Health Uncomplicated: What is Multiple Sclerosis?
What is Multiple Sclerosis?
Multiple sclerosis (MS) is a chronic condition affecting the central nervous system (CNS) - which includes the brain and spinal cord. The immune system mistakenly targets the protective covering (myelin) that surrounds nerve fibers, causing inflammation, damage to the myelin, and sometimes the underlying nerve fibers. This damage disrupts the normal flow of nerve impulses, causing a wide range of symptoms.
What are the different types of MS?
Relapsing Remitting MS (RRMS) - This is the most common form of MS. It is defined by the periods of symptom exacerbations called relapses or flares. These periods are followed by the disappearance or lessening of symptoms.
Primary-Progressive MS (PPMS) - Individuals with PPMS have symptoms that steadily worsen, without periods of remission or flares. Approximately 10% of individuals with MS have PPMS.
Secondary-Progressive MS (SPMS) - Individuals with RRMS may experience an advancement in their disease to SPMS. SPMS does not have periods of flares or remissions, and it’s experience is similar to that of PPMS. Approximately half of the individuals with RRMS convert to SPMS within 10-20 years.
Progression-Relapsing MS (PRMS) - Only a small percentage of individuals with MS have PRMS. This rare form of MS worsens from onset, despite flares or periods of remission. About 5% of individuals with MS have PRMS.
What are symptoms of MS?
Because MS affects multiple parts of the body, MS can manifest with a wide range of symptoms that vary from person to person. Experienced symptoms are dependent on which nerves are affected and the extent of nerve damage. Some common symptoms include:
Fatigue: One of the most common and often debilitating symptoms.
Vision Problems: Blurred or double vision, eye pain, and partial or complete vision loss can occur due to inflammation of the optic nerve.
Muscle Weakness and Spasms: Difficulty walking, muscle stiffness, tremors, lack of coordination or problems with balance and dexterity
Sensory Changes: Numbness, tingling, or a "pins and needles" sensation in various parts of the body, especially in the face, limbs, or trunk.
Pain and Spasticity: Chronic pain, including neuropathic pain, muscle spasms, and stiffness.
Cognitive Changes: Issues with memory, attention, concentration, and problem-solving are often experienced, particularly as the disease progresses to its later stages.
Emotional and Psychological Changes: Depression, anxiety, mood swings, and emotional disturbances may occur due to the impact of the disease on daily life.
Bladder and Bowel Problems: Issues with urination and bowel movements, such as urgency, hesitancy, or incontinence, can be symptoms of MS.
Speech and Swallowing Difficulties: Weakness or coordination in the muscles used for speaking or swallowing can occur.
Sexual Dysfunction: Some individuals with MS may experience reduced libido, erectile dysfunction, or difficulty achieving orgasm.
How do I know if I have Multiple Sclerosis?
There is no one test to diagnose MS. Instead, doctors use a series of exams to decide whether you have MS. For a diagnosis, three criteria must be met:
There must be evidence demonstrating impairment in a minimum of two distinct regions within the central nervous system (CNS), encompassing the brain, spinal cord, and optic nerves.
This damage had to occur at different points in time
All other possible diagnoses must be ruled out.
Doctors may utilize the. McDonald criteria - a tool to ensure they provide an accurate diagnosis of MS as early as possible. This criteria combines findings from laboratory evaluations and MRI data. This also can help them to run any additional tests that may be necessary to confirm the diagnosis. (1) The McDonald criteria is built around five different paths to diagnosis, including clinical evidence of lesions, relapses, and “insidious neurological progression suggestive of Multiple Sclerosis”. (2)
What are the treatments for Multiple Sclerosis?
There is no cure for MS. However, there are treatments to reduce the number and severity of relapses, or flares, and delay the progression of the disease. (3, 4)
Treatments for MS flares:
Corticosteroids: These help to suppress the immune steroids and reduce inflammation
Plasmapheresis (plasma exchange): This can help to treat flare ups in certain types of MS.
Treatments to modify progression:
Treatments that modify progression are called DMTs - disease modifying therapies. There are multiple DMTs available for relapsing-remitting MS, some individuals with secondary progressive MS have found them helpful, and there is one available for primary progressive MS.
Researchers have found that a majority of the immune response associated with MS happens early in the disease. This means that DMTs should be utilized as early as possible to lower the relapse rate and slow the rate of formation of new lesions.
Like many other treatments, DMTs come with risks. They come as injectables, oral medications, and infusion medications.
Treatments for general signs and symptoms
Therapy, muscle relaxants, medications to reduce fatigue, increase walking speed, assist with mental health, sexual dysfunction, insomnia, and bladder control are all utilized to help manage symptoms associated with MS.
Emerging Therapies:
Bruton’s tyrosine kinase (BTK) inhibitor is an emerging therapy for patients with relapsing-remitting MS and secondary-progressive MS. This is a stem cell transplant that works by modulating immune cells in the central nervous system. (5)