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Multiple Sclerosis - Types, Symptoms, Causes, Diagnosis, and Treatment

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Multiple Sclerosis - Types, Symptoms, Causes, Diagnosis, and Treatment

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Multiple sclerosis (MS) is a chronic autoimmune disease that affects the protective sheath (myelin) that covers the nerves of the brain and spinal cord (central nervous system). Learn about its causes, symptoms, types, risk factors, treatment, and more.

Medically reviewed by

Dr. Ambekar Sudheer

Published At December 2, 2019
Reviewed AtJanuary 29, 2024

What Is Multiple Sclerosis?

Multiple sclerosis, otherwise called MS, is a chronic disease, which can be potentially disabling, resulting from an illness affecting the central nervous system (brain and spinal cord). Here, the immune system in the body attacks the myelin, which is the protective sheath that covers all nerve fibers. The resulting scar formation makes it difficult for the brain to send signals to the other body parts. As it progresses, the disease most commonly causes permanent damage to the nerves.

The signs and symptoms depend on the severity and amount of nerve damage, and the on which nerve gets affected. Most patients go into remission and do not experience any symptoms for a long time. But some patients lose the ability to walk without support or become wheelchair-bound. As of now, there is no known cure for this disease. Treatments help manage symptoms and slow the progression of the disease.

What Are the Types of Multiple Sclerosis?

The types of MS are:

  1. Clinically isolated syndrome (CIS) - Here, the symptoms result from demyelination of the CNS, and one episode of symptoms last at least for 24 hours. The episodes of symptoms are of two types:

    1. Monofocal - It is when a single lesion causes a single symptom.

    2. Multifocal - When more than one lesion results in more than one symptom.

2. Relapsing-remitting MS (RRMS) - Here, the disease relapses after a period of remission. Most patients have mild or no symptoms during the remission period. This is the most common form, and almost around 85 % of all cases of MS are this type.

3. Primary progressive MS (PPMS) - Here, from the onset of symptoms, the neurological function worsens progressively. It was previously called progressive-relapsing MS (PRMS).

4. Secondary progressive MS (SPMS) - This is when RRMS form turns progressive.

What Are the Symptoms of Multiple Sclerosis?

As it is a disease affecting the central nervous system, which controls the functions of the entire body, the symptoms are plenty and widespread.

The common symptoms of multiple sclerosis include:

  • Muscle weakness - It occurs due to the lack of stimulation because of nerve damage.

  • Numbness and tingling sensation - Patients often have pins and needles-like sensation in the face, arms, legs, or any body part.

  • Urinary problems - Most patients have problems with emptying their bladder and urinary incontinence.

  • Neuropathic pain.

  • Vision problems - Blurred vision, a partial or total vision loss, or color distortion (red-green). In later stages, pain while moving the eyes.

  • Lhermitte's sign - It is when the patient gets an electric shock sensation on moving the neck.

  • Constipation and bowel incontinence.

  • Vertigo (dizziness).

  • Tiredness and fatigue.

  • Sexual dysfunction.

  • Decreased libido.

  • Muscle spasms.

  • Tremors (involuntary jerky movements).

  • Change in gait.

  • Balancing problems.

  • Depression.

  • Learning disabilities.

  • Memory problems.

  • Difficulty concentrating.

Symptoms that are less common include:

  • Headaches.

  • Deafness.

  • Itching.

  • Breathing problems.

  • Seizures.

  • Speech problems.

  • Difficulty swallowing.

All these symptoms severely impact a person's social and personal life. This is a list of commonly seen symptoms, but different people show different symptoms. Some experience mild symptoms at first, which progresses suddenly and causes disability. In some patients, the symptoms worsen for a period, after which, they feel better.

What Causes and Risk Factors of Multiple Sclerosis?

As mentioned earlier, the exact cause of MS is not known. The myelin layer that surrounds nerve fibers gets damaged. This damage can result from an autoimmune reaction, which can be triggered by environmental factors like viral infection or toxins.

The immune system of the body attacks the myelin, resulting in inflammation. This causes scar tissue and lesions in the brain and spinal cord, which disrupts the communication and signals between the brain and other parts of the body.

