What is Multiple Sclerosis?
Multiple sclerosis is a chronic neurological disease that affects the central nervous system, especially the brain, spinal cord, and optic nerves. It is considered an autoimmune disease. The symptoms of the medical condition are mild in some, while in some others it can have far-reaching consequences, such as sudden vision loss and severe cognitive abnormalities. These symptoms negatively affect the myelin, or fatty tissue that surrounds the nerve fibers. This causes damage in the form of inflammation, scarring, lesions or plaques. Such damage, known as sclerosis, disrupts the conduction of electrical impulses to and from the brain.
Types of multiple sclerosis
The medical condition is classified into four categories as below:
- Clinically Isolated Syndrome (CIS): When the medical condition first appears, it usually lasts for a single episode with symptoms manifesting for at least 24 hours.
- Relapse remitting MS (RRMS): When a single episode of CIS is later followed by a second bout of symptoms, it is medically referred to as relapse-remitting MS. Here the symptoms are more intense or characterized by frequent episodes of the state of health after periods of remission. During these phases of remission, symptoms may diminish in whole or in part. This is the most common form of multiple sclerosis.
- Primary Progressive MS (PPMS): In this type of MS, the symptoms gradually worsen, without remissions or early relapses. However, some patients may experience temporary phases where symptoms worsen before improving.
- Secondary Progressive MS (SPMS): In this type of MS, there will be episodes of relapse and remission, with symptoms gradually getting worse.
Multiple Sclerosis Causes
There may be several likely factors behind the development of MS. However, there is compelling evidence regarding the causes of the medical condition. The likely risk factors are as follows:
- Age: Individuals with pernicious anemia between the ages of 20 and 40 have a higher risk of developing the disease, although it can also affect younger and older people.
- Sex: Women are more than two to three times more likely to get relapsing-remitting MS than men.
- genetic history: A person with parents or siblings who have/had MS is at higher risk for the health condition.
- Breed: People of Asian, African, and Native American descent are less likely to develop MS compared to white people of North American descent.
- Environmental Factors: The incidence of MS is higher in countries with a temperate climate, such as the northern US, Canada, southeastern Australia, New Zealand and Europe, than in other parts of the world.
- To smoke: Smokers who have experienced a first episode of the disease are more likely than nonsmokers to experience a second episode of relapsing-remitting MS.
- Vitamin D Deficiency: Low vitamin D levels are often associated with MS.
- Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
- Certain autoimmune diseases: The immune system of individuals with autoimmune diseases attacks its own tissues. In the case of this medical condition, the myelin is destroyed by the immune system. Hence, individuals with autoimmune diseases such as pernicious anemia, psoriasis, inflammatory bowel syndrome, type 1 diabetes, thyroid disorders, among others, are relatively more prone to developing MS.
Symptoms of multiple sclerosis
The possible symptoms of MS are:
- Pain and loss of vision due to inflammation of the optic nerve
- Double or blurred vision
- Red-green colored distortion
- Difficulty while walking
- Weakness in the muscles of the arms and legs
- Paresthesia or sensations of normal sensation or pain such as pins and needles, numbness, etc.
- Spasticity or spasm of the muscles
- Fatigue and tiredness
- hearing loss
- Bowel and bladder disorders
- Changes in sexual functions
- Cognitive dysfunction such as impaired memory, difficulty focusing and poor judgment
Diagnosing Multiple Sclerosis
There are no specific tests to confirm the medical condition. The symptoms of MS can indicate several other health problems. A diagnostic procedure for this condition usually includes checking the patient’s personal and genetic medical history, along with a neurological exam. These neurological tests involve evaluating language skills, emotional and mental functions, balance, vision, movements, and analyzing the five sensory organs. The doctor may also refer the patient to an ophthalmologist for a thorough examination.
The doctor will likely ask and confirm the following to suspect the presence of this medical condition. These are as follows:
- The patient must have had at least two sudden episodes of MS symptoms at least once a month, or one episode that lasts longer than 24 hours and gradually gets worse.
- There must be at least one part of the central nervous system that has been damaged by more than one episode of MS and not by any other medical condition.
The above can be confirmed through certain medical tests as follows:
- MRI: This helps diagnose the presence of scars or plaques caused by MS.
- Analysis of cerebrospinal fluid: Also called epidural and lumbar puncture, this diagnostic test involves evaluating the fluid collected from the spine. The fluid is checked for chemical and cellular abnormalities associated with MS.
- Evoked potentialsHere, the brain’s electrical response to auditory, visual, and sensory stimuli tracks the rate at which messages are received by the brain.
- Blood tests: These may be recommended to eliminate the extent of symptoms caused by neurological disorders.
Multiple sclerosis treatment
Multiple sclerosis treatment focuses on controlling the medical condition to prevent exacerbations. There are no treatments that guarantee a cure. Treatment involves improving certain bodily functions that cause the symptoms of MS – bladder dysfunction, spasticity, neurological disorders, fatigue and depression.
Treatments for multiple sclerosis either focus on transforming the immune system to suppress the condition or on treating the symptoms.
Now let’s discuss the most common treatments for multiple sclerosis. The medications that may be prescribed are:
- Corticosteroid drugs: The most common treatment for treating MS relapses. These drugs are generally injected into the veins. They are known to shorten the time span of relapses and also improve recovery time after an attack.
- Interferon beta: This is also given as an injection under the skin or into the muscle, usually for the treatment of relapsing-remitting MS. This may be prescribed to manage the incidence of recurrences and also to reduce the risk of worsening symptoms and subsequent disability.
- plasmapheresisPlasma exchange: In this procedure, the liquid part of the blood is removed and replaced with plasma from donors or a suitable substitute. This may be recommended to reduce flare-ups of symptoms that cannot be effectively treated with corticosteroids.
- Glatiramer Acetate (Copaxone): An alternative treatment for relaxant-remitting MS, it is generally prescribed when interferon beta cannot be administered, the patient is allergic to it, or has become ineffective.
- Oral fingolimod
- dimethyl fumarate
Dr. Amit Shrivastava, Senior Consultant – Neurology, Dharamshila Narayana Superspeciality Hospital, New Delhi