The National Institute of Neurological Disorders and Stroke defines multiple sclerosis (MS) is an unpredictable disease of the central nervous system. MS can manifest in many ways, ranging from relatively benign symptoms all the way to extreme physical disability. Ultimately, MS is a disease that disrupts the communication between the brain and the other parts of the body. This neurological disease can be incredibly crippling at its worst when the brain is unable to control the rest of the body’s functions.
The earliest documented MS case dates all the way back to 1395! A young woman in Holland named Lidwina the Virgin developed an acute illness that was noticed after she fell while skating on a frozen canal. Her symptoms included blindness in one eye, weakness, and pain. A number of specialists that have studied her case in the modern era believe that signs point to Lidwina having MS.
However, multiple sclerosis was first truly defined by Jean-Martin Charcot, a neurologist in France’s Hôpital de Salpétrière in 1868. Studying nerve damage, he noticed that there was a distinct difference between Parkinson’s disease and MS. Charcot was the one who gave the disease its name.
Throughout the 1800s and 1900s, numerous therapies were developed to treat MS. Cortisone was first used to treat relapses in 1951, though it was discovered it had no long-term effects.
To date, there is still no cure, but more than 20 brand name and generic medications have been approved to help alleviate symptoms.
MS is an autoimmune disease, which means that it triggers an attack of the body against itself. MS attacks the body’s tissues; specifically, it targets the central nervous system or CNS. According to researchers, the immune system’s cells—otherwise known as the “surveillance cells” of the body—behave differently in the brain of MS-afflicted individuals. As an autoimmune disorder, the cells mistakenly attack healthy tissue instead of foreign invaders like viruses or bacteria.
The CNS is made of the brain, spinal cord, and optic nerves. The nerves in the CNS are covered in myelin, which insulates them. But people with MS have immune systems that attack this insulation, wearing it away and damaging the nerve fibers themselves. This causes severe inflammation. The loss of myelin leads to communication issues between the brain and the body. MS can damage the nerves of the brain stem, the cerebellum (impacting balance and movement control), the spinal cord, the optic nerve, and even white matter found in some regions of the brain.
The more damage occurs, and the more lesions develop, the more the nerve fibers—also known as axons—themselves will be damaged or even break completely. When the nerve fibers become damaged or destroyed by MS, the CNS has difficulty or is entirely unable to send the correct messages to where they need to go. The electrical impulses from the brain will have trouble reaching the target nerves or fail, losing bodily functions. The further the disease develops, the brain might also endure cortical atrophy, wherein the brain’s cortex starts to shrink.
The damaged areas may also develop scar tissue. This is how multiple sclerosis earned its name—multiple areas of scarring, also known as sclerosis or plaques, are found in the white matter of the brain. These plaques can be as small as pinheads to the size of golf balls. Left untreated, this can cause permanent damage and deterioration of the body’s nerves.
Multiple sclerosis is known to be hard to predict. For many people with MS, its different symptoms can lead to flare-ups of the illness. These flare-ups can run over a few days, but can stretch for months or even years before subsiding.
As a result of its unpredictability, many individuals who haven’t encountered MS may find it confusing and strange. The signs and symptoms that lead towards MS can vary greatly. Many of them depend largely on the severity of the nerve damage the disease has caused, as well as which nerves are affected.
The effects of the illness, particularly in the most severe cases, can cause people to be unable to walk independently, or at all. However, there are instances where others may experience remission with no new symptoms.
According to the National Institute for Neurological Disorders and Stroke, roughly 250,000 to 350,000 people in the USA live with MS. Meanwhile, the National Multiple Sclerosis Society notes that the number may be closer to one million.
Most symptoms of MS first appear between the ages of 20-40 years old, but anyone of any age may be diagnosed with it. The disease for most people may be mild, but there are also cases where people will lose motor functions or the ability to write or speak. As mentioned before, the signs and symptoms can vary from person to person, and this contributes to the confusion about MS. The symptoms may vary depending on the extent of the nerve damage and where the plaques are located.
Some of the most obvious or commonly reported symptoms are as follows:
- Numbness and weakness – These symptoms manifest in many MS patients where the nerve endings can no longer receive commands from the brain. It typically occurs from one side of the body at a time, and usually in the legs.
- Tingling sensations – This is a symptom that may be easier to understand for many people. Sometimes, limbs seem to “fall asleep,” and you experience a tingling as blood flow and feeling returns to the limb. But in MS patients, these are electric-shock sensations, usually around the neck. Called the Lhermitte sign, MS patients report that they feel these shock-like sensations when they bend their neck forward.
- Tremors – As the body starts to lose control of its functions and motor coordination, there are times when the limbs start to shake. The body becomes uncoordinated, and there is an unsteady gait when the person is walking. The unsteadiness is also accompanied by dizziness. The dizziness doesn’t go away even after sitting still.
