Every five minutes, someone in the world is diagnosed with multiple sclerosis (MS). This disease affects more than 2.8 million people worldwide, including 55,000 in Spain. It usually appears between the ages of 20 and 40 and is the second leading cause of disability in young people, surpassed only by road traffic accidents. Around three out of every four people affected are women.
MS is a neurodegenerative disease of autoimmune origin that affects the central nervous system – the brain and the spinal cord. In people with MS, the immune system, which normally protects us, mistakenly attacks the myelin and axons of our nerve cells, known as neurons. Myelin is a substance that coats the axons and allows nerve impulses to be transmitted properly. When this “insulating layer” and the nerve fibres are damaged, lesions or plaques appear that interrupt communication between the brain and the rest of the body, leading to a wide range of neurological symptoms and progressive disability.
Known as "the disease with a thousand faces", MS presents differently in every person. No two cases are alike: each individual experiences a unique combination of symptoms and progression. These symptoms may include fatigue, vision problems, cognitive changes, spasticity, pain, balance issues, bladder and bowel dysfunction, and difficulties walking or speaking, among others. This variability makes diagnosis more challenging and means the impact on quality of life varies greatly from one patient to another.
Although its exact cause remains unknown, experts consider MS to be a multifactorial condition involving both genetic and environmental factors. It is more common in countries further from the equator, suggesting a link with lower sun exposure and reduced vitamin D levels. Other risk factors have also been identified, such as smoking, a sedentary lifestyle, and the composition of the gut microbiota, which may influence how the immune system is regulated.
Despite there being no definitive cure, current treatments can alter the course of the disease, reduce the frequency of relapses and slow the progression of disability. Disease-modifying therapies have transformed the outlook for many patients, especially when started early. In addition, there are treatments available to manage relapses and symptoms, as well as rehabilitation programmes that include physiotherapy, occupational therapy and psychological support.
Research into MS is advancing rapidly and opening up highly promising pathways. In this debate, three experts will help us better understand the disease and the latest scientific developments. Has the number of cases truly increased, or are we simply diagnosing it better? Is it hereditary? What is the link between sun exposure and the risk of developing MS? Why does it affect women more than men? What role does the Epstein–Barr virus play in its development? Are there treatments capable of slowing its progression? Can artificial intelligence help us diagnose and treat the disease more effectively? Are we close to achieving a cure or a preventive vaccine?
Early diagnosis and the prompt start of effective treatment are essential to improving outcomes. In this vein, Pablo Arroyo is co-leading a project using artificial intelligence to predict the course of the disease by analysing clinical, laboratory and imaging data. This tool will help identify patients at higher-risk of progression, enabling earlier therapies to be introduced, tailored to individual needs.
Meanwhile, Pablo Villoslada is leading research focused on neuromodulation. His team is developing a device that applies low-intensity focused ultrasound to the spinal cord, with the aim of stimulating nerve cells and promoting the repair of myelin. This non-invasive technique, used alongside pharmacological treatments, could slow disease progression, promote neuronal regeneration and improve symptoms such as mobility and bladder control.
One of the most significant discoveries in recent years is the link between MS and the Epstein–Barr virus, which causes glandular fever. Nearly all people diagnosed with MS have been exposed to this virus, suggesting it may act as a trigger in individuals with a genetic predisposition. For neurologist Mar Tintoré, a leading international expert in the disease, this finding offers a glimmer of hope: a vaccine against the virus could prevent many cases in the future. She also highlights the importance of early diagnosis and healthy lifestyle habits as key factors in improving patients’ long-term outcomes.
Thanks to advances such as these, the outlook for MS is changing dramatically. Today, the condition is no longer seen as an inevitable sentence of disability. Treatments have succeeded in reducing the frequency of relapses by up to 80 %, and increasingly safer and more effective therapies are being developed. However, research continues: much remains to be understood about the underlying mechanisms of the disease, and the major challenge for the future will be not only to halt its progression, but also to repair the damage already done.
Speakers:
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Pablo Villoslada, head of the Neurology Department at Hospital del Mar and director of the Neurosciences Programme at the Hospital del Mar Research Institute (IMIM).
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Pablo Arroyo-Pereiro, neurologist at the Multiple Sclerosis Unit, Department of Neurology at Bellvitge University Hospital (HUB).
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Mar Tintoré Subirana, clinical head of the Multiple Sclerosis Centre of Catalonia (Cemcat) and of the Neurology/Neuroimmunology Department at Vall d’Hebron University Hospital (VHIR), and professor of Neurology at the Universitat de Vic – Universitat Central de Catalunya (UVic-UCC).
Moderator:
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Jessica Mouzo, journalist at El País specialized in health.
Projects supported by ”la Caixa” Foundation:
