Multiple sclerosis: What you need to know

Multiple sclerosis is a chronic disease affecting the central nervous system, particularly the brain, the spinal cord and the optic nerves. This can contribute to a large variety of symptoms across the body.

It is not possible to predict how any person will experience progression of multiple sclerosis (MS).

Many may have mild symptoms, including blurred vision and numbness in the limbs and tingling. In severe cases , an individual may experience paralysis, loss of vision and problems with mobility. That is, however, rare.

It is impossible to say precisely how many people have MS. 250,000–350,000 people in the United States live with MS according to the National Institute for Neurological Disorders and Stroke (NINDS).

The National Society for Multiple Sclerosis estimates the number could be nearer to 1 million.

Newer treatments, however, are proving effective in slowing down the disease.

What is MS?

Pain, weakness, and tingling are common symptoms of MS.
Pain, weakness, and tingling are common symptoms of MS.

Researchers do not know precisely what causes MS, but they agree the central nervous system ( CNS) is an autoimmune disease. If a person has an autoimmune disease, the immune system attacks healthy tissue, just like a virus or bacteria may be targeted.

In the case of MS, the immune system is destroying the myelin sheath that covers the nerve fibers and protects them, causing inflammation. Myelin also helps the nerves to quickly and efficiently conducte electrical signal.

Multiple sclerosis means “Multiple Area scar tissue.”

It leaves a scar, or sclerosis, when the myelin sheath disappears or sustains damage in several locations. Physicians also call plaques or lesions on these regions. They are mostly affected by:

  • the brain stem
  • the cerebellum, which coordinates movement and controls balance
  • the spinal cord
  • the optic nerves
  • white matter in some regions of the brain

Nerve fibers can break or get damaged as more lesions develop. As a consequence the brain’s electrical impulses do not flow easily through the target nerve. This means the body would not be able to perform other functions.

Types of MS

Four types of MS do exist:

Clinically Isolated Syndrome (CIS): It is a single, first episode with at least 24 hours of symptoms. A doctor can treat relapse-remitting MS if another episode happens at a later date.

Relapse-remitting MS (RRMS): This is the most common form, affecting about 85 per cent of people with MS. RRMS includes episodes of new or increasing symptoms, followed by periods of remission, during which symptoms partially or totally disappear.

Primary progressive MS (PPMS): Symptoms slowly intensify, without early recurrences or remissions. Many people may experience stable times and periods when symptoms worsen, and then improve. About 15 percent of MS-patients have PPMS.

Secondary progressive MS (SPMS): people may have periods of recurrence and relapse at first, but eventually the condition can continue to advance gradually.

Symptoms

Vision changes can be an early sign of MS.
Vision changes can be an early sign of MS.

Because MS affects the CNS which controls all of the body ‘s actions, symptoms can affect any part of the body.

The most common MS signs are:

Muscle weakness: People may develop weak muscles due to nerve damage due to lack of use or stimulation.

Numbness and tingling: A feeling of the form of pins and needles is one of the earliest symptoms of MS which may affect the face, body, or arms and legs.

Sign of Lhermitte: When a person moves his arm, known as the sign of Lhermitte, he can feel a sensation like an electric shock.

Bladder problems: a person may have trouble emptying the bladder, or urinating regularly or unexpectedly (urge incontinence). Loss of control at the bladder is an early sign of MS.

Bowel problems: Constipation can cause fecal impaction, which may contribute to incontinence of the intestines.

Fatigue: This may weaken the ability of a person to operate either at work or at home. Fatigue is among the most prevalent symptoms of MS.

Dizziness and vertigo: These are common symptoms, along with symptoms of balance and coordination.

Sexual dysfunction: Males and females can lose sexual interest.

Spasticity and muscle spasms: This is an early sign of MS. Damaged nerve fibers in the spinal cord and brain, especially in the legs, can cause painful muscle spasms.

Tremor: Some people with MS can experience involuntary quivering movements.

Vision issues: Many people may experience double or blurred vision, partial or total loss of vision, or distortion of red-green colour. Normally this affects one eye at a time. Optic nerve inflammation may cause pain while the eye is moving. Problems with vision are an early symptom of MS.

Changes in gait and mobility: MS may change the way people walk, due to muscle weakness and balance, dizziness, and fatigue problems.

Emotional changes and depression: Demyelination and damage to the nerve fibers in the brain can cause emotional changes.

Problems with learning and memory: This can make focusing, preparing, learning, prioritizing and multitasking difficult.

Pain: Pain is a common symptom of MS. Neuropathic pain is caused directly by MS. Certain forms of pain are caused by muscle fatigue or stiffness.