- Vision Problems – People with MS can also have their optic nerves damaged by the disease. This results in a partial or complete loss of vision. It starts from one eye before going on to the other. Other signs include pain when the eyes move, along with a prolonged double or blurry vision.
- Slurred speech – MS can also cause difficulty in talking along with loss of control of motor functions.
- Fatigue – This symptom sets in following the other signs. Mental and physical fatigue manifest as the body has more difficulty than usual in performing even simple tasks. The sense of weakness may also show in weak, stiff muscles. The muscles may develop painful spasms.
- Bowel problems – Bladder control and bowel problems happen when the body can no longer control the excretory system. It occurs in almost 70% of individuals with MS. Some people report bowel incontinence, while others may experience slow bowels and constipation. Constipation is prevalent in MS sufferers, particularly ones that lack physical activity and do not eat enough fiber.
- Cognitive problems – As the disease progresses, with lesions and plaques continuing to grow in the brain, cognitive difficulties arise. This issue can also lead to mood changes that include bouts of depression or euphoria. The afflicted individual can have trouble making decisions or creating plans. They may have difficulty concentrating or multitasking as well.
- Anxiety – This symptom becomes one of the most taxing to overcome for many individuals with MS, even though it’s often overlooked. Research shows that the reality of living with MS and its unpredictability leads to a huge mental and emotional toll on sufferers.
Transverse Myelitis is a secondary condition that accompanies MS, developing in a subset of individuals. This condition is caused by spinal cord inflammation and leads to loss of spinal cord function as the disease progresses. This can last from several hours up to several weeks and is characterized in the beginning by sudden lower back pain. Accompanied by muscle weakness as well as abnormal sensations in the lower extremities, this condition can rapidly worsen. More severe symptoms can appear, including paralysis. For most people suffering from this secondary condition, they can start to see some recovery of function after roughly 12 weeks after the attack.
For some people, MS symptoms may be triggered environmentally. It could be caused by another issue in the body or a viral infection. However, MS is not a contagious disease. While its causes are not fully known, researchers around the world continue to search for answers that can help people identify and find ways to prevent it.
Multiple sclerosis is most frequently diagnosed in young adults, but people of any age could find themselves diagnosed with it. It also occurs in most ethnic groups, though it’s most common in Caucasians of northern European ancestry. A combination of factors are attributed to the onset of MS:
- Immunology – An abnormal immune response can cause stripping of myelin and inflammation, damaging the central nervous system. The T-cells become activated in the lymph system and cause damage. T-regulatory cells typically dampen or “switch off” the inflammation, but people with MS have regulatory cells that do not function correctly. As a result, the B-cells (or secondary immune cells) activate, producing even more antibodies and stimulating other proteins, exacerbating the issue.
- Environmental Factors – MS occurs more frequently in areas farther from the equator. Epidemiologists are still studying the disease patterns in geography, demographics, and genetics to determine why this is. So far, they have found that people born in an area with a high risk of MS that then migrate to a lower risk location before the age of 15 will take on the area’s same risk level. This suggests that exposure to some environmental regions may predispose a person to develop MS.
- Genetic factors – While a person cannot inherit MS, there may be genetic risk factors that can be inherited by individuals. Roughly 1 in 750-1000 people carry some of these risk factors. If one identical twin has MS, the other twin’s risk of developing MS is roughly 1 in 4. Furthermore, the likelihood of developing MS also increases if first-degree relatives in one’s nuclear family also have MS, but the risk is far less than that of twins.
There are different types of MS also to consider. There are four basic “courses” of the disease—also known as phenotypes—as defined by the International Advisory Committee on Clinical Trials of MS in 2013.
- Clinically Isolated Syndrome (CIS) - This form of MS is the first episode of neurological symptoms. As the name implies, it is a single event characterized by some symptoms of MS that typically lasts for at least 24 hours. People who experience CIS may or may not go on to develop MS itself.
- Relapsing-remitting MS (RRMS) - This disease course is the most common and defined by attacks of neurological symptoms that are either new or increasing over time. These relapses are also followed by periods of remission. This can be partial or complete recovery, and during remissions, the symptoms may disappear or partially abate. RRMS can be active (with relapses), not active, worsening (increase in disability over time following a relapse), or not worsening.
- Secondary Progressive MS (SPMS) - This is an initial relapsing-remitting course. People with RRMS may transition into this course as their neurological symptoms worsen over time. Just like RRMS, it can be classed as active, not active, with progression (signs that the disease is worsening over time), or without progression.
- Primary Progressive MS (PPMS) - This course is characterized by worsening neurological functions and the accumulation of disability from the symptoms, without remissions or early relapses. Approximately 15% of people with MS are diagnosed with PPMS. Similar to the other phases, it has multiple classifications: active, not active, with progression, or without progression.
