Overview of Demyelination

When the Protective Layer That Surrounds Nerves Is Impaired

By Olivia Guy-Evans, published Feb 10, 2022

Fact checked by Saul Mcleod, PhD

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What is demyelination?

Demyelination is where the myelin sheath surrounding the axons of the nerve cells becomes damaged or worn away. 

Some conditions and illnesses can cause a loss of myelin, through wearing it away or damaging these protective layers. Damage to the myelin is called demyelination.

Demyelination can slow down the speed of messages being communicate between neurons and causes the axons to deteriorate. This can lead to the neurons weakening which can cause problems in the brain and throughout the nervous system, including the spinal cord and peripheral nerves.

Some neurological deficits as a result of demyelination include vision changes, weakness, altered sensation, and behavioural or cognitive problems.

Some of the symptoms of demyelination can be temporary and recovery is possible, whereas other conditions can be more serious and even life-threatening. 

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Symptoms

The symptoms that are experienced by demyelination depend on the condition and where in the nervous system the demyelination has occurred.

The symptoms of demyelination correspond to the area of the nervous system affected, for instance peripheral neuropathy affects the hands and feet.

Demyelination affecting the lower spine or spinal nerves can cause problems of the legs, bowel, and bladder. Whereas demyelination in the brain can cause a variety of cognitive problems or issues with vision. 

Not everyone who is affected by demyelination have the same symptoms, although some are very common. Early signs which are among the first symptoms of demyelination include:

• Loss of vision

• Unusual nerve pain

• Bladder or bowel problems 

• Overall fatigue 

Depending on the condition, the symptoms of demyelination may come and go, or they may gradually worsen. In multiple sclerosis for instance, which is a common chronic condition, the symptoms can come and go and progress over the years.

Below are some of the common areas where demyelination can cause impairments, and how they affect different parts of the nervous system:

Vision

Demyelinating conditions can lead to blurry or double vision. They can also result in a loss of vision that can be either temporary or permanent depending on the severity of the demyelination. 

Reflexes and movement

Demyelination can cause changes to the motor system which can lead to muscle weakness, stiffness, uncoordinated movements, and problems with balance.

This can ultimately affect how someone moves, meaning that they may not be able to perform some motor tasks or find it harder to walk, speak, or swallow. 

Sensations 

Those with demyelinating conditions may experience numbness and tingling, burning, or prickling sensations in their arms, legs, or feet.

In some cases, they may even feel pain when touched lightly which can make it extremely difficult for navigating life as normal. 

Cerebellum 

The cerebellum is a part of the brain that plays a role in controlling balance and coordination. Demyelination in this area can lead to tremors or incoordination such as finding it harder to walk without losing balance. 

Genitourinary system

Some people with demyelinating conditions may experience problems with urination and bowel movements. This can also affect sexual health and make someone more likely to develop a urinary tract infection (UTI). 

Mood and thinking

There may be changes in mood associated with demyelination, such as many experiencing depression, anxiety, and irritability.

There may also be problems with thinking such as memory issues and a loss of focus, with some taking longer to process their thoughts. 

Blood pressure and heart 

In some cases, demyelination may result in people having poorer control over their blood pressure, as well as having a racing heartbeat or palpitations with no apparent cause. 

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Causes of demyelination

Demyelination occurs when there is a loss of myelin. When there is a deficiency or a sudden decrease in myelin, the nerves may not be able to function at all, resulting in the neurological problems associated with demyelination. 

There are different types of demyelination, the most common being inflammatory. Inflammation can result from an immune response that goes wrong and causes the body to attack its own tissues, becoming an autoimmune condition.

Types of demyelination conditions such as multiple sclerosis (MS) are caused by inflammation in the brain and spinal cord, resulting in the body’s immune system attacking the myelin.

Another condition known as Guillain-Barre syndrome (GBS) involve inflammatory demyelination of the peripheral nerves in other parts of the body. 

Demyelination can also be caused by viral infections. Viral demyelination occurs with progressive multifocal leukoencephalopathy (PML), another demyelinating condition.

PML is caused by the JC virus, a common germ which more than half of adults have been exposed to and usually does not cause problems but can be dangerous to those with a weak immune system.  

Aside from inflammatory and viral causes, in some cases the cause of demyelinating conditions is unclear, although they can result from the following risk factors:

• Genetics 

• Damage to blood vessels in the brain

• A lack of oxygen to the brain

• Nutritional deficiencies 

• Toxicity 

Damage to myelin can also occur alongside:

• Alcoholism 

• Liver damage 

• Electrolyte imbalances

• Vascular disease

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Diagnosis

Demyelinating conditions can be diagnosed through using different methods. However, sometimes the signs and symptoms can be confusing, and it may take a long time to determine the type and cause of demyelination. 

A medical history is usually established to understand if there are any genetic disorders which could explain why someone is experiencing symptoms of demyelination.

The healthcare provider will ask details about how long the symptoms have lasted, whether they have been experienced in the past, and whether the person has recently had an infection. The person will likely be asked about other symptoms being experienced such as pain, nausea, vomiting, and fevers. 