Less common symptoms include:

  • headache
  • hearing loss
  • itching
  • respiratory or breathing problems
  • seizures
  • speech disorders
  • swallowing problems

There is also a higher risk of:

This can affect the work and social life of an person.

People can experience changes in perception and thinking in the later stages, and heat sensitivity.

MS affects people differently. For others, it begins with a mild feeling and for months or years, their symptoms are not improving. Symptoms sometimes get worse quickly, within weeks or months.

A few people will have only minor symptoms and most people will experience major changes leading to disability. And, when symptoms escalate, most people will experience periods, and eventually get better.

The sign of Lhermitte is a typical symptom of MS occurring when a person moves his or her head.

Causes and risk factors

Researchers have no clear idea of what causes MS, but risk factors include:

Age: The majority of patients get a diagnosis between the ages of 20 and 40.

Sex: Some types of MS appear to affect women twice as often as men.

Genetic factors: Susceptibility can transmit in the genes, but scientists also agree that an environmental stimulus is necessary for the development of MS, even in people with specific genetic characteristics.

Smoking: People who smoke tend to be more prone to grow MS than non-smokers. They appear to get more tumors and brain shrinkage.

Infections: Virus exposure, such as Epstein-Barr virus (EBV), or mononucleosis, may increase a person’s risk of developing MS, but a definite correlation has not been found in research. Certain viruses that can play a role include type 6 human herpes virus (HHV6) and pneumonia to the mycoplasma.

Vitamin D deficiency: MS is more common in people with reduced access to bright sunlight, which the body requires to produce vitamin D. Some experts think low vitamin D levels can influence how the immune system functions.

Deficiency of vitamin B12: The body uses vitamin B in the development of myelin. A deficiency of this vitamin, such as MS, may increase the risk of neurological illness.

Previous theories involved exposure to canine distemper, physical damage, or aspartame, an artificial sweetener.

MS probably does not have a single cause but multiple factors may contribute.

Diagnosis

The doctor will conduct a physical and neurological exam, inquire about the symptoms and consider the medical background of the person.

No single test can confirm a diagnosis so a doctor will use several strategies to decide if a person meets the diagnostic criteria.

These include:

  • MRI scans of the brain and spinal cord, which may reveal lesions
  • spinal fluid analysis, which may identify antibodies that suggest a previous infection
  • an evoked potential test, which measures electrical activity in response to stimuli

Other disorders have similar symptoms to those of MS, and a doctor can recommend further testing to determine other potential causes.

If MS is treated by the doctor, they may need to determine what type it is, and if it is active. In the future, the individual will need further testing to evaluate for more modifications.

Treatment

A doctor can help the individual find treatment to suit them.
A doctor can help the individual find treatment to suit them.

There is no cure for MS, but treatment is available that can:

  • slow the progression and reduce the number and severity of relapses
  • relieve symptoms

Some people also use complementary and alternative therapies but the usefulness of these is not always confirmed by research.

Medications to slow progression

A number of disease-modifying therapies (DMTs) have Food and Drug Administration ( FDA ) approval for relapsing forms of MS. These work by changing the way the immune system works.

Some of these can be given by a doctor by mouth, some by injection and some as an infusion. It will depend on the drug how often the person needs to take them and whether or not they can do this at home.

The following DMTs currently have approval:

Injectable medications

  • interferon beta 1-a (Avonex and Rebif)
  • interferon beta-1b (Betaseron and Extavia)
  • glatiramer acetate: (Copaxone and Glatopa)
  • peginterferon beta-1a) (Plegridy)

Oral medications

  • teriflunomide (Aubagio)
  • fingolimod (Gilenya)
  • dimethyl fumarate (Tecfidera)
  • mavenclad (cladribine)
  • mayzent (siponimod)

Infused medications

  • alemtuzumab (Lemtrada)
  • mitoxantrone (Novantrone)
  • ocrelizumab (Ocrevus)
  • natalizumab (Tysabri)

Current guidelines recommend the use of these drugs from the early stages, as there is a good chance that they can slow the progression of MS, especially when the person is taking them when symptoms are not yet serious.

At certain times certain medications are more effective. In a later, more severe stage of MS, for example , a doctor may prescribe mitoxantrone.

A doctor should track how well a drug performs, because adverse effects will occur and the same medications don’t suit everyone. New product solutions entering the market are proving safer and more effective than any current ones.

Adverse effects of immunosuppressive medicines include increased risk of infection. Some medications may also harm the liver.

If an individual notices adverse effects or their symptoms are getting worse, they should seek medical advice.