Some factors seem to increase the risk of this disease, which are:

  • People between ages 20 and 40 years.

  • Women are affected twice as compared to men.

  • Genetic.

  • Caucasians are more prone to get MS.

  • Smokers are more at risk than non-smokers.

  • Infections like Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV6), or mycoplasma pneumonia, increases the risk of a person to develop MS.

  • Autoimmune diseases like type 1 diabetes or inflammatory bowel disease.

  • Vitamin D deficiency, as it affects the immune system.

  • Vitamin B12 deficiency increases the risk of neurological problems.

Instead of a single cause, it is usually a combination of these factors that results in MS.

What Are the Ways to Diagnose Multiple Sclerosis?

As there is no specific test to diagnose MS, diagnosis is done by conducting tests to rule out conditions that can result in similar symptoms. The tests that are commonly done are:

  • Blood tests - To rule out other medical conditions.

  • Spinal tap or lumbar puncture - A small sample of the CSF (cerebrospinal fluid) is collected from the spinal canal for analysis. This sample is tested for abnormalities in the antibodies associated with MS and to rule out other infections.

  • MRI - Lesions caused by MS can be seen in the brain spinal cord.

  • Evoked potential tests - The electrical signal produced by the nervous system when electrically stimulated is tested.

Some forms of MS can be diagnosed based on the pattern of on and off symptoms. It becomes a challenge when the symptoms are unusual and the disease is progressive.

What Are the Treatment Options for Multiple Sclerosis?

Treatment only helps manage symptoms, treat an attack of MS, and slow the progression of MS, as there is no known cure. If the symptoms are mild, then no treatment is needed. The treatment options include:

To treat MS attacks:

  • Corticosteroids - Prednisone (oral) Methylprednisolone (IV) to decrease inflammation of the nerves.

  • Plasmapheresis (plasma exchange) - The plasma from the blood is separated and mixed with Albumin and then sent back to the body. It has shown to help patients who have not responded to steroids.

To slow or modify the progression of MS:

  • Primary-progressive MS - Ocrelizumab.

  • Relapsing-remitting MS - The options include disease-modifying therapies (DMTs) such as -

    • Injectable medications - Beta interferons and Glatiramer acetate.

    • Oral medications - Fingolimod, Dimethyl fumarate, Teriflunomide, and Siponimod.

    • Infusion treatments - Ocrelizumab, Natalizumab, Alemtuzumab, and Mitoxantrone.

To treat signs and symptoms of MS:

  • Physical therapy - A physiotherapist will help you with stretching and strengthening exercises, and an occupational therapist will train you to perform daily activities more efficiently with disabilities.

  • Muscle relaxants - Baclofen and Tizanidine.

  • Tablets to decrease fatigue - Amantadine, Modafinil, and Methylphenidate.

  • Tablets to increase the speed of walking - Dalfampridine.

Along with these medicines, if the patient has other symptoms like depression, insomnia, sexual dysfunction, and urinary problems, the doctor will also prescribe medicines for them.

Around 10 to 15 % of MS patients only have mild symptoms, but it is almost impossible to determine how the disease progresses. For more treatment options and information on multiple sclerosis, consult a neurologist now.

Frequently Asked Questions

1.

What Medical Condition Can Cause Multiple Sclerosis-Like Symptoms?

Medical conditions presenting symptoms similar to multiple sclerosis are
- Nerve damage.
- Epstein-Barr virus.
- Stroke (damage to the brain caused due to rupture and bleeding in the blood vessels).
- Parkinson’s disease (central nervous system disorder that affects movement and also causes tremors).
- Diabetes (high glucose levels in the body).
- Autoimmune diseases (diseases that cause the body’s immune system to attack its own healthy tissues).
- Vitamin B-12 deficiency.

2.

Can Multiple Sclerosis Lead to Death?

Multiple sclerosis does not cause death, as the condition can be managed. However, complications caused due to multiple sclerosis can lead to the death of a person. In addition, multiple sclerosis can cause many disabilities due to worsening symptoms.

3.

How Can We Treat Multiple Sclerosis?

