What is MS?
What is Multiple Sclerosis (MS)?
Multiple Sclerosis (MS) is a progressive, immune-mediated disease. In an immune-mediated disease, the body’s immune system mistakenly attacks your central nervous system and affects the nerves that help you move and feel. With MS, the immune system damages or destroys myelin, a protective layer that wraps around your nerve fibers. Without that insulating layer of myelin, the brain cannot communicate with or control the body as efficiently or as quickly, which leads to issues from motor function to vision.
The name Multiple Sclerosis comes from the impaired nerve fibers building scar tissue after attacked, or multiple areas of scarring.
The symptoms of MS are unpredictable and vary. The disease can cause complications with eyesight, muscle control, balance, and overall fatigue.
In particular, there are four disease courses of MS: Clinically Isolated Syndrome (CIS), Relapsing-Remitting MS (RRMS), Primary Progressive MS (PPMS), Secondary Progressive MS (SPMS)
Clinically Isolated Syndrome (CIS)
Clinically isolated syndrome (CIS) is an isolated episode similar to Multiple Sclerosis in that the condition has the same symptoms as MS. However, CIS is exacty that – isolated. This means that the neurologic symptoms last at least 24 hours and never happen again. Because of this key difference to MS, this does not mean a formal MS diagnosis for the patient.
Someone with CIS may experience numbness or tingling, trouble seeing, or difficulty with walking, balance, or controlling their bladder for a short period. People typically recover fully or at least partially from the episode of symptoms.
If someone experiences CIS, they may or may not go on to develop Multiple Sclerosis. In some cases, CIS remains a one-time event that never happens again. In others, however, CIS can act as the precursor and progress to Multiple Sclerosis. Your doctor will be able to determine the likelihood of advancing to MS through an MRI.
Relapsing-Remitting MS (RRMS)
Relapsing-remitting MS is the most common type of MS that typically begins in your 20s or 30s. With RRMS, individuals experience “relapses” or “exacerbations”, or flare-up attacks of MS symptoms. Following the attack, symptoms disappear for a full recovery – this is known as “remission”. Remission can last for any period of time – weeks, months – and during remission the disease does not progress.
RRMS can also be described in modifiers. These include active (experiencing a relapse), not active, or worsening (a permanent decrease in function after a relapse), or not worsening. The symptoms people experience vary and largely depend on the areas of your brain or spinal cord where the inflammatory attacks take place.
Primary Progressive MS (PPMS)
On the other hand, the rarest form of MS is primary progressive MS (PPMS). Lacking in relapses that happen intermittently with periods of remission, this type of MS is progressive from the start. In other words, people experience symptoms of MS that tend to be consistent and lead to an increase in disability over time. Unlike RRMS, there are no clear signs of remission. In PPMS, the disease progresses after the initial onset of symptoms. Early signs of those with PPMS include trouble walking, often worsening over two years time, but the rate at which symptoms develop varies from person to person.
Secondary Progressive MS (SPMS)
Secondary progressive MS (SPMS) is a type of Multiple Sclerosis that progresses after relapsing-remitting MS (RRMS). With SPMS, your disability progresses and gets worse. Unlike RRMS where there are periods of remission, this stage leads symptoms to gradually become worse despite treatment. Some individuals may still experience relapses, however, with SPMS they may never make a full recovery from that relapse.
Because symptoms develop slowly, it may take you and your doctor some time to realize and diagnose SPMS. Some initial signs of SPMS include issues with bladder control, vision, walking, and feeling numbness, tingling, or fatigued. While symptoms with RRMS are temporary and generally mild, the symptoms in SPMS are markedly more severe and can pose challenges to everyday activities.
The cause of MS is unknown, but researchers believe a combination of genetics and environmental factors may make people more susceptible to developing MS than others.
The risk factors of MS include the following:
- Smoking: Studies have shown that smokers are more likely to develop MS and is related to more severe symptoms and progression of the disease.
- Vitamin D: Individuals with low Vitamin D levels and less sun exposure are identified to have an increased risk of developing MS.
- Obesity: Obesity, especially in childhood and early adolescence, is tied to developing MS. Studies show obesity may increase the risk of MS by as much as 40 percent.
- Family History: If your parents or siblings developed MS, you are at a higher risk of developing MS than those without the disease in their family history.
- Gender: The MS diagnosis is more prevalent among women than men, with the woman’s risk of developing the disease two to three times more likely than men.
- Race: White people, especially those of Northern European descent, are at a higher risk of developing MS more than any other race. Those of African, Native American, and Asian descent have low risks of getting MS.
- Viruses & Bacteria: Most notably, studies have shown that the Epstein-Barr virus (EBV) which activates mononucleosis (also known as “mono”) may result in higher risks for developing MS.
- Geography & Climate: MS appears most common in individuals geographically located farthest from the equator. The disease is more prevalent in temperate climates, like Canada, northern U.S., Europe. southeast Australia, and New Zealand.
- Autoimmune Diseases: MS has been tied to those who also have thyroid disease, type 1 diabetes, and irritable bowel disease (IBD).
