Multiple Sclerosis (MS)

Overview

Multiple sclerosis (MS) is a chronic disease that affects the central nervous system of the body. It is classified as an autoimmune disease where the immune system attacks the host body itself, negatively impacting the workings of the brain, optic nerves and spinal cord, even leading to disability.

Specifically, the immune system attacks the myelin sheath, a fatty and protein sheath that serves as a protective layer surrounding the nerve fibres. The resulting loss of myelin in several areas causes scar tissues to develop, which is called sclerosis. These disrupt the communication channels between various nerve cells.

Multiple sclerosis affects various people differently, inducing symptoms that may be considered mild, ranging to a dangerous degree. In severe cases, affected individuals may lose sensibility and become unable to write, speak, walk or write properly.

What is Multiple Sclerosis?

Multiple Sclerosis or MS is a condition where the immune system attacks the myelin i.e. a protective substance surrounding the nerve cells. This obstructs the communication channels between the brain and the rest of the human body. It may also lead to the absolute and permanent damage of nerve fibres.

The intensity of symptoms depends on the severity of the condition in affected individuals, and the location impacted. While some people may go into long-term remission, some others may completely lose the ability to walk or partake in daily activities.

Even though there is no cure for MS, the treatments can help with recovery from attacks and slow down the progression of the disease. Some tell-tale signs of multiple sclerosis include vision loss, numbness, weakness in the muscles, memory issues, etc.

Types of Multiple Sclerosis

There are different types of MS, the knowledge of which is crucial. Based on it, one’s doctor can appropriately prescribe the necessary treatment plan, best-suited to the individual. According to the International Advisory Committee on Clinical Trials of MS, multiple sclerosis is categorised under 4 disease courses, including:

Clinically Isolated Syndrome (CIS)

This is the first stage triggering neurological symptoms. The individual may or may not develop multiple sclerosis later on. Some commonly experienced symptoms include vision loss, dysfunction of the bladder, overall coordination issues, loss of balance while walking, mumbling and ataxia (swallowing issues).

Relapsing-Remitting MS (RRMS)

RRMS is the 2nd stage, where defined, notable attacks of new or progressive neurologic symptoms, called exacerbations or relapses are recorded. These attacks may be followed by full recovery or periods of remission. This type is also considered to be the most common disease course in multiple sclerosis.

Secondary Progressive MS (SPMS)

People with RRMS may often cross over to the secondary progressive MS course. At this point, neurologic function may decline vastly and progressively. As a result, disability may result. Individuals may experience this stage differently, with some experiencing relapses and others having stable periods of recovery.

Primary Progressive MS (PPMS)

This is the final stage where neurologic function worsens by a huge margin. Disability results from existing or newer symptoms intensifying. Everyone experiences PPMS differently. There might be short timespans of stability, with/without relapses or new activity. However, others may progressively march towards high degrees of disability, with/without relapses or new lesions showing up on the MRI scan.

MS has a few rare variants, namely tumefactive multiple sclerosis (widespread areas of the brain characterised by loss of myelin; similar to tumours); Balo's concentric sclerosis (concentric rings with myelin damage; appear on the MRI); and Marburg variant multiple sclerosis (rare and dangerous; rapidly progresses and may culminate in death).

Symptoms of Multiple Sclerosis

Symptoms of multiple sclerosis may differ in the early and the later stages. Initially, the commonly experienced symptoms include vision alterations, like double vision, optic neuritis, partial loss of sight; muscle spasms and weakness; numbness or other unusual sensations. The latter two typically affect one side of the face/body or waist down.

Other associated symptoms of MS may include dizziness, fatigue, tremendous loss of balance or coordination, bladder problems, clumsiness, vertigo, electric shock-like sensations upon making certain neck movements, slurred speech, sudden mood changes and difficulty with learning, thinking, judging, etc. (cognitive function).

Causes of Multiple sclerosis

The human immune system generally protects the body from bacteria or viruses. However, in certain cases like with MS, the immune system is in its overactive state, mistakenly identifying myelin as a threat to the body. As a result, the immune system attacks the healthy myelin deeming it as the right response, and damages it in the process. This phenomenon is known as demyelination.

Demyelination is the destruction of the myelin around the neurons in one’s brain and spinal cord. It otherwise transfers signals to and from the brain and the rest of the body, prompting necessary functions like movement, vision and sensation. These signals or messages are not able to pass owing to myelin damage, leading to the formation of lesions, plaques and scars.

Some risks that may increase the chances of developing multiple sclerosis include habits like smoking, and other circumstances including toxin exposure through secondhand smoke and inhalation of pesticides, low vitamin D levels, exposure to a virus, childhood obesity and genetic predisposition.

Multiple Sclerosis Diagnosis and Tests

There is no specific diagnosis method for multiple sclerosis. Therefore, a directional diagnosis process is adopted. Healthcare professionals rule out the conditions that the individual does not have, and if MS is the answer - it is then confirmed. To begin with, the doctor shall conduct a thorough analysis of the individual's medical history. They may then proceed to recommend blood tests, MRIs, spinal taps and other tests as and when required.

Treatment of Multiple sclerosis

There is no dedicated treatment regimen for multiple sclerosis. However, management options are available that can slow down the progression of the condition, manage symptoms, speed up the recovery process from attacks and reduce future relapses.

Treatment for the multiple sclerosis attacks includes prescriptions of Corticosteroids (reduces nerve inflammation) and plasmapheresis where the plasma of one’s brain is eliminated and separated from the blood cells. The blood cells are then infused with albumin and introduced back into the body. This is a step recommended if only steroids do not respond in the expected way.

Disease-modifying therapies (DMTs) are available that can modify the progression of the condition. Injectables include Interferon beta medications, Monoclonal antibodies and Glatiramer acetate. Oral treatment options like Teriflunomide, Diroximel fumarate, Fingolimod, Dimethyl fumarate, Monomethyl fumarate, Cladribine, Ponesimod, Ozanimod and Siponimod may be recommended.

Other than the above, there are infusion treatments including Natalizumab, Ocrelizumab, and Alemtuzumab. Finally, physical and occupational therapy, muscle relaxants, and medications to control fatigue and boost walking speed may help manage the symptoms of multiple sclerosis.

Preventive Measures for Multiple Sclerosis

Certain preventative measures can be undertaken by individuals to avoid the risk of multiple sclerosis. These include quitting smoking, maintaining proper Vitamin D levels by soaking in the sunlight and indulging in nutritious foods; drinking coffee, regulating stress levels, staying active, having resveratrol, following a balanced diet, engaging in supervised intermittent fasting and consuming supplements containing flaxseed oil.

Myths and Facts Related to Multiple Sclerosis

Find some popular myths associated with multiple sclerosis and the fact-checked alternatives below:

Myth 1: Multiple sclerosis is Contagious
Fact: Multiple sclerosis is not contagious. It is caused when the immune system attacks the host body mistaking the protective myelin sheath as a threat. Due to the condition having been connected to the Epstein-Barr virus, studies showed that children with the virus were more likely to develop MS. However, it is not a viral infection that can be spread from one person to another.

Myth 2: I Am Going to Need a Wheelchair at Some Point as I Have Multiple Sclerosis
Fact: Multiple sclerosis may cause difficulty in walking in certain people. However, most people do not have to use a wheelchair to get around. Nonetheless, some people may resort to the assistance of a cane or a walking stick for better mobility.

Myth 3: If I Have Multiple Sclerosis, I Cannot be Physically Active
Fact: It’s false that you cannot or should not be physically active if you have multiple sclerosis. Healthcare professionals recommend physical activities during MS to stay healthy and possibly delay chances of disability.