Have you or someone you know ever experienced numbness in your body, difficulty walking, or a sudden change in personality? While these may seem like common things, sometimes there can be a serious reason behind them. Today we are going to talk about one such very rare, but very serious brain infection. This is called Progressive Multifocal Leukoencephalopathy , or PML for short.
Simply put, what is PML?
PML is a very serious and rare infection that affects our brain. The main reason for this is that our body's ability to fight disease, that is, the immune system, is very weak.
Now look, our brain has a protective covering around the nerve cells. It's like the plastic sheath around an electric wire. We call this myelin . This myelin sheath helps messages travel through the nerves quickly and accurately. When PML occurs, this myelin sheath is damaged. It's like the plastic sheath on that wire melts. Then the messages in the brain don't travel properly, which causes problems with walking, thinking, and feeling.
This disease is caused by a virus called the JC virus . Surprisingly, about 85% of adults carry this virus in their bodies without any problems. As long as our immune system is strong, this virus remains silent. But if our immune system is severely weakened, this virus suddenly becomes active and starts attacking the brain.
The most important thing is that PML is not a contagious disease. This means that a person with PML cannot spread the disease to another person.
What are the symptoms of PML?
The symptoms of PML can vary depending on where in the brain the damage is. Let's take a look at the early and late symptoms of this disease.
| Characteristic type | Commonly seen symptoms |
|---|---|
| First Signs |
|
| Later Signs |
Who is most at risk of developing this disease?
This is a very rare disease. It usually affects about one in two hundred thousand people. But some people are at higher risk. Let's see who they are.
- People infected with HIV/AIDS: Because this disease directly attacks the immune system.
- Some cancer patients: Especially those with blood-related cancers such as leukemia and lymphoma.
- Organ transplant patients: When an organ (such as a kidney or liver) is transplanted from someone else, they are given immunosuppressants to prevent the body from rejecting it. These people are also at higher risk.
- People taking medications that alter or suppress the immune system: There are some diseases in which our own immune system attacks our own body. Examples include diseases such as multiple sclerosis, Crohn's disease, rheumatoid arthritis, and lupus. Some medications used to treat these conditions may increase the risk of developing PML.
Some studies have shown that people with certain gene variations are more likely to develop PML when taking these immunosuppressant drugs. Therefore, you may want to talk to your doctor about having genetic testing done before starting these medications.
How to accurately diagnose the disease?
If your doctor suspects PML based on your symptoms, he or she will recommend several tests.
1. MRI scan: This is the most important test. An MRI machine can take very clear, detailed pictures of the brain. It can clearly see the areas (lesions) where the myelin in the brain has been damaged due to PML.
2. Lumbar Puncture: This involves inserting a very thin needle into the back of the neck and taking a small sample of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid). This fluid can be tested to see if the JC virus is present.
3. Brain Biopsy: This is done very rarely, and only if other tests are inconclusive. In this, a very small piece of tissue is surgically removed from the brain and examined under a microscope.
How is PML treated?
The most important thing in treating PML is to treat the condition that caused your immune system to weaken.
- Suppose you developed PML due to HIV. Then you need to use antiretroviral therapy (anti-HIV drugs) correctly and rebuild your immunity.
- If you developed PML due to an immunosuppressive medication, you should immediately talk to your doctor to decide whether to stop or change the medication.
- Sometimes, a treatment called plasma exchange is used to remove these immunosuppressive drugs from the blood. This gives the immune system the strength to fight the JC virus again.
Research is still ongoing into drugs that work against the JC virus itself, but no effective drug has yet been found.
Unfortunately, the white matter, or myelin, of the brain that is destroyed by the virus does not regenerate. Therefore, even after the disease has resolved, some symptoms (e.g., numbness, memory loss) may persist for life. This is similar to the long-term effects of a stroke.
Take-Home Message
- PML is a very rare but serious brain infection.
- This only occurs in people with very weak immune systems. A healthy person has no reason to worry about this.
- The JC virus that causes this lives in most of our bodies without causing any harm.
- If you are taking medications that suppress your immune system (e.g., for cancer, arthritis, MS), inform your doctor immediately about any new neurological symptoms you experience (numbness in your arms, difficulty walking, difficulty speaking).
- Early detection and treatment to rebuild immunity can help control the further spread of the disease.
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