Being diagnosed with a chronic and degenerative disease such as multiple sclerosis can be scary for anyone, and even though a patient goes through a lot of testing to determine the diagnosis, they may not entirely understand the disease and what it means for the future. What causes multiple sclerosis, and how does a patient know what to expect when given the type of MS they’ve developed? Can it be treated or cured, and what can the patient do to supplement traditional medicine for the best prognosis? These are questions that should be answered early on so that the patient has peace of mind and can quickly learn how to cope with the disease.
What is multiple sclerosis?
Multiple sclerosis is a neurodegenerative disease, which means that it causes the damage and destruction of nerves. There are several types of diseases that attack the nervous system, but in the case of multiple sclerosis, it focuses on the central nervous system (CNS), which includes the brain, the spinal cord, and the optic nerve.
It’s also considered an autoimmune disease, since it involves a malfunction of the immune system where the body attacks itself. Patients who have developed MS have an overreaction of the immune system, which sees the myelin coating of the nerves and nervous fibers in the CNS as foreign, enemy objects and attacks the substance with antibodies. Myelin is a protective substance that also helps speed electrical signals through the CNS, back and forth between the brain and the peripheral nerves, which are spread throughout the rest of the body.
When the myelin is damaged, signals slow down or don’t reach their destination, and the nerves are exposed to other dangers, which can cause them extreme harm. In addition, peripheral nerves can begin to atrophy due to lack of signal.
Prior to 2018, the medical community thought the number of individuals suffering from multiple sclerosis was much lower, but with new evidence, they have since revised estimates to more than double the number of cases believed to exist (from 400,000 to one million in the United States alone).
What are the risk factors for multiple sclerosis?
Anyone can develop multiple sclerosis, but there are some who are at much higher risk than others for the disease. Risk factors each increase the chance of having MS by different degrees, and there is no guarantee that a person at higher risk will necessarily develop multiple sclerosis.
- Age – While some types of MS (primary progressive multiple sclerosis) are more commonly diagnosed later in life, the vast majority of patients are diagnosed between the ages of eighteen and forty, with another larger quantity between forty and fifty.
- Gender – Those who were born as female are three times as likely as males to develop multiple sclerosis. This may have something to do with hormonal imbalance, though research is still needed, as there is no conclusive evidence.
- Race – Caucasians, especially those that trace ethnicity back to northern Europe, are at a higher risk of developing MS than any other race. Those with the lowest occurrence are Native Americans and Asians.
- Other autoimmune diseases – Someone who already suffers from another autoimmune disease, especially rheumatoid arthritis, thyroid disease, and type 1 diabetes, are more likely to be diagnosed with multiple sclerosis.
- Climate – Though the connection is not well understood, people who live in a temperate, or cooler, climate are more likely to develop the disease. The closer to the equator a place is, the lower occurrence there is of MS.
- Vitamin D – This could be linked to climate, as a connection with vitamin D deficiency has been linked to higher occurrence of MS. Cooler climates with less sunlight don’t promote high levels of vitamin D, since the body’s production of the vitamin is activated by sunlight.
- Infections – There may be a link between MS and viruses, like the herpesviruses that cause mononucleosis and chicken pox. While a vast majority of the population has been exposed to one form of these and are carriers (about eighty percent), in patients with multiple sclerosis, the number is close to one hundred percent.
- Family history – While there is no indication that a particular gene mutation is passed down to inherit the development of multiple sclerosis, patients who have immediate family members (parents or siblings) with the disease have a greater likelihood of being diagnosed.
- Smoking – While it hasn’t been proven that smoking increases the initial onset of symptoms, it does exacerbate the disease. In fact, smokers who have had one event of MS-like symptoms are far more likely to develop the disease than nonsmokers, and MS smokers see their disease progress much more quickly than those who give up smoking.
What causes MS to develop?
Researchers are still seeking out a cause for the immune response that causes multiple sclerosis. Some theories are currently being tested, based on commonalities found between patients. For example, most patients with MS have a vitamin D deficiency, are low on certain other substances produced by the body, have been exposed to a herpes virus which may have triggered the immune system to become overactive, and are women. However, nothing has been determined, and there is a push to discover the cause, since far more people live with the disease than previously thought.
Symptoms and signs of multiple sclerosis
One of the reasons multiple sclerosis is difficult to diagnose is that MS has a vast array of symptoms, and they don’t always appear the same way, at the same time, or in the same combination. In fact, cases of MS in people are as unique as their DNA. However, the basic symptoms of multiple sclerosis appear in some configuration in all patients.
- Numbness, tingling and weakness in the limbs, usually on one side or the other at a time
- Lhremitte sign, a sharp electrical shock sensation when bending the neck forward or moving it around
- Decreased coordination, difficulty walking, unsteady gait, and tremors
- Extreme fatigue, regardless of amount of rest
- Blurry or double vision or partial to full loss of vision
- Pain during eye movement
- Slurred or difficult speech
- Trouble swallowing
- Dizziness and foggy mind
- Trouble concentrating or thinking normally
- Problems with bladder and bowel function
While most patients won’t experience every symptom, and there are other rarer occurring symptoms, a combination of several of these that last for two to three days could be a reason to go see the doctor.
