Multiple Sclerosis: Symptoms, Causes, and Treatment
Multiple Sclerosis, MS is a potentially disabling medical condition that affects the functions of your brain, spinal cord, and the central nervous system, CNS.
It happens when your immune system attacks the myelin that covers the nerve fibers that have the ability to send or transmit signals from the nerves to other parts of the body.
Learn more about Multiple Sclerosis in detail.
Multiple Sclerosis MS
Multiple Sclerosis is a potentially disabling medical condition that affects your brain and spinal cord or central nervous system.
In MS, your immune system attacks the protective layer or sheath, myelin that covers the nerve fibers and causes communication problems between your brain and the rest of your body.
Eventually, it leads to permanent damage or distortion of the nerves in your body.
MS causes inflammation and temporary lesions, and it potentially leads to lasting lesions due to scar tissue.
This often makes it hard for your brain to send signals to the rest of your body.
To this date, there is no cure for MS, however, with the help of different treatment options, doctors can help manage the symptoms.
Statistics on Multiple Sclerosis, MS
According to NMSS, there has been no scientifically good national study on the prevalence of MS in the United States since 1975.
However, according to a study in 2017, the Society estimated that about 1 million Americans have MS.
Other things you should understand are as follows:
Worldwide, MS is the most common and widespread neurological condition that affects young adults.
Moreover, it causes them to live with disabilities.
Most often, individuals diagnosed with RRMS are between the age of 20 and 50 at the time of diagnosis.
Overall, it is more common in women than in men. According to NMSS, RRMS is 2 to 3 times more common in women than in men, however, the rate of PPMS is roughly equal in both genders.
It is important to note that the rate of MS, tends to be lower in places closer to the equator.
This may have to do with sunlight and Vitamin D exposure.
Moreover, individuals who relocate before the age of 15 generally acquire the MS risk factors associated with the new location.
Surprisingly, Canadians experience the highest rate of MS in the world.
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Types of Multiple Sclerosis, MS
There are different types of MS. Let’s discuss them as follows:
Clinically Associated Syndrome, CIS
CIS is a pre-MS condition involving 1 episode of the symptoms lasting at least 24 hours.
These symptoms are often due to demyelination in your CNS.
Though these are the characteristics of MS, it is not enough to prompt a diagnosis.
Moreover, if there is more than one lesion or positive oligoclonal band, OCB in your spinal fluid at the time of spinal tap, you will more likely receive a diagnosis of RRMS.
However, if lesions are not present, you are less likely to receive an MS diagnosis.
Relapsing-Remitting MS, RRMS
Relapsing-remitting MS or RRMS involves clear relapses of disease activity followed by remissions.
During each remission period, symptoms are mild or absent and there is mild to moderate disease progression.
RRMS is the most common form at the onset of MS and accounts for about 85% of all cases, according to NMSS.
Primary Progressive MS, PPMS
If you have PPMS, your neurological function becomes progressively worse from the onset of the symptoms.
However, short periods of stability can occur.
Your doctor may use the term ‘active’ and ‘nonactive’ to describe disease activity with new or enhancing brain lesions.
Secondary Progressive MS, SPMS
SPMS occurs when PPMS transits into the progressive one, and you might have noticeable relapses, in addition to a disability or gradual worsening of functions.
Now let’s learn about the early symptoms of MS.
Causes of Multiple Sclerosis MS
There are certain early signs of MS, however, it can develop all at once.
It may also be so mild that you can easily dismiss them. However, understanding the early signs and symptoms of MS are important.
It is not uncommon for these signs to go away, however, they do return. You may go weeks, months, or even years between flare-ups.
Moreover, the signs and symptoms often vary from one person to another, and the relapses and remission periods may also vary.
Let’s discuss this in detail.
Early Signs of MS
The following are the early signs of MS:
Numbness and tingling that affects your arms, legs, or one side of your face
It is important to note that these sensations are similar to the pins-and-needles feeling that you get when your foot falls asleep.
However, they occur without a trigger warning. People with MS may have:
Uneven balance and weak legs
You may find yourself tripping over easily while walking or doing other types of physical activity.
Double Vision, blurry vision in one eye, or partial vision loss
These are the early indicators of MS and can also give you eye pain.
Moreover, these symptoms can have different causes, and even if you have them, it does not necessarily mean that you have this condition.