Diagnosis & Testing
To date, no single test can diagnose MS. However, there are several strategies used to diagnose MS, including a comprehensive study of a patient’s medical history, neurological exams, and lab tests.
To rule out other possible causes of symptoms, doctors must look back at the patients’ records as deeply as possible. They may also turn to magnetic resonance imaging (MRI) to determine if plaques or scarring is growing around the central nervous system. They may also perform a spinal fluid analysis or other blood tests to rule out other conditions before they officially diagnose an individual with MS.
The criteria to diagnose MS is as follows:
- There must be evidence of damage in at least two separate areas within the central nervous system. Often, doctors will look into the brain, spinal cord, and optic nerves.
- There must be evidence that the damage did not happen simultaneously. The injury must have occurred within a period of time between one another, showing the progression of the disease.
- Finally, all other diagnoses must be ruled out.
The Food and Drug Administration has approved numerous medications in the treatment and management of MS symptoms. Injectable medications include interferon beta-1a, interferon beta-1b, glatiramer acetate, and peginterferon beta-1a. Oral medications include teriflunomide, fingolimod, cladribine, siponimod, dimethyl fumarate, and diroximel fumarate. Infused drugs also include alemtuzumab, mitoxantrone, ocrelizumab, and natalizumab. There are even more medications that are designed to manage relapses as well as symptoms, particularly for mental and emotional health.
Diet & Lifestyle
For people with MS, there is no specific diet that can prevent or cure the disease. Patients need to carefully consult with their physicians before taking on any special kind of diet that could cause harm. Typically, people with MS need a balanced, low fat, and high-fiber diet. They should avoid processed food and look for natural alternatives similar to a Mediterranean diet. Alcohol also should be limited as much as possible. Some research suggests that people with MS may benefit from omega-3s and should eat food like fish and nut-based fat like olive oil, avocado oil, and almond butter.
Therapy and Procedures
Managing MS includings managing relapses or inflammation that damages myelin. Apart from medication, they can turn to rehabilitation to maintain their body and motor functions. Physical therapy is vital for patients as physical strength can promote independence and improve safety. It also prevents major complications such as muscle weakness from lack of mobility, contractures from spasticity, and deconditioning of muscles.
Occupational therapy is another method to help people with MS to maintain their energy. Through the use of adaptive tools and devices, everyday tasks can become more straightforward and more comfortable to do.
Speech-language pathology and cognitive rehabilitation can also significantly improve quality of life. Safe swallowing and overall health are taken into consideration here, with a careful study of the individual’s problems with thinking, memory, reasoning, and concentration.
Research & Advancement
Since there is so much still unknown about MS, it’s become incredibly important to continue to do research and learn more about it. Research is vital in many aspects in the treatment of MS, but it’s even more essential when it comes to diagnosing it.
Researching a patient’s medical history is critical as doctors need to rule out every other disease or cause of symptoms that a patient is having. This means that healthcare providers must make a note of everything; they must identify past or present MS symptoms, information about the patient’s birthplace and family history, environmental exposures, places traveled, and even other illnesses. They will also need comprehensive exams such as cranial nerve tests, sensation, reflexes, coordination, and balance.
Because of technology’s advancements, electronic health records can make the process easier for healthcare providers. Digital records allow them to get a more in-depth look into the patient’s history, from family to previous illnesses, and genetic concerns, among others. By having a comprehensive look into the patient’s health file, doctors are more easily able to diagnose or eliminate the possibility of MS in a patient.
Does MS always cause paralysis?
No. The majority of people with MS don’t even become severely disabled. Two-thirds of people afflicted with MS are still able to walk, and might only need an aid such as a cane or crutches.
Is MS fatal?
Life expectancy in MS has dramatically increased over time due to breakthroughs in medicine and treatment, as well as better healthcare. It’s come to the point that the average life expectancy of people with MS is about seven years less than the general population. Most complications can be prevented or can be managed.
Does MS or MS treatments put pregnancies at risk?
MS does not affect fertility, and pregnancies may progress with all the same risks and benefits as other people who don’t have MS. New mothers may need more rest and assistance during their first months. Some medications, however, may increase the risk of miscarriage and can be transmitted in breast milk. It’s highly advised that you consult with your doctor with regards to your medication if you plan on having children.
Having your comprehensive medical history is essential in helping doctors diagnose illnesses like multiple sclerosis. If you would like help obtaining your medical records, PicnicHealth can do the hard work of collecting and organizing your medical records into a secure, digital Timeline. PicnicHealth also enables people to make their voice heard by contributing their records anonymously to research into new treatments for MS. Visit Flywheel.MS to learn more.