Understanding multiple sclerosis and the FAA requirements

A diagnosis of the neurological condition known as multiple sclerosis raises many questions for a pilot. What is this condition and how does it affect your medical certification?

Multiple sclerosis, or MS, is a disease that affects the central nervous system. The brain has difficulty getting messages to the rest of the body. Researchers feel that MS is an autoimmune disease. The body’s immune system attacks myelin, which is the insulation covering of the nerve cells. When one’s myelin erodes, the communication between your nerve cells becomes broken and the instructions that are sent to parts of the body are not received. This can affect almost everything that the body does.

What are the types of MS?

  1. The most common type, affecting about 85 percent of those with the condition, is called relapsing-remitting. The MS will come and go over time. Individuals will get symptoms and then the symptoms disappear.
  2. When a person develops MS and the symptoms do not go away, this is called secondary-progressive.
  3. There are those who develop MS later in life and begin a slow decline. This type is called primary-progressive.
  4. In another form, individuals will develop symptoms and progress slowly in the beginning, but then begin to worsen over time. This last type is called progressive-relapsing.  

What can cause MS?

Among people who have a close family member with the disease, such as a brother, sister, father, or mother, there can be up to a four percent chance of also developing the disease.

Interestingly, people who live near the equator have a lower incidence of developing MS.

The more common belief as to the cause of MS is that one’s immune system causes the disease by attacking the myelin. Researchers are evaluating whether bacteria or viruses affect the response that leads to MS. MS most commonly affects people ages 20 to 40, but it can present at any age. It is more common in women.  

Symptoms that one may experience include problems with balance, numbness and tingling of the arms and legs, disturbances in vision, loss of bladder or bowel control, spasm in muscles, or even problems with thinking.  

The tests that commonly support a diagnosis of MS are MRIs of the brain and spinal cord. These studies show abnormal lesions in the nervous system.. The neurologist will usually perform a spinal tap (lumbar puncture) where a small sample of fluid is removed from the canal that surrounds your spinal cord and brain. The sample will be studied for the number and types of white blood cells (cells that fight infection) and the levels of glucose and proteins, especially immune system proteins called antibodies or immunoglobulins. In MS, the spinal fluid will contain large amounts of these proteins.    

So, if you have this condition, what does the FAA want and what treatments are acceptable?

The medical certification physicians want to see a good current report from the treating neurologist that describes how the condition presented, the number of times it recurred, and what treatment was provided and whether there have been any side effects of the treatment. They will want to see the reports from the MRI of the brain and spinal cord and the results of the spinal fluid analysis. 

What are some of the FAA’s acceptable medications that can be used?

Interferon beta 1a is an antiviral, antiproliferative immune regulatory protein. Copaxone (glatiramer), a synthetic amino acid copolymer, may work through immune modulation. Gilenya (fingolimod) blocks lymphocytes' (a type of white blood cell) capacity to leave the lymph nodes and reduces the lymphocyte count in the blood. The actual mechanism by which fingolimod affects multiple sclerosis is unknown, but it may reduce the ability for lymphocytes to get into one’s central nervous system. Tecfidera (dimethyl fumarate) works by eliciting effects on the immune system, but its exact mechanism on MS is also not fully understood. Aubagio (teriflunomide), inhibits the function of specific immune cells that are implicated in MS. Aubagio can inhibit a key enzyme that is required by white blood cells (lymphocytes), which in turn reduces the production of immune cells that are active in MS.

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