Multiple sclerosis (MS) is a disorder of central nervous system including brain and spinal cord. It is a potentially damaging disease that deteriorates the nerves.
In MS, communication problems occurs between the brain and body of a person as the immune system of that person attacks the protective sheath covering the nerve fibers leading to permanent damage or to the nerves.
Symptoms of MS vary from person to person depending on the severity of nerve damage and also on which nerves have been affected. People having severe MS may not be able to walk or perform daily chores. Some people might experience long duration of remission with no appearance of new symptoms.
Although there is no cure of MS, however, some treatments are available that can ensure a speedy recovery from MS attacks or modify the disease and relieve some symptoms. Generally, people might develop multiple sclerosis in their 20s to 30s. It’s has been seen to affect women 2 to 3 times more than men. In younger adults, MS is the most common cause of disability. [i]
Types of multiple sclerosis
MS is classified into two groups depending on the disease progression. It either starts with individual relapses or progresses gradually.
Relapsing remitting MS
This type is seen in about 8 out of 10 people. In this type of MS, the patient will have new episodes with worse symptoms, these are called as relapses. The symptoms may become worse inn a few days or weeks to even months. The improvement may occur in a similar period of time. Relapses can occur without any warning however sometimes they are associated with stress or a period of illness.