Multiple sclerosis attacks can be managed with corticosteroids and plasma exchange therapy (plasmapheresis). Symptoms of multiple sclerosis are treated with muscle relaxants such as Tizanidine and Baclofen. In addition, infusion treatment with Mitoxantrone, Ocrelizumab, and oral medications can prevent the progression of multiple sclerosis. Physical therapy is also a part of a treatment plan for multiple sclerosis.

4.

What Is the Initial Symptom of Multiple Sclerosis?

The initial symptom of multiple sclerosis includes a partial or total loss of vision, numbness or tingling sensation in arms, legs, and face, and Lhermitte’s signs in which a person feels an electric shock sensation during neck movements.

5.

What Do We Call the First Stage of Multiple Sclerosis?

The first stage of multiple sclerosis (MS) is called clinically isolated syndrome (CIS). It is caused due to damage and inflammation to the myelin sheet covering nerves of the spinal cord or brain. However, the exact criteria for the dissemination or the multiple sclerosis damage that can occur on different dates still need to be met by the first stage of MS.

6.

Which Virus Causes Multiple Sclerosis?

Multiple sclerosis is believed to be caused by the Epstein-Barr virus. The infection caused by the Epstein-Barr virus shows features resembling the etiological factors of multiple sclerosis. There is no definitive cure for multiple sclerosis caused by this virus; therefore, it is a progressive disease.

7.

Can Stress Cause Multiple Sclerosis Type Symptoms?

Stress is often associated with multiple sclerosis as it can significantly increase the risk of developing the condition in a few weeks to months. However, there is no substantial evidence to prove that stress causes multiple sclerosis, but it can exaggerate or trigger the condition.

8.

Can Multiple Sclerosis Be Detected Through Blood Tests?

Multiple sclerosis cannot be diagnosed with blood tests. However, blood tests can rule out various other medical conditions causing symptoms similar to multiple sclerosis. These conditions include vitamin and mineral deficiencies, lupus erythematosus (an autoimmune disease), and other hereditary diseases.

9.

How Can We Stop Multiple Sclerosis Symptoms?

Symptoms of multiple sclerosis can be stopped by
- Administering muscle relaxants such as Baclofen.
- Physical therapy.
- Medication to increase walking speed, such as Dalfampridine.
- Medication to reduce fatigue, such as Amantadine.

10.

How Is the Diagnosis of Multiple Sclerosis Confirmed?

There is no specific test to diagnose multiple sclerosis. However, MRI (magnetic resonance imaging) can help detect the condition. MRI scans can show the scarring and damage of the myelin sheath in the spinal cord or brain.

11.

How Long Does a Person With Multiple Sclerosis Survive?

A person with multiple sclerosis is usually 25 to 35 years after diagnosis of the condition. Death due to multiple sclerosis is rare and mainly due to secondary complications arising from chronic urinary tract infections, immobility, breathing issues, and problems with swallowing.

12.

What Aggravates Multiple Sclerosis?

Multiple sclerosis can get worse due to high temperatures. It can also be aggravated due to smoking, stress, and heart disease. In addition, the condition can also get aggravated due to hot baths, saunas, and hot showers. Therefore, people should avoid such activities if they have multiple sclerosis.

13.

Can Multiple Sclerosis Develop Suddenly?

Multiple sclerosis can occur suddenly within an hour or days. However, the sudden attacks of multiple sclerosis can reach their peak in no time and can even get resolved in several days. However multiple sclerosis can develop at any age, but the symptoms are usually experienced between the age of 20 to 40 years.

14.

Is Multiple Sclerosis a Painful Condition?

Multiple sclerosis is a very painful condition, and the pain is mainly experienced by almost 70 percent of people suffering from this condition. A person usually experiences pain due to somatic or neuropathic pathologies that may be present. Nerve pain can also occur and can be felt as an unusual and painful sensation on the skin.
Source Article IclonSourcesSource Article Arrow
Dr. Ambekar Sudheer
Dr. Ambekar Sudheer

Neurosurgery

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multiple sclerosisvitamin b12 deficiencycorticosteroidstremorsmuscle weakness
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