Multiple Sclerosis (MS) Symptoms & Signs
Individuals who develop MS experience different symptoms and severity. However, below are the more common signs and symptoms of the disease, especially in the beginning stages of Multiple Sclerosis:
- Having issues with eyesight, like blurry vision, dull colors, or eye pain
- Feeling fatigued
- Having trouble with walking and gait
- Feeling dizzy, off-balance, or lightheaded
- Feeling tingling and numbness
- Feeling muscle spasms, especially in the legs
- Experiencing sexual problems
- Experiencing bowel problems
- Experiencing mood swings, depression, and other emotional changes
- Experiencing cognitive issues
- Feeling chronic pain and itchiness
Other symptoms reported but not as common include trouble breathing, speaking, swallowing, hearing, and experiencing tremors or seizures.
Multiple Sclerosis (MS) Diagnosis
There is no specific, single test to diagnose Multiple Sclerosis. Rather, doctors will work by process of elimination – your physician will conduct tests and exams to rule out other diseases with similar symptoms to MS.
In confirming if you have MS, your doctor will begin with a comprehensive examination of your medical history and a neurological exam. Your healthcare provider will look at information like your symptoms, family history, health history, and evaluate any factors you’ve been exposed to that may put you at risk for MS. In addition, they’ll perform an exam to test your vision, hearing, facial sensation, reflexes, coordination, strength, and overall neurological function.
Some other tests your doctor may conduct include:
- Blood Tests: Blood tests can help eliminate other conditions with similar symptoms to MS like lupus, vitamin and mineral deficiencies, Sjogren’s, and hereditary diseases.
- MRI Scan: MRIs can identify lesions on the brain or spinal cord, a suggestive sign of MS, through showing new lesions or lesions that are growing larger in size.
- Spinal Tap (lumbar puncture): A sample of cerebrospinal fluid is collected and analyzed for abnormal results, specifically in proteins and inflammatory cells that may point to MS.
- Evoked Potentials (EP) Tests: EP tests measure electrical signals and activity in parts of the brain caused by sound, light, and touch. Evoked Potentials can help doctors detect issues in nerves that aren’t as clearly seen in other tests.
After receiving a diagnosis that you have MS, you may feel comfort in knowing a concrete diagnosis, or the news may come as a surprise. Whichever you’re feeling, it’s understandable to question the future for yourself, your family, and loved ones. Your doctor will be able to craft a treatment plan that is uniquely suited to your needs and helps to make your day-to-day life as easy as possible. Besides looking after your health, we recommend speaking with your family, friends, a therapist, or even a support group, to lean on for assistance and reassurance.
Multiple Sclerosis (MS) Treatment
While there is no cure for MS, there are treatment options to help relieve symptoms, maintain a quality of life, and manage the disease. We recommend considering a comprehensive care plan that addresses treatment, rehabilitation, and psychosocial factors as well. In addition, the earlier you seek treatment, the better. Studies have found that MS has the ability to do more damage in its early stages than in later years.
While there are many treatment options to help alleviate symptoms of MS, below is a list of treatments that have been shown to slow down the disease from advancing and lessen the amount of relapses. Decreasing the frequency of relapses is crucial because the disabilities that develop out of a relapse could have lasting effects.
- Corticosteroids. Meant to minimize relapses through lessening inflammation in the nerves. This treatment can be taken orally or intravenously.
- Plasma exchange (plasmapheresis). When someone experiences a relapse, the plasma in their blood could be the culprit in attacking their own body. Replacing their blood with donated plasma may reduce symptoms.
- Beta interferons. Interferons are a protein produced by the body that reduce nerve inflammation. Beta interferons are essentially the man made versions of this protein that are injected to reduce the frequency and severity of attacks.
- Glatiramer acetate (Copaxone, Glatopa). Also an injectable medication, glatiramer acetate works by combining four amino acids to help prevent the body’s attack on the myelin sheath that surrounds the nerves.
- Fingolimod (Gilenya). This oral medication can help decrease the severity of flare-ups and can delay the progression of disability. It helps block immune system cells from attacking the nerves in the brain and spinal cord.
- Teriflunomide (Aubagio). A tablet taken once daily, this medication also blocks T-cells from reaching your brain and spinal cord and damaging the nerves there, therefore reducing the rate of relapsing.
- Dimethyl fumarate (Tecfidera). Meant to protect the nerves through limiting access of T-cells to the central nervous system, and thus lessen inflammation to treat relapses.
- Mitoxantrone. Mitoxantrone is administered by infusion in the hospital and typically only used in severe MS cases. The infusion suppresses the immune system, giving your body a chance to reboot itself and decrease the cells attacking myelin.
- Natalizumab (Tysabri). Patients receive an infusion at their doctor’s office every 28 days, where the treatment works by preventing white blood cells from accessing the brain and spinal cord.
It’s important to note that this list is not exhaustive, and many, if not all, of these treatment options have side effects. Talk to your doctor about the best options for your case and educate yourself on the side effects and risks associated with certain medications.
Ongoing Support for Those Living with MS
For those living with MS, there’s resources available to you and your families to utilize for your benefit. Support groups, counseling, wellness groups and other opportunities can help connect you to people with common interests and experiences. In particular, the National Multiple Sclerosis Society offers countless options to find support: forums, one-on-one support, local support groups, and dedicated professionals to help you navigate MS.
Some other resources available include:
- The Multiple Sclerosis Foundation Facebook Group
- MS LifeLines Facebook Group
Multiple Sclerosis, while a progressive disease, can be managed through the right care and taking advantage of the resources available to you. It’s important to build a medical team you can trust, educate yourself about the disease as much as possible, and find the right resources to support your journey to maintain your quality of life.