A physical examination will usually be completed to check the muscle strength, sensations, coordination, and the ability to walk. Depending on the symptoms, an ophthalmologic exam may be necessary, in which the healthcare provider looks at the eyes to see if demyelination has occurred in the optic nerves.

Physical exams are useful for establishing whether the brain, spine, optic nerves, or peripheral nerves have been affected. 

In some instances, brain imaging techniques may be necessary to diagnose a demyelinating condition. Brain or spine imaging such as magnetic resonance imaging (MRI) can often identify areas of demyelination in the central nervous system.

Often, there are patterns of demyelination that correspond to different conditions. Demyelinating conditions such as multiple sclerosis and optic neuritis (inflammation of the optic nerve), are detectable with MRI scans. MRIs can reveal demyelination plaques in the brain and nerves. 

There are also some types of non-invasive diagnostic tests that can be used to identify the effects of demyelination on the peripheral or optic nerves:

• Electromyography (EMG) – this is done as part of a neuropathy evaluation. This test is used to measure the muscle’s response to nerve stimulation. 

• Nerve conduction studies (NCV) – alike to EMG, NCV studies are completed to evaluate peripheral neuropathy. This type of test measures how fast the nerves conduct electrical signals. It involves direct stimulation of the nerve by shock-emitting electrodes that are placed on the skin directly over the nerve. 

• Evoked potentials - these tests are used to measure the brain’s response to certain stimuli. Visual evoked potentials, for instance, measure the brain’s response to light and other visual stimuli. 

• Lumbar puncture (LP) – often referred to as spinal tap, this test allows the examination of cerebrospinal fluid (CSF). CSF often shows signs of infection or inflammatory disease, and the result can be used to assist in the diagnosis of demyelinating conditions. 

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Demyelinating disorders

Treatment 

The treatment options for demyelination depends on the conditions and the severity of symptoms. Currently, there are no treatments that effectively restore or rebuild myelin, but usually myelin will often regenerate on its own.

The growth of new myelin can occur in areas of damage, although this myelin is often thinner and not as effective. If there is little or no nerve damage, the symptoms can resolve, and recovery from the symptoms of demyelination is possible.

Treatments for demyelinating conditions work to reduce the immune response, are focused on managing the symptoms, and in preventing further demyelination. 

Below are some of the ways in which demyelination can be treated:

Immunosuppression 

Being able to prevent the inflammation of many conditions such as MS, ADEM, and GBS is a key part of the treatment. Many of these conditions are treated with a brief course of intravenous steroids or plasma exchange.

Plasma exchange is a common treatment which involves removing some of the liquid part of the blood called plasma and replacing it with a manmade version. Plasma exchange is a common treatment for GBS.

Since MS is chronic, it can be managed with disease-modifying therapy (DMT). Steroids and DMTs work through suppressing the immune system to prevent further inflammation destruction on the myelin.

It is advisable that DMT is prescribed from the earliest possible stage which is when the treatment appears to be the most effective. 

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Treatment for symptoms

Since people with demyelinating conditions often experience a lot of different symptoms, these symptoms can be targeted in treatment to help make the condition more bearable.

For instance, medication to help control the pain and discomfort surrounding a person’s condition, medications for associated anxiety and depression, and medication for bladder dysfunction, can all be used to improve the quality of life of these individuals.

For CMT for instance, whilst there is no known cure and it is progressive, medications can be given for the pain.

Supplements 

There is thought to be an association between demyelination and nutritional deficiencies, specifically with B12 and copper. Therefore, supplementing these nutrients to recommended levels may be an important treatment strategy.

Therapy 

For many people with demyelinating conditions, rehabilitation therapy is the key to recovery. Physical therapy, occupational therapy, balance therapy, speech or swallow therapy are types that can all help to either recover from or to help someone cope with their condition.

The treatment for CMT especially, focuses heavily on physical and occupational therapy, with interventions to help the person to learn to use their affected limbs again, maintain flexibility, muscle strength, and ways to perform daily tasks.

Physical therapy can also help with coordination and balance problems which are prevalent in many conditions of demyelination.

APA Style References

Railton, D. (2021, November 28). What is demyelination, and what causes it? Medical News Today. https://www.medicalnewstoday.com/articles/318750

Apetauerova, D. (2021, September 20). An Overview of Demyelination. Very Well Health. https://www.verywellhealth.com/demyelination-4691934#toc-causes 

Healthline Editorial Team. (2019, October 1). Demyelination: What Is It and Why Does It Happen? Healthline. https://www.healthline.com/health/multiple-sclerosis/demyelination

Reiff Ellis, R. (2020, August 9). What Are Demyelinating Diseases? WebMD. https://www.webmd.com/multiple-sclerosis/what-are-demyelinating-disorders  

National Multiple Sclerosis Society. (n.d.) Understanding MS. Retrieved 2022, January 10, from https://www.nationalmssociety.org/What-is-MS/MS-FAQ-s 

Centers for Disease Control and Prevention. (2019, December 20). Guillain-Barré Syndrome. https://www.cdc.gov/campylobacter/guillain-barre.html