Aaron Boster

Just the ethnicity alone, there is a difference in severity of disease, even when you parse out like socioeconomic things and the like.

So if you and I were to go for a stroll and I attached weights to your feet and you kept time with me, so we're walking in step together.

At the end of our stroll, and you finished at the same time I did, you're exhausted, way more tired than I am because you were dragging weights behind the whole time we were walking.

When you look at where the brain damage occurs in the setting of multiple sclerosis, it's most commonly in the so-called white matter.

Now, the white matter are the wires connecting the parts of the computer.

So when one side of the brain, the cortex, the thinking part, wants to communicate with the other side, it sends electrical messages through the wires, the white matter.

And when you have new lesions, that's a doctor term for like the white spot, the area of brain damage that you can see on the MRI, the brain rewires around it.

Oh.

And so, yeah, what ends up happening is the brain repairs itself to the best of its ability and the human being can continue to do whatever function that is, but they use a boatload more brain to get the job done.

To make that point, a long time ago, I was an assistant professor at a university, and we were doing a really cool study where we put people into a functional MRI machine, and we had them wiggle their finger.

And if a, quote, healthy control wiggled their finger, you would see the contralateral motor cortex light up like in a textbook, like normal stuff.

When someone with MS wiggled their finger, both sides of the brain lit up like a Christmas tree.

They were using tremendous amounts of brain to get the job done.

Now, many of them were able to do it just as fast, just as accurately as a healthy control.

But coming back to this fatigue thing, it's my opinion, at least to some degree, that the reason that someone with MS suffers from such profound fatigue, the most common symptom in MS, is because in order for them to get the job done, they're using a lot more brain.

They're using a lot more real estate.

It's such a good point.

I'm really glad that you brought it up because the vast majority of pathology in MS is invisible.

And honey, you look so good is a very common comment.

And a really savvy patient will say, I'm not faking sick, I'm faking well.