Multiple Sclerosis

Multiple sclerosis (MS) is a long-lasting (chronic) disease of the central nervous system. It is thought to be an autoimmune disorder, a condition in which the body attacks itself by mistake. MS is an unpredictable disease that affects people differently. Some people with MS may have only mild symptoms. Others may lose their ability to see clearly, write, speak, or walk when communication between the brain and other parts of the body becomes disrupted.

Myelin is the fatty tissue that surrounds and protects nerve fibers. In MS, the myelin is destroyed in many areas. This loss of myelin forms scar tissue called sclerosis. These areas are also called plaques or lesions. When the nerves are damaged in this way, they can’t conduct electrical impulses to and from the brain.

Experts don't know what causes MS. But most research suggests that the body’s immune system attacks and destroys myelin by mistake. MS most often begins in adults between ages 20 and 40. It happens in women more often than men. It also is more likely to occur if a person has a family history of MS. Smoking does not cause MS, but can make it worse. Possible causes of MS include:

• Autoimmune disorders.
• Infectious agents, such as viruses.
• Environmental factors.
• Genetic factors.

There are four main types of MS. These are:

• Relapsing-remitting MS. This type of MS is the most common. It is marked by isolated episodes of symptoms (also called attacks or flare-ups). Periods of partial or complete recovery follow these episodes. Each attack may be worse than the one before it.
• Primary-progressive MS. This type of MS is marked by a slow onset of symptoms that gradually worsen over time. There are no periods of recovery.
• Secondary-progressive MS. This type of MS begins as relapsing-remitting MS. After a period of stability, the disease steadily gets worse. About 50% of people with relapsing-remitting MS have secondary-progressive MS within 10 years of their first attack. About all of them have it within 25 years.

Progressive-relapsing MS. This type of MS includes both slowly progressive symptoms and periods of flare-ups together.

The symptoms of MS are often unpredictable. They may be mild or severe, short-term or long-lasting. They may appear in different combinations, depending on the area of the nervous system affected. The following are the most common symptoms of MS. But each person may have different symptoms.

• Blurred or double vision.
• Red-green color distortion.
• Pain and loss of vision because of swelling of the optic nerve (optic neuritis).
• Trouble walking.
• An abnormal feeling, such as numbness, prickling, or pins and needles (paresthesia).

• Muscle weakness in the arms and legs.
• Trouble with coordination. You may have problems walking or standing. You may also be partly or completely paralyzed.
• Spasticity. This is the involuntary increased tone of muscles leading to stiffness and spasms.
• Fatigue. This may be brought on by physical activity. But it may ease with rest. You may have constant tiredness that doesn't go away.
• Loss of feeling.
• Speech problems.
• Tremor.
• Dizziness.
• Hearing loss.
• Bowel and bladder problems.
• Depression.
• Changes in sexual function.

About 50% of all people with MS have thinking (cognitive) problems linked to the disease. The effects of these problems may be mild. Your healthcare provider may only find them after much testing. The problems may be with:

• Focusing (concentration).
• Attention.
• Memory.
• Poor judgment.

Symptoms of MS are grouped as primary, secondary, or tertiary as described below:

Primary symptoms. These symptoms are a direct result of the destruction of myelin:

• Weakness.
• Numbness.
• Shaking (tremors).
• Loss of vision.
• Pain.
• Paralysis.
• Loss of balance.
• Bladder and bowel problems.

Secondary symptoms. These are complications that may occur as a result of the primary symptoms, for example:

• Paralysis can lead to bedsores.
• Bladder problems may cause repeated urinary tract infections.
• Inactivity can result in weakness, poor posture, muscle imbalances, decreased bone density, and breathing problems.
• Becoming less mobile because of weakness and trouble swallowing can lead to a greater risk of pneumonia.

Tertiary symptoms. These are social, job-related, and psychological problems:

• A person who becomes unable to walk or drive may lose his or her livelihood.
• Strain of dealing with a chronic illness may disrupt personal relationships.
• Depression is often seen among people with MS.

Not one specific test is used to diagnose MS. Diagnosis is based on symptoms and signs, imaging tests, and lab tests. A healthcare provider can make a diagnosis by following a careful process to rule out other causes and diseases. Two things must be true to make a diagnosis of MS:

1. You must have had two attacks at least 1 month apart. An attack is when any MS symptoms show up suddenly. Or when any MS symptoms get worse for at least 24 hours.
2. You must have more than one area of damage to the central nervous system myelin. Myelin is the sheath that surrounds and protects nerve fibers. This damage must have occurred at more than 1 point in time and not have been caused by any other disease.

Your healthcare provider will ask about your health history and do a neurological exam. This includes:

• Mental functions.
• Emotional functions.
• Language functions.
• Movement and coordination.
• Vision.
• Balance.
• Functions of the five senses.

You may also need:

• MRI. This diagnostic test uses a combination of large magnets, sound waves, and a computer to make detailed pictures of organs and structures within the body. It can find plaques or scarring caused by MS. Generally, a single attack along with certain patterns of changes in brain tissue seen on an MRI scan of the brain done with contrast can mean that you have MS.
• Evoked potentials. These tests record the brain's electrical response to visual, auditory, and sensory stimuli. These tests show if you have a slowing of messages in the different parts of the brain.
• Cerebrospinal fluid analysis. This is also called a spinal tap or lumbar puncture. It looks at the fluid taken from the spinal column to make an evaluation or diagnosis. This test checks for cellular and chemical abnormalities seen with MS.
• Blood tests. These are done to rule out other causes for various neurological symptoms.
• Eye exam and visual fields measurements.

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Currently, treatments are divided into:

• Disease-modifying treatments. These directly target inflammation in the central nervous system. They help slow its deterioration.
• Treatment of acute relapses. The use of steroids and plasma exchange (PLEX) can speed up your recovery when you have an MS attack.

There is no cure yet for MS. But you can do things to help change the course of the disease, treat flare-ups, manage symptoms, and improve your function and mobility.

Treatments for the conditions seen with MS may include:

• Medicines (talk with your provider to see what medicines may be an option for you).
• Equipment such as canes, braces, or walkers.
• Rehabilitation activities.

Rehab varies depending on your symptoms and how severe they are. MS rehab may help you to:

• Get back functions that are important for daily living.
• Be as independent as you can.
• Involve your family.
• Make the right decisions relating to your care.
• Learn about equipment like canes, braces, or walkers that can make is easier to move around.
• Set up an exercise program that builds muscle strength, endurance, and control.
• Get back motor skills.
• Speak more easily if you have weakness or a lack of coordination of face and tongue muscles.
• Manage bowel or bladder incontinence.
• Relearn thinking skills.
• Change the way your home is set up to keep you safe but allow you to move about as easily as possible.

The complications of MS range from mild to severe. They can range from fatigue to the inability to walk. Other problems include loss of vision, balance, and bowel or bladder control. Depression can result from the difficulty of living with a chronic condition.

It's important to take your medicines as directed. You may get help by taking part in a clinical trial. Using equipment like canes or walkers can help you get around as walking becomes harder to do. Rehab activities can also help you keep or get back functioning. Changing the way your home is set up can help you stay independent. Talk with your family and healthcare providers about what you need.