Understanding Multiple Sclerosis
By Sarah Sheldon OMS-II
What is Multiple Sclerosis (MS)?
Multiple sclerosis (MS) is believed to be an autoimmune disease that affects the brain and spinal cord of the central nervous system. In this disease, for reasons not entirely understood, the body’s immune system attacks a fatty material that insulates nerves called myelin. The myelin sheath that surrounds nerves allows electrical signals to spread quickly throughout the body. The myelin damage and scarring that occurs in multiple sclerosis causes problems in communication between the brain and the body. As a result, nerves can deteriorate or become permanently damaged.
What causes Multiple Sclerosis?
The cause of multiple sclerosis is unknown. It is likely due to a combination of environmental, genetic, and viral factors. Some of the possible risk factors are:
- Age: people of any age can be affected but MS most commonly begins between ages 20 and 40
- Sex: women are about two times more likely than men to develop the disease
- Race: White (Caucasian) people, particularly of Northern European descent, are more likely to develop MS than people of other races
- Family History: people are at some increased risk of developing MS if they have a parent or sibling who has the disease
- Certain Infections: some viruses have been linked to MS
- Other Autoimmune Diseases: people who already have other autoimmune diseases, such as thyroid disease, type 1 diabetes, or inflammatory bowel disease might have a slightly increased risk of developing MS
- Climate: research has suggested that people who live in temperate climates such as the northern US and Canada have an increased risk of MS
What are the symptoms of Multiple Sclerosis?
Multiple sclerosis has a wide range of symptoms that are dependent on both the level of nerve damage and the location of nerves affected. This means that each individual with the disease might experience completely different symptoms. Additionally, an individual’s symptoms can change over time as the disease worsens. Some of the most common symptoms patients experience include:
- Problems with vision such as double vision, blurriness, partial color blindness, eye pain, partial or complete loss of vision in one eye
- Muscle weakness, stiffness, or spasms
- Numbness or weakness on one side or the bottom half of the body
- Sensations such as numbness or tingling (pins and needles)
- Problems with coordination and balance
- Mild thinking and memory problems
- Electric shock sensations caused by moving the head in a certain way (e.g. bending the neck forward)
- Slurred speech
- Changes in bowel or bladder control
How is Multiple Sclerosis diagnosed?
Multiple sclerosis can be difficult to diagnose because there is no single test used to diagnose the disease. A medical history will be taken to learn about the symptoms the patient is experiencing. A physical exam will be done to look for changes or weaknesses in eye movements, leg and hand coordination, balance, sensation, speech, and reflexes. An MRI of the brain and spinal cord may be performed to look for areas of scarring (lesions). A lumbar puncture (spinal tap) may be performed in which a small sample of fluid is removed from the spinal canal and analyzed for abnormalities associated with MS. An evoked potentials test might be performed in which electrical activity in the brain is recorded when nerves are stimulated. Patients might also have blood tests done as a way to rule out other diseases that have symptoms similar to MS.
What are the treatments for Multiple Sclerosis?
There is no cure for MS. The purpose of treatment is to speed up the recovery from attacks, slow the progression of the disease, and manage symptoms.
Disease modifying therapies (DMTs) decrease symptoms and future brain and spinal cord lesions/inflammation. Medications that work as DMTs include:
- Teriflunomide (Aubagio), Fingolimod (Gilenya), and Dimethyl Fumarate (Tecfidera): work to block certain functions of immune cells to help prevent further nerve damage
- Beta Interferons (Avonex, Betaseron, Extavia, Plegridy, Rebif): these medications slow the worsening of MS symptoms over time
- Glatiramer acetates (Copaxone, Glatopa): block the immune cells that damage myelin thereby leading to fewer relapses, as well as, new cell lesions
- Monoclonal antibody drugs such as Natalizumab (Tysabri), Ocrelizumab (Ocrevus), and Alemtuzumab (Lemtrada): used to treat severe forms of MS that work by altering the immune system’s response to inflammation
- Antineoplastic drug Mitoxantrone (Novantrone): used in cases of severe MS to suppress the activity of immune cells that attack the myelin sheath
For acute MS attacks, treatment options include:
- Corticosteroids: steroids like prednisone (oral) or methylprednisolone (injection) can be given to reduce inflammation from an MS attack
- Plasma exchange therapy: used in cases of MS attacks for which the patient has not responded to steroids
There are also therapies that can be used to manage MS such as:
- Physical therapy: to help with walking, strength, balance, posture, fatigue, and pain
- Occupational therapy: to help increase level of independence and safety at work and at home
- Speech therapy: for patients who have difficulty talking or swallowing