RRMS is more common in women than in Men while PPMS is equally common in both genders.
Experts are of the view that MS in men tends to progress aggressively and recovery from relapses is often incomplete.
Let’s learn the signs and symptoms of multiple sclerosis in detail.
Symptoms of MS
If you are suffering from MS, you will experience a wide range of symptoms.
Due to the nature of the diseases, symptoms can vary from one person to another.
They can also range in severity from year to year, month to month, and even day to day.
The following are the most common symptoms associated with MS: Fatigue About 90% of the individuals with MS report fatigue, and according to the National Multiple Sclerosis NMSS, it can make it harder for you to go about everyday tasks.
Due to numbness in the legs, difficulty balancing, muscle weakness, muscle spasticity, and difficulty with vision you may find walking difficult.
Moreover, if you fall, it can lead to injuries.
These are often the first symptoms for most individuals and can affect both your eyes.
However, they may come and go, or even get worse with time. They can also resolve entirely.
Some common vision problems are as follows:
- Optic neuritis: can cause pain or blurry vision in one eye
- Diplopia or double vision
- Nystagmus: involuntary movement of the eye
MS causes lesions in your brain and can affect your speech. These speech issues or dysarthria can range from mild to severe.
Symptoms include slurred speech, ‘scanning’ speech where there are long pauses between words o syllables, and changes in the volume of your speech.
Acute or chronic pain, tremors, cognitive issues, difficulty chewing and swallowing, sleep issues, and bladder control are other common symptoms of MS.
Learn more about Sleep Paralysis here.
Causes of MS
If you are suffering from MS, the protective layer of myelin around some of the nerve fibers of your brain, optic nerve, and spinal cord becomes damaged.
Many doctors and researchers believe that the damage is the result of an immune system attack.
Moreover, according to them, environmental triggers like viruses, toxins, can also set off your immune system to attack myelin.
As your immune system attacks myelin, it causes demyelinations and can go into remissions as new layers of myelin form.
However, chronic inflammation can lead to scar tissue and can result in lasting neurological impairment.
It is important to note that MS is not heredity, however, if any one of your parents or sibling with MS can raise your risk slightly.
Moreover, scientists have identified some genes that may also seem to increase susceptibility to developing MS, according to studies in 2001.
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Diagnosis and Treatment
Most often a healthcare professional or most probably a neurologist will perform a neurological exam.
They will also discuss with you, your clinical history and order a series of other tests to help determine whether you have MS or not.
There are different treatment options that aim to treat the symptoms as there is no cure for Multiple Sclerosis, MS.
Let’s discuss it as follows:
Diagnosis of MS
Diagnosing Multiple Sclerosis depends on the signs and symptoms as well as the following diagnostic tests.
Using a contrast dye with the MRI allows your doctor to detect active and inactive lesions throughout your brain and spinal cord.
Optical Coherence Tomography, OCT
During this test, your doctor will take a picture of the nerve layers in the back of your eye to check for thinning around your optic nerve.
Spinal Tap or Lumbar Puncture
A spinal tap or lumbar puncture helps to find abnormalities in your spinal fluid.
This test can help to rule out infectious diseases as well. Moreover, your doctor will also use this test for oligoclonal bands, OCBs that help to diagnose MS.
Blood tests help to eliminate the possibility of other conditions that have similar symptoms.
Visual Evoked Potentials VEP test
This test requires stimulation of your nerve pathways to analyze electrical activity in your brain.
Previously, brain stem auditory-evoked and sensory-evoked potential tests were used to diagnose MS.
It is important to note that the diagnosis of MS requires evidence of demyelination occurring at different times in more than one area of your brain, spinal cord, or optic nerve.
It is a process that prevents the nerves in your brain, spinal cord, or other nerves to efficiently send signals.
Diagnosis of MS also requires ruling out conditions like Lyme disease, lupus, and Sjogren’s disease for instance.
To this date, there is no cure for MS, however, different treatment options are there that can help manage the symptoms and improve your quality of life.
Let’s discuss them in detail.
Disease-Modifying Therapies DMTs
DMTs help to slow down the progression of MS and lower your relapse rate.
Moreover, self-injectable disease-modifying medications for PPMS are glatiramer acetate, or Copaxone and beta interferons are as follows:
Avonex, Betaseron, Extavia, Piegridy, and Rebif.
