Nerves are protected by a fatty outer layer called myelin. MS targets myelin and the cells that make it, a process called demyelination. Without that protective layer, the nerve fibers become damaged and develop scar tissue. (In medical terms, multiple sclerosis means many areas of scarring). As a result, communication to and from the brain is altered or interrupted, causing unpredictable symptoms. These may include:
- Incontinence and/or constipation
- Mood changes
- Speech difficulties
- Memory problems
- Walking difficulties and changes in gait
- Weakness in the limbs
- Impaired coordination
- Vision problems
These symptoms may be temporary or permanent. The type, severity, and duration of symptoms is different from one person to the next.
Types of MS
There are four types of MS, and they are defined based on the number and frequency of episodes and the course of the disease:
- Clinically isolated syndrome (CIS)
Clinically isolated syndrome (CIS) refers to a first and only occurrence of neurologic symptoms related to inflammation. More than 60% of people who experience CIS go on to develop MS. A person with CIS may be diagnosed with MS if a brain MRI shows active inflammation or scarring in a part of the nervous system other than the one causing the current symptoms.
- Relapsing-remitting MS (RRMS)
Relapsing-remitting MS (RRMS) is the most common disease progression. Roughly 85% of people with MS initially receive a diagnosis of RRMS. People with RRMS have clearly defined attacks, also called relapses or exacerbations, followed by partial or even complete recovery. Symptoms may improve or even disappear or lead to a higher degree of disability.
- Secondary progressive MS (SPMS)
Secondary progressive MS (SPMS) refers to a more advanced stage of MS in which neurological function gets progressively worse. Disability increases over time, even without changes on an MRI. People whose MS has been classified as SPMS will experience periods of stability, as well as relapses. Not all people diagnosed with RRMS will progress to SPMS.
- Primary progressive MS (PPMS)
With PPMS, neurologic function and disability worsen as soon as symptoms begin. There is no pattern of remission. PPMS accounts for about 15% of all MS diagnoses.
Causes of MS
The cause of MS is a medical mystery scientists are still working to solve. Genetics, infectious diseases, and environmental factors may all play a part in triggering the disease. Ethnicity and geography may also have a role.
Ongoing research covers a variety of areas, including immunology, genetics, viruses and other infectious agents, and epidemiology. People who have a close relative with MS are more likely to develop the condition.
MS is a complex disease with a wide variety of symptoms and there is no simple test for it. Doctors diagnose MS by process of elimination, ruling out other conditions that could cause a person's symptoms. Your doctor will start by examining you and getting a thorough medical history. Next will come a variety of tests, which usually includes blood tests, a spinal tap, and MRI. An evoked potential test, which involves placing electrodes on your scalp and other parts of your body to measure how quickly your brain and spinal cord respond to stimuli is also a common tool for diagnosing MS.
Treatment of MS
MS is a chronic condition that can be managed but not yet cured. Treatment focuses on accelerating recovery after an attack, reducing the incidence of relapse, slowing the progression of the disease, and managing symptoms.
Corticosteroids are prescribed to reduce nerve inflammation, but these have side effects and must not be used long term. Another treatment is plasmapheresis, or plasma exchange, in which your blood plasma is removed and separated from your blood cells. The blood cells are mixed with a protein solution and put back into your body. This procedure removes the excess antibodies being created by your immune system.
Much of the immune response associated with MS occurs early in the disease process. Medications that lower relapse rate, slow the development of new lesions, and potentially reduce risk of disability should be used as early as possible. Treatment options for relapsing-remitting MS include injectables, infusions, and oral medication. Your doctor will discuss your options and potential side effects of the drugs you are prescribed.
Lifestyle Tips for Living With MS
- Get plenty of sleep. Fatigue is a common problem for people with MS, and getting adequate, good quality sleep is critical.
- Exercise. Low impact forms of exercise such as swimming, walking, stretching, low-impact aerobics, stationary bicycling, yoga, and tai chi can help people with mild to moderate MS maintain their strength, muscle tone, balance, and coordination.
- Stay cool. Some people find that their symptoms worsen when their body temperature goes up, so take care not to get overheated when you exercise.
- Eat a healthy, balanced diet. Get plenty of vitamin D, which research indicates may be helpful for people with MS.
- Relieve stress. Try yoga, tai chi, massage, meditation, or deep breathing to help reduce symptoms exacerbated by stress.
This article first appeared in the April 2023 edition of the HealthPerks newsletter.