Medicines used to relieve symptoms during flare

Many medications are helpful when a person is experiencing symptoms worsening, during a flare. We are not going to use those medications all the time.

Corticosteroids: reduce inflammation and eliminate the immune system. In certain types of MS, they can treat an acute flare-up of the symptoms. Examples include Solu-Medrol (methylprednisolone) and Deltasone (prednisone). When a person uses them too much, steroids may have negative effects, and they are unlikely to have any long-term benefit.

Changes in behaviour: If vision problems occur, a doctor may recommend that the eyes be rested from time to time or that screen time be reduced. A person with MS may need to learn to rest when fatigue sets in and take pace to complete activities.

Mobility and balance problems: Physical therapy and walking equipment, such as a cane, may help. This can also prove useful for the medication dalfampridine (Ampyra).

Tremor: A person can use assistive devices to minimize shaking or add weights to the limbs. Also drugs can help with tremors.

Fatigue: It will help you get enough rest and escape sun. Physical and physical therapy can help teach the people how to do it more comfortably. Assistive devices, such as a mobility scooter, can aid in energy conservation. By improving sleep, medicine or therapy may help improve the strength.

Pain: A doctor may prescribe anticonvulsant or antispasmodic drugs or injections of alcohol to alleviate trigeminal neuralgia, which is a sharp pain affecting the face. Medications for pain relief, including gabapentin, can help with body pain. Medications may also be used to relieve muscle pain and cramping in MS.

Problems with the bladder and bowel: Some medicines and dietary changes can help solve these problems.

Depression: A doctor may prescribe a selective serotonin reuptake inhibitor (SSRI), as these are less likely than other antidepressant drugs to trigger fatigue.

Cognitive changes: Donepezil, an Alzheimer’s drug, can be of benefit to others.

Complementary and alternative therapies

The following may help with different aspects of MS:

  • heat and massage treatment for pain
  • acupuncture for pain and gait
  • stress management to boost mood
  • exercise to maintain strength and flexibility, reduce stiffness, and boost mood
  • a healthful diet with plenty of fresh fruits, vegetables, and fiber
  • quitting or avoiding smoking

Medical marijuana

Research have shown that cannabis can help alleviate pain , stiffness of the muscles and insomnia. There’s not enough proof to prove that though.

People should also note that:

  • There is a difference between using street cannabis and medical cannabis.
  • Not all forms of cannabis are legal in all states.

Before using cannabis a person should ask their doctor for advice, as certain types may have adverse effects. Smoking cannabis is unlikely to be beneficial, and can exacerbate symptoms.

Some people have suggested that biotin may help. 

Rehabilitation and physical therapy

Physical therapy can help with strength and flexibility.
Physical therapy can help with strength and flexibility.

Rehabilitation may help enhance or sustain an individual’s ability to successfully function at home and at work.

Programs generally include:

Physical therapy: It is aimed at delivering the skills needed to sustain and regain full mobility and functional ability.

Occupational therapy: the use of work , self-care and play as a therapy can help to maintain mental and physical function.

Speech and swallowing therapy: Advanced instruction for those who need it is carried out by a speech and language therapist.

Cognitive rehabilitation: It helps people control complex thought and perception disorders.

Vocational rehabilitation: This helps a person whose life with MS has changed in making career plans, learning work skills, finding and maintaining a work.

Plasma exchange

Exchanging plasma involves removing blood from the individual, removing the plasma, replacing it with new plasma, and transfusing it back into the individual.

This procedure eliminates the blood antibodies that target parts of the person’s body but it is unknown if it will benefit people with MS. Studies have produced results which are mixed.

Typically, plasma exchange only suits severe MS attacks.

Stem cell therapy

Scientists are investigating the use of stem cell therapy to rebuild different body cells, and to restore function to those who have lost it due to health.

Researchers hope that stem cell therapy techniques may one day be able to reverse MS damage and restore functionality within the nervous system.

Outlook

MS is a potentially severe state of health which affects the nervous system. MS development is different for each person, so it’s hard to predict what’s going to happen but most people won’t experience serious impairment.

Scientists have made rapid progress in the development of drugs and treatments for MS in recent years . New drugs are safer and more effective, and offer significant hope for slowing progression of disease.

As researchers learn more about the genetic characteristics and changes that occur with MS, there is also hope that they can more easily predict what type of MS a person will have and establish the most effective treatment from the earliest stage.

A person who is treated properly and follows a healthy lifestyle can expect to live the same number of years as a person without MS.

It is important that people who understand what it is like to get a diagnosis of and live with MS have support.

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