In 2020, the FDA, the Food and Dry Authority approved Kesimpta for the treatment of MS.
This medication is a monoclonal antibody treatment that can also be self-administered.
Oral medications for RRMS are as follows:
Dimethyl fumarate or Tecfidera, fingolimod or Gilenya, teriflunomide, cladribine, diroxomel fumarate, and siponimod.
Intravenous, IV infusion treatments for RRMS are:
Alemtuzumab, natalizumab, mitoxantrone, and ocrelizumab.
Moreover, in 2017, FDA approved the first DMT for individuals with PPMS.
This infusion drug is also called Ocrelizumab or Ocrevus and can also help to treat RRMS.
Recently, another medication has been approved called Ozanimod or Zeposia, to treat CIS, RRMS, and SPMS. However, it has not yet been marketed due to COVID-19.
It is important to note that not all available medications are appropriate for everyone.
It is thus important to consult your doctor about which drugs are most appropriate for you and the risks and benefits for each one.
In some cases, your doctor can also prescribe Corticosterops like methylprednisolone, Medrol or Acthar Gel, ACTH to treat relapses.
Other treatments may also be targeted at easing specific symptoms that can help to improve your quality of life.
As MS is different for everyone, treatment depends on your specific symptoms.
A flexible approach is necessary for most individuals.
Studies regarding the effectiveness of some complementary therapies are not enough, however, that does not mean that these therapies cannot help.
Meditation, massage, tai chi, acupuncture, and hypnotherapy can help you feel less stressed and more relaxed.
Living with Multiple Sclerosis, MS
You can find different ways to manage MS, its symptoms, and function well.
These are as follows;
You will need an experienced doctor to treat MS.
Moreover, if you are taking DMTs, you will need to adhere to the recommended schedule and they may prescribe other medications to treat specific symptoms as well.
Diet and Exercise
Regular exercise is important for both your mental and physical health even if you have disabilities.
If you have difficulty in physical movement, then swimming or exercising can help.
Some yoga classes can also help as they are specially designed for MS patients as well.
A well-balanced diet, low in empty calories, and high in nutrients and fiber will help manage your overall health.
You should include a variety of fruits and vegetables, lean sources of protein, whole grains, and other sources of fiber in your daily food.
Moreover, it should also contain nuts, legumes, low-fat dairy products, and enough water and other fluids.
Thus, the healthier you are, the better will be your overall health.
Try to avoid saturated fats, trans fat, red meats, foods and beverages high in sugar, foods high in sodium, and highly processed foods.
However, if you have other medical conditions, you should consult your doctor about whether you should follow a special diet or take any specific supplements.
Make sure to read the food labels as foods high in calories but low in nutrients will not help you feel better or maintain a healthy weight.
The lesions MS causes can appear anywhere in your central nervous system and have wide-ranging effects.
These are as follows:
MS can cause more pronounced disabilities as you age.
If you have these issues, falling may put you at an increased risk for bone fractures. Having other conditions like arthritis, and osteoporosis can complicate matters more.
Risk Factors of MS
To this date, doctors and researchers have not been able to identify the causes of MS, however, there are different risk factors for developing MS.
These factors are as follows:
- having a close relative with multiple sclerosis, MS
- Certain infections
- autoimmune disorders like type 1 diabetes and rheumatoid arthritis
Life Expectancy of People with Multiple Sclerosis
It is almost impossible to predict how multiple sclerosis will progress in an individual. Thus, life expectancy is increasing according to NMSS.
About 10 to 15% of the individuals with MS have rare attacks and minimal disability 10 years after diagnosis.
According to NMSS, it is generally presumed that such individuals are not on treatment or injectable medications. This is sometimes termed benign MS.
It is important to note that progressive MS generally advances faster than RRMS, thus, with RRMS remission can be for many years.
Moreover, a lack of disability after 5 years is a good sign for the future.
This disease tends to be more severe and debilitating in men according to a review of studies.
Multiple sclerosis is a lifelong medical condition and with it, you will face several unique challenges that can change over time.
It is important to communicate your concerns with your doctor, learning about MS, and discovering what makes you feel your best. You can also join support groups or in-person groups to share your challenges and coping strategies will other individuals as well.