Types of Multiple Sclerosis
Four types of multiple sclerosis have been recognized. The most commonly diagnosed form (more than 80 percent of cases) is relapsing-remitting multiple sclerosis (RRMS). The typical patient will have an onset of symptoms, called a relapse, that lasts from about a day to a week, and then the symptoms will fade away, called remission. A remission period lasts at least thirty days but could last for months or even years before another relapse occurs.
The second most common type is secondary progressive MS (SPMS). This is the point at which a patient who has been diagnosed with RRMS no longer has remissions. The symptoms appear and do not go away at all, and they begin to worsen over time.
About 10 percent of those with MS are diagnosed with primary progressive multiple sclerosis (PPMS). In this case, patients are typically older (though this is not guaranteed) and experience a sudden onset of symptoms that never let up, so they never experience a remission. The progression and worsening of the disease tends to be more aggressive for these patients, and therefore, so do treatments.
Progressive relapsing multiple sclerosis (PRMS) is very rare, seen in less than five percent of patients. In this form of the disease, patients see symptoms relapsing, sometimes with remissions but without all symptoms going away. Each relapse is progressive, with the symptoms worsening, whereas in RRMS, relapses are usually steady, with symptoms coming and going but remaining at the same level of disturbance.
Other diseases that look like MS
Several other diseases may mimic the symptoms of MS. For example, any neurological disease may show similar symptoms. Some chronic pain conditions may also seem to signal MS, as well as acute onset conditions. Some of these that must be ruled out prior to a diagnosis of multiple sclerosis include:
- Lyme disease, caused by a tick bite
- Syphilis, an STI that can cause symptoms in the nervous system for years after infection
- PML (leukoencephalopathy), a infection of the white matter in the brain that can be fatal
- HIV, and STI that can lead to AIDS and affects the immune system
- HTLV-1 (human T-cell lymphotropic virus), an uncommon progressive nervous disease
- Sjögren’s syndrome, an autoimmune disease attacking moisture glands
- Vasculitis – an autoimmune disorder that causes problems with the blood vessels
- Systemic lupus erythematosus, an autoimmune disorder that can cause inflammation in a number of organs, including the CNS
- Sarcoidosis, a chronic disease causing granulomas (groups of inflammatory cells) throughout the body
- Behçet’s disease, an autoimmune disease that attacks blood vessels, skin, and white matter in the brain
- Myelopathy, a group of other disorders found in the spinal cord
- Vitamin B12 deficiency, which can lead to permanent damage if not supplemented appropriately
- Neuromyelitis optica (NMO), a condition that causes changes to vision and eye pain
- ADEM (acute disseminated encephalomyelitis, an intense attack of inflammation on the CNS that is both acute and short lived
Diagnosing multiple sclerosis
To diagnose multiple sclerosis, a doctor (usually a neurologist) has to eliminate other diseases and conditions that could be causing the patient’s symptoms. The testing process that leads to diagnosis can be very difficult and very long, but it’s essential to assure the patient gets the proper treatment. The typical battery of tests includes:
- A thorough patient medical history and a physical and neurological exam by the doctor
- An MRI of the brain and spinal cord to diagnose MS, looking for lesions and damage to the nerves
- An EP (evoked potential) test, which stimulates certain nerves and watches for speed and type of response
- A spinal tap for MS diagnosis is a possibility as well, drawing spinal fluid to test for the presence of antibodies and inflammation
- Blood tests, which help rule out a plethora of other conditions that could be culprits
Conventional medical treatment options for MS
When a patient has a relapse, doctors will likely have them take intravenous corticosteroids to ease inflammation for four to five days and may follow up with an oral steroid for several more days. But that’s just the short-term fix, as are various pain medications. Long-term treatments for multiple sclerosis include a variety of options.
- Beta interferon – An injectable anti-inflammatory that helps control the symptoms of MS, beta interferon drugs are typically the first choice prescribed early on in the treatment process. Some are subcutaneous, and others are intramuscular. They range between daily and weekly treatment and can ease the pain from symptoms and potentially help slow the frequency of relapses.
- DMTs – Disease modifying therapies for multiple sclerosis are prescribed to assist with holding off relapses and progression. While there is no cure for multiple sclerosis, these treatments can slow down the effects and help prevent some permanent damage from occurring in the CNS. For example, fingolimod is taken once daily by capsule to help delay any physical disability that could arise from the disease. Natalizumab, on the other hand, is an intravenous treatment administered every four weeks and typically used for patients with rapidly progressing MS who haven’t responded to other treatments.
Multiple sclerosis is a serious disease, and it’s unfortunate that there are no cures for it. However, with early diagnosis and treatment, as well as supplementing conventional medicine with complementary and alternative therapies for MS (some patients respond well to acupuncture, with less pain, and others benefit from taking certain supplements but should always consult with their physician first), patients can have long, full lives.
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Quality of life is assisted through physical and occupational therapy for multiple sclerosis patients, with other options such as speech pathology and vocational therapy also available for those who need it. Continuing with the right diet and exercise, avoiding stagnancy and excess weight, can also improve overall health and happiness for those with multiple sclerosis. There is no reason someone with MS can’t live an independent, healthy life.