Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic illness.  It is an autoimmune disease that affects the Central Nervous System (CNS).  The parts of the body that make up the CNS are the brain, the spinal cord and the optic nerves (NMSS, 2020).  In the brain, MS will affect areas such as the brainstem, the cerebellum and white matter (MNT, 2019).   An individuals' immune system attacks the protective layer of nerve fibers called myelin (Healthline. 2022)  As the myelin is destroyed, communication between the brain and the body is altered (Mayo, 2020).  Over time, the nerves deteriorate and are permanently damaged due to inflammation, scar tissue and lesions (Healthline, 2022).  As nerves are damaged, CNS messages are altered, symptoms arise and scar tissue forms (NMSS, 2020).

There are several symptoms of MS.  Symptoms will vary from person to person.  Common symptoms include:

• Fatigue: occurs in 80% of cases.  May occur at levels that interfere with daily life.
• Difficulty walking:  occurs due to such things as weakness, loss of balance, numbness, balance difficulties, and muscle spasticity.
• Numbness/Tingling: occurring in face, body, arms and legs and is many times is the first symptom.
• Spasticity: includes stiffness and involuntary movements.  Is more common in legs.
• Weakness: results from the deconditioning of muscles.
• Dizziness: may experience lightheadedness or vertigo.
• Bladder Dysfunction: occurs in 80% of cases.
• Bowel issues: both constipation and loss of control of bowels.
• Sexual problems: may result due to CNS damage
• Pain: may occur in up to 55% of cases
• Cognitive changes: In more that 50% of cases, high level brain functions are affected.
• Lhermitte's sign: electric shock with neck movement
• Emotional changes: mood swings, irritability.
• Depression: common with MS.

Less common symptoms include:

• Speech problems: slurring, loss of volume.
• Swallowing: dysphagia.
• Tremor: uncontrollable shaking
• Seizures
• Breathing problems
• Hearing loss (NMSS, 2020)(MNT, 2019)(Healthline, 2022).

There are four types of MS.  They include:

• Clinically Isolated Syndrome: an initial single episode of symptoms lasting at least 24 hours.
• Relapse Remitting MS (RRMS): most common type.  Involves "attacks" where neurological symptoms are exacerbated then periods of either partial or complete relapse.  Based on whether  someone is having symptoms or relapses or not, can be characterized as active or not active.  Based on if the level of disability is increasing, it will be characterized as worsening or not worsening.
• Secondary Progressive MS (SPMS): begins in the same manner as RRMS.  At a point, the neurological function will transition in where it progressively worsens over time and there is increased disability.  Like RRMS, SPMS can be characterized as active or not active.  It can also be characterized as with progression or without progression based on whether there is evidence of a current increase in disability.
• Primary Progressive MS (PPMS):  neurologic function worsens and disability increases or remissions.  Can also be characterized as active or not active and with progression or without progression (NMSS, 2020)(MNT, 2019)(Healthline, 2022).

Risk factors that may play a role in developing MS.  They include:

• Age: most often diagnosed between 20 and 40 years of age.
• Gender: 2-3 times more likely to be diagnosed in women
• Family history: at increased risk if you have a parent or sibling who has MS.
• Smoking: increased likelihood of developing MS.
• Vitamin D deficiency: is thought low levels of vitamin D impacts immune system
• Vitamin B12 deficiency: Vitamin B12 is necessary for Myelin production.
• Infections: Some viruses increase the risk of developing MS.
• Race: MS is more common in Whites.
• Geography: locations further from the equator have higher incidence of MS (Mayo, 2020)(Healthline, 2022)(NMSS, 2020).

When trying to diagnose MS, there is no one test that specifically tests for MS.  Diagnosis of MS typically occurs with ruling out other similar conditions.  A medical history and a neurologic exam are important in making a diagnosis.  Parts of the history and exam that should be done include:

• history of:
• past and present symptoms
• birthplace
• family history
• environmental exposures
• illnesses
• travel history
• test
• Cranial nerves
• sensation
• reflexes coordination
• walking
• balance

Tests used to help in diagnosis also include:

• Blood tests: may find biomarkers associated with MS.
• Lumbar Puncture: can rule out infections and other conditions
• Magnetic Resonance Imaging (MRI): can show areas of lesions in brain and/or spinal cord
• Evoked potential tests: use stimuli to measure speed of information travelling nerve pathways
• Optical Coherence Tomography (OCT): takes picture of optic nerves (Mayo, 2020)(Healthline, 2022)(NMSS, 2020).

There are several options for treatment of MS.  They include:

• Disease-Modifying Therapies (DMTs): slow progression and lower relapse rate.
• Corticosteroids: treat relapses.
• Diet and exercise: regular exercise and a well balanced diet can help manage overall health.
• H.P. Acthar Gel: treats relapses.
• Rehabilitation: include Physical Therapy, Occupational Therapy, and Speech Therapy.
• Muscle Relaxants: control muscle spasms.
• Rest (MNT, 2019)(Mayo, 2020)(Healthline, 2022)(NMSS, 2020).

To learn more about Multiple Sclerosis, watch our video:

UPDATED 4/23/23

For more information on Multiple Sclerosis, go to the National Multiple Sclerosis Society website at https://www.nationalmssociety.org/Treating-MS/Managing-Relapses

Healthline. (2022) Understanding Multiple Sclerosis.  Healthline.  Retrieved from https://www.healthline.com/health/multiple-sclerosis

Mayo Clinic. (2020) Multiple Sclerosis.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274

MNT. (2019) Multiple Sclerosis: What you need to know.  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/37556

NMSS. (2020) What is MS? National Multiple Sclerosis Society.  Retrieved from https://www.nationalmssociety.org/What-is-MS