarted your immune system again by reintroducing some of your stem cells your hemeo poetic I want to say, stem cells, ye your own right, um, that it would build your immune system up again, and then they could watch the immune system restart MS and they'd be able to watch the disease progression from square one. But as one of them said in an interview, they failed miserably. But it's great that they did, because what they found was that when they devastated the immune system, brought it to zero, wiped it out, and then reintroduced your blood stem cells to the patient again, the MS didn't come back. In most of the people they tried this on. Yeh six remained relapse free for three years after three years and counting, and almost showed no sign of progression of the disease. Which is and then in that original I think UM study that Friedman and Atkins carried out, something like twenty three of the twenty four UM the disease was stopped in its tracks. And apparently these people had like a pretty bad bad cases of MS. This wasn't it wasn't a lightweight case of MS. Yeah. There's something called the Expanded Disability Status Scale, which basically kind of ranks how bad they are in terms of walking, dexterity, cognition. And they all had to rate between a three and a five point five on that scale, which is, you know, fairly severe, right, And so some people for twenty three out of twenty four in the original study, and I think, like you said, six and later studies, Um, the disease just stopped, that did not get any worse, even though these were progressive cases of MS. And in something like six of the twenty four they actually there the disease was walked back. So like the permanent damage apparently there's a rule of thumb among people with multiple sclerosis or doctors that if you have a symptom that doesn't get better or go away after a year, you can consider it permanent damage. That permanent damage was actually reversed in six of the twenty four patients by this incredibly radical procedure that seems to work. Yeah, like that they one of the doctors is, like, 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. Yeah, some of these people have been in remission for four teen years and for all intents and purposes, that's that's cured. It's amazing, it is. It's pretty great. But again it's also a very very risky procedure. What they're using in UM and I think the most current incarnation, i think it's called halt MS is the process, but it's based on those Autawa doctors discovery that you use five different kinds of chemotherapy to kill your immune system. And so obviously you have to be kept in isolation and everyone has to wear a crazy bio hazard suit around you, and they have you on anti microbials and it kills everything UM and they are trying to fight off any infection in Anyone who's ever stayed in the hospital knows the best place to get an infection is a hospital. So it's extraordinarily dangerous. But if you can survive, and if you have like a pretty bad case of MS, I'm guessing you'd be willing to try this UM it can cure you. Yeah, Billy would have tried this in a second. I guarantee it. Uh. They had twenty four volunteers initially between two thousand and six and two thousand and ten. For the first study, I think, oh no, no, this one was um, this was in Denver, So I guess are they doing follow up research? Yeah, this is a difference. So the one that you're talking about, that's the Halt study. UM. I'm not sure exactly what Freedman and Atkins called their technique, but as far as I know, they're the pioneers of wiping out your immune system and then replacing it to get rid of MS. Yeah. So I think I might have mixed together some of the stats for these two studies. But let's just say they're both very promising. Um. And you know who knows, like I don't. I don't know the procedure. I know we've talked about doing shows on medical testing and stuff, and the procedure like the stepping stones from here to like all right now, when is this going to be a thing? Um? But I mean it's so kind of dangerous and frought with complications. I don't know if they this can be super widespread, you know, I from what I'm seeing in the research, though, it has such positive backing. I think kind of across the spectrum that it's I think people are gung hollo about it, Like people should be able to decide if they want to take that risk, Like Billy was certainly in a position where he's like, it's not gonna get any worse for me, right, Yeah, Like I'm willing to take this chance and maybe die. Right. Uh. It's basically I guess what these volunteers are saying to make my life better. Yeah. I think one of the things that's probably staying in most people like that's way is the cost associated because I supposedly there's really just stupid loopholes that you have that regarding um stem cell therapies. Like like the article I sent you UM talked about a guy named Dave Bexfield and he was UM accepted to the study, willing to take the risks, and UM his insurance company was like, yeah, that's great, it's a stem cell um study, but we only cover stem cells that are that come from donors, and this study has stem cells that come from you, So you're gonna have to pay the two thousand dollars yourself. And he did. This guy got together, he's scraped together like a hundred and eighties six grand, which is what it costs to to carry out this trial for him specifically, And um, I guess afterward he went after his insurance company and got not only that money back, but like another two thousand dollars or something in interest and he's cured. So boom, I should say, and he's c worded. That's right. Uh. There are UM some other diseases that are sort of like MS, and there is debate in the medical community whether or not they want to actually classify them. There's something called clinically isolated syndrome, which means you can have an attack or a flare up or an episode UM from this de milonization. But it's just like one lesion. And sometimes you might develop MS, but not always. Sometimes it's just c I D. Yeah. I thought that was weird, and to me it is kind of suggests how incomplete and understanding science has of MS. Well, yeah, and