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

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.

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• 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.