To mark National Multiple Sclerosis Day, observed every year on 18 December, it is timely to provide an update on this chronic neurological condition, which continues to have a major impact on healthcare, society and working life in Spain.
According to the Spanish Ministry of Health’s specific guidance on the management of multiple sclerosis, published as part of the National Health System’s Strategy on Neurodegenerative Diseases, an estimated 58,510 people in Spain are living with multiple sclerosis. The average prevalence is 123 cases per 100,000 inhabitants, while the annual incidence is 4.2 new cases per 100,000 inhabitants. This equates to around 1,900 new diagnoses each year, or approximately 158 per month. In addition, 68% of those diagnosed are women, and the average age of onset is around 32.
The Spanish Society of Neurology has also warned of the condition’s growing impact on health and social care, noting that multiple sclerosis usually develops between the ages of 20 and 40, affects women more frequently and is one of the leading causes of neurological disability in young adults.
Multiple sclerosis is a chronic autoimmune, inflammatory, demyelinating and neurodegenerative condition of the central nervous system. In people with the condition, the immune system attacks structures in the brain and spinal cord, particularly myelin, the substance that surrounds and protects nerve fibres. When myelin is damaged, the transmission of nerve impulses may be disrupted, slowed or blocked. The World Health Organization states that the condition can affect cognitive, emotional, motor, sensory and visual functions.
Causes of and risk factors for multiple sclerosis
Although the exact causes remain unknown, current evidence suggests that multiple sclerosis is a multifactorial condition involving genetic, environmental and lifestyle factors. The Spanish Ministry of Health highlights several associated factors, including low exposure to ultraviolet radiation, low vitamin D levels, certain previous infections — particularly those caused by herpesviruses, such as the Epstein–Barr virus — smoking, obesity and physical inactivity.
Low vitamin D levels have been associated with an increased risk of developing multiple sclerosis, as well as a higher risk of relapse following diagnosis.
Most common symptoms of multiple sclerosis
Multiple sclerosis is a highly heterogeneous condition: symptoms vary from person to person, may change over time and depend on which areas of the central nervous system are affected. The most common manifestations include fatigue, visual problems, muscle weakness, difficulty walking, stiffness, spasms, tingling, numbness, balance problems, urinary symptoms, emotional changes and cognitive symptoms such as difficulty concentrating, memory problems or slower information processing.
Current management is based on early diagnosis, specialist neurological follow-up, disease-modifying treatments where appropriate, symptom management, physical and cognitive rehabilitation, psychological support and multidisciplinary care. The European Medicines Agency assesses multiple sclerosis treatments across several areas: modifying disease progression, treating relapses, promoting repair or functional restoration, and improving symptoms.
New avenues of research into multiple sclerosis
Research into multiple sclerosis is progressing in several areas. The Spanish Ministry of Health identifies key fields including immunological, genetic, neurobiological, environmental and epidemiological research, as well as neurorehabilitation. Areas of particular interest include myelin regeneration, neuroprotection, biomarkers, the role of the Epstein–Barr virus, environmental factors, vitamin D and the gut microbiota.
The gut microbiota is one of the emerging areas of research. It is being studied because of its potential interaction with the immune system and its possible involvement in inflammatory and anti-inflammatory responses. However, although modulating the microbiota has been proposed as a potential future therapeutic strategy, the Spanish Ministry of Health’s document cautions that there is not yet enough evidence to support this conclusion.
Why is there interest in certain mushrooms in their pure form in relation to multiple sclerosis?
In recent years, interest in certain mushrooms and fungal extracts has grown due to their content of polysaccharides, beta-glucans and other bioactive compounds. Some edible mushrooms, such as shiitake and oyster mushrooms, can form part of a balanced diet and provide fibre with potential prebiotic effects. However, in the context of multiple sclerosis, it is important to avoid claims suggesting that mushrooms can treat, slow or reverse the condition.
With regard to Hericium erinaceus, commonly known as lion’s mane, preclinical and in vitro studies are exploring its potential effects on cells involved in myelination. For example, research indexed in NIH scientific databases has described the effects of Hericium extracts or compounds on oligodendrocyte maturation and myelin markers in experimental models. This area of preclinical neuroprotection research is of considerable interest and is likely to expand over the coming years.
Conclusion
Multiple sclerosis is a complex, chronic and highly heterogeneous condition. However, its prognosis has changed over recent decades thanks to earlier diagnosis, improved monitoring and the availability of disease-modifying treatments.
Emerging areas of research — including vitamin D, the Epstein–Barr virus, the microbiota, biomarkers, neuroprotection and myelin regeneration — offer promising new avenues, although caution is still needed until more robust evidence becomes available.