like I said that, some people say, well, you shouldn't even call this MS, and some people say no, it's like maybe the mildest form you can get. Uh. What else, There's something called Marburg m s H shoulders diffuse sclerosis Belo concentric sclerosis and devits disease. They are all sort of in that UM range of what's called ideopathic inflammatory demylinating diseases. And children can get it too, even though it's pretty rare. Yeah, eight thousand cases in the US. And remember there's like four dred thousand of MS, but of pediatric multiple sclerosis UM, there's eight thousand of them, which is I mean talk about prime of life disease. Yeah, and I think it's even harder to diagnose in kids because that's certainly not something they're looking for, right, And we're like the drugs that they're using, it's it's like what we don't know what effects are going to have on kids. You know, it is the career worse than the disease because there's you know, we said that there's some disease altering drugs. There's a new one called O Crivous that is UM pending approval from the FDA but looks like it's going to go through, which is I think the first UH disease modifying agent that is shown to treat both progressive and relapsing forms of multiple sclerosis UM. And it goes after the immune system. I think it tries to suppress your B cells in the immune system. Um So, there's there's plenty of treatments that go after the disease, but there's also a lot of treatments that treat symptoms, right, and um one of the ones that are used are antidepressants and anti convulsants. And so there's a lot of questions like, should we be giving those two kids even though they have MS. What's the long term effect of giving antidepressants to a child whose brain chemistry is still in the beginning stages of development. Yeah, I mean, drugs can be wonderful, but there there's not a drug you can take that doesn't have some sort of other effect. And um, the benefits outweighing the side effects, Like you gotta take all this into consideration for anything, you know. One of the other things I saw about antidepressants, Chuck, was, um, they have figured out that they can use it to treat chronic pain. And one of the outcroppings from m S. So again, MS is like your body going haywire and really unique ways for each person with multiple sclerosis. Um So, it kind of in a way provides researchers ways to whenever the body does something it is not supposed to. It's a great place for researchers to go study the normal processes of the body. And one of the things they figured out is that in treating chronic pain with multiple sclerosis, um, you can use antidepressants. And the reason why is because apparently chronic pain and depression use a lot of the same neural pathways and create a lot of the same changes to the plasticity of the brain as one another, and that chronic pain and depression maybe in a lot of ways more related at least neurologically than chronic pain and acute pain, which seemed to be kind of different animals. Yeah, fascinating, I think so too. Have you got anything else? Uh? Yeah, you know, I think I would just advise anyone. And it's not just MSS, but like if you got a I wasn't the friend to Billy that I should have been towards the end, and it's fraught with regret, uh. And part of that is because life gets in the way, uh. And part of it is just you know, it's not the easiest thing to face as a friend. And I think what I did was I let myself off the hook too easily. For that stuff, which I feel really crappy about now, like try to overcome that. If you have something like this going on. That's good advice, man, That's what I will say. I swore I wasn't gonna do this. Are you missing? Yeah, it's it's It was very hard and I wasn't the friend I should have been. And my friend Eddie was great and stood by Billy, and uh, I went and saw him at the end in the hospital, but it was you know, I had a lot of regret about the final years and not going to see him. You should have and it's understandable. Man. Yeah, I think you just did some sort of absolution though. Well we'll see. Well, if you want to know more about multiple sclerosis, you could type those words into the search part how stuff works dot com and it will bring up this article. Um. And since I said that and Chuck is missing, it's time for listening mail. That means it's Wednesday. Uh, this is on empathy a little bit too. Um. Hey, guys listening to empathy right now. I had a pause to say thank you when you were talking about the study relating to autism and alex athemia. Uh, you listed four groups studied as individuals with autism and alexothemia, individuals with autism, um uh without alexithemia, individuals with alexithemia but not autism, and then people who didn't have either one. Growing up as a sister of a guy with autism, I can tell you how many times I've heard people describe individuals without autism as normal people. It's such a lazy way to describe a group who doesn't exhibit just one of a multitude of other characteristics, and frankly, it's demeaning and rude. So thank you for not being those guys. You're always careful in your wording, so I shouldn't be surprised, But having thirty years plus experience hearing normal people condition me to brace myself when you started the list inclusive language for the wind keep up the great work. That is from Megan is isgin in Indianapolis? And she said, psh, Indianapolis is no Seattle, but maybe come to the Circle City sometime. Oh nice, up uh, and we I think we have been batting around the idea of in Indianapolis show, so yeah, hopefully it will happen. Thanks a lot, Megan. That was very nice of you. We appreciate the kudos. Um And if you want to get in touch with this, like Megan and tell us to come to your city, you can tweet to us We're at s Y s K podcast or josh um Clark Uh. You can hang out with us on Facebook dot com slash stuff you Should Know or Facebook dot com slash Charles W. Chuck Bryant. You can send us an email stuff podcast at how stuff Works dot com, and as always, join us at our home on the web, stuff you Should Know dot com For more on this and thousands of other topics. Is it how stuff Works dot com