Multiple Sclerosis (MS)
Understanding MS
Multiple sclerosis (MS) is believed to be an autoimmune disorder. An autoimmune disorder develops when the immune system malfunctions and creates antibodies that attack and cause damage to a part of the body. In MS, the myelin sheath in the central nervous system (includes the brain, optic nerves, and spinal cord) is attacked. The myelin sheath is the protective covering over nerves, which aids in transmitting nerve signals from spine to muscles. This attack on the myelin sheath results in myelin being stripped from nerves. These areas are called plaques or sometimes lesions and, depending on the location, can result in many different symptoms. Eventually, the disease can cause permanent damage or deterioration of the nerve fibers. There are several types of MS, but the most common are relapsing-remitting and chronic progressive. In the relapsing-remitting form, there are periods when MS worsens or exacerbates, followed by periods of improvement. The chronic progressive type slowly worsens over time.
Symptoms of MS
Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. Weakness, numbness or tingling and/or visual disturbances may be the first symptoms. When symptoms occur in a more acute manner, it is known as the first demyelinating event, and can be useful in making a definitive diagnosis.
Subsequent symptoms may include:
- Depression
- Constipation
- Urinary retention
- Poor coordination and balance
- Difficulty walking
- Fatigue
- Dizziness
- Problems swallowing
- Sexual dysfunction
Diagnosing MS
Diagnosing multiple sclerosis (MS) can be difficult and is often a lengthy process. Symptoms of weakness, numbness and/or tingling can indicate a wide variety of issues and alone are not a basis for a definitive diagnosis. A careful health history and neurological examination, along with other diagnostic testing, will help rule out other possibilities and give a definitive diagnosis of MS.
Additional diagnositic testing may include:
- Magnetic resonance imaging (MRI) of the brain and/or spinal cord.
- Lumbar puncture to analyze the spinal fluid.
- Lab tests to rule out other causes of the symptoms.
Treating MS
Treatment of multiple sclerosis (MS) may include disease-modifying first level medications (injectable interferon [e.g., Avonex®, Betaseron®, Rebif®] and glatiramer [e.g., Copaxone®, Glatopa®]) and then progressing as needed to oral medications (e.g., dimethyl fumarate [Tecfidera®], fingolimod [Gilenya®], teriflunomide [Aubagio®]) and injectable monoclonal antibodies (e.g., alemtuzumab [Campath®, Lemtrada®], natalizumab [Tysabri®], ocrelizumab [Ocrevus®]). Steroids may be used during acute flares. Immune globulin therapy administered into the blood stream intravenously (IVIG) can be used when other MS disease modifiers are not effective and exacerbations or declines occur despite compliance with these medications, or if there are intolerable side effects. Another use is after childbirth. It is thought the hormones during pregnancy keep MS symptoms under control. Once the child is born, the risk of exacerbation increases. IVIG is also thought to be safe while mothers breastfeed. Additionally, IVIG is sometimes used during pregnancy while MS drugs that may cause fetal harm are discontinued.
Resources:
Support Groups:
- MSWorld's Chat & Message Board features patients helping patients.
- Multiple Sclerosis Foundation
References:
- Multiple sclerosis - Symptoms and causes - Mayo Clinic
- Multiple Sclerosis (MS): Symptoms, Diagnosis & Treatments (clevelandclinic.org)
The information provided on this website is not medical advice, nor is it intended to be a substitute for medical advice, diagnosis, and treatment. Always seek the advice of a physician or other qualified health provider with questions concerning a medical condition. Never disregard professional medical advice, or delay seeking it based on information provided on this website.
