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What is multiple sclerosis?

Multiple sclerosis – causes, symptoms, diagnosis, treatment, pathology

MS exercises

Six surprising facts about MS

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is an autoimmune condition affecting the central nervous system particularly the brain and the spinal cord. MS causes destruction of the myelin sheath (protective cover) covering nerve fibers thereby disrupting communication between the brain and the body. Consequently, the nerves become damaged. Depending on the severity, MS can be a disabling condition. MS is more common among women than men and usually appears in people aged 20-40.

While the exact cause of MS has been hard to pinpoint, doctors and researchers believe that is an autoimmune disease as the immune system begins to attack the healthy cells by mistake. A combination of genetic and epigenetic factors could be responsible for MS. MS affects more than 2.3 million people globally.

There are two main types of MS. MS with relapses and MS with gradual progression.
  • Relapse remitting MS – 8 out of 10 people diagnosed with MS have the relapse remitting type. In this type of MS, people experience a periodic burst of severe symptoms and complications which can last from days to weeks or months. This slowly settles over a time period and stays dormant until the next relapse. The time period between a relapse could vary from months to years. Many people with this type of MS go on to develop secondary progressive MS within 15-20 years. During this phase, symptoms appear now and then and gradually abate.
  • Primary progressive MS – 1 in 10 people diagnosed with MS have this type. In this type of MS, there is no remission but a gradual worsening of symptoms though people do experience periods of stability.

Some of the risk factors for developing MS include:

  • Family history – if a sibling or a parent has had MS, one is at higher risk of developing it too
  • Ethnic groups – the European race has been more susceptible to MS than Asian or African races
  • Infections – prior infections like the Epstein-Barr virus which leads to infectious mononucleosis is a major risk factor for MS
  • Other autoimmune conditions – like type 1 diabetes, psoriasis, inflammatory bowel disease and polycystic ovary syndrome

Though every individual experiences MS differently, some of the common symptoms include:

  • unexplained fatigue
  • trouble walking and climbing stairs
  • visual disturbances like blurred or double vision
  • Numbness and tingling in the limbs
  • problems with balance and coordination (frequent episodes of falling)
  • learning problems
  • loss of bladder control

These symptoms may appear on and off and then gradually fade or suddenly become worse. In some cases, the onset of MS begins with a host of other autoimmune disorders like type 1 diabetes, PCOS, psoriasis and other inflammatory conditions of the skin.

There is no single test which can actually diagnose MS. Clinicians use a number of tests and criteria to make a diagnosis. You may be referred to a neurologist who may clinically examine you and look for abnormalities in eye movements, limb strength, speech, balance, coordination and reflexes.

Blood tests are usually done to rule out other autoimmune diseases like Lupus since a test positive for antinuclear antibodies (ANA) may indicate these conditions.

A lumbar puncture for cerebrospinal fluid analysis may be done since changes in the fluid can be indicative of a neurological condition like MS. The fluid is usually tested for immune cells and antibodies which can signal an autoimmune disease.

An MRI scan which uses strong magnetic field and radio waves can indicate if there is damage to the myelin sheath in the brain and spinal cord. This is usually a confirmatory test if the scan indicates scarring of the myelin sheaths.

Currently, no permanent cure is available for MS. Treatment is aimed at preventing deterioration and preserving mobility. An interdisciplinary team of doctors including neurologists, orthopedicians, primary care physicians and physiotherapists will be required to take care of the clinical needs of the individual. Attacks and flare-ups are treated with the following medications:
  • plasma exchange (plasmapheresis) – where the plasma in your blood is removed and separated from the red blood cells, mixed with albumin (protein) and put back into the body. Plasma exchange is used only when the individual does not respond to steroids.
  • corticosteroids – like prednisone tablets or IV methylprednisolone. These medications can reduce neural inflammation and mute the immune system. Side effects can include weight gain, depression, high blood pressure and fluid imbalances.
There are many treatment options for relapse-remit MS and the physician or neurologist may suggest a line of treatment depending on the individual condition and access to drugs. Some of these drugs include:
  • beta interferon injections
  • ocrelizumab which is humanized immunoglobulin antibody medication. This is an IV to be given under clinical supervision. Clinical trials have indicated positive effects in slowing down disability
  • glatiramer acetate prevents the immune system from attacking the myelin sheath
  • dimethyl fumarate is a twice daily medication which can reduce the rate of relapses
  • fingolimod is a once-daily medication to prevent relapses
  • teriflunomide is also a once-daily medication to prevent relapses. his drug must not be used during pregnancy
  • natalizumab blocks the movement of damaging immune cells from the bloodstream to the brain and spinal cord. It is the first line of treatment for individuals with severe MS
  • alemtuzumab is aimed at reducing the nerve damage caused by MS. This treatment involves five continuous days of IV infusions followed by three days of infusion after a year. Special safety monitoring is required for individuals on this medication
  • mitoxantrone has a number of side effects including development of blood cancers and this drug must be used only in severe, advanced MS
Patients taking the above medications need to regularly monitor their heart and liver health. Physical therapy and rehabilitation is required for individuals with MS to maintain their mobility, endurance and strength. Stretching and strengthening exercises are strongly recommended. Individuals with extreme stiffness may be prescribed muscle relaxants. Other medications may be prescribed for bladder control and other dysfunctions associated with MS.

Individuals with MS can participate in all life activities and must be encouraged to go to college, work and participate in social activities. Psychosocial counselling must be made available whenever required with other supportive measures. Though it is not easy living with any chronic illness, individuals are encouraged to seek out support and help whenever required. It is important to stay on line with normal, routine activities and socialize to keep up connections with friends who can provide support. Talk to your doctor or counselor whenever you feel the need for help.

While MS is a challenging condition, new treatments developed over the past 20 years have improved the outlook and quality of life.

The Rights of People with Disability Act (2016) in India includes MS and thereby provides legal rights and protection to all individuals with MS. Know your rights including access to education, employment, medical facilities and tax benefits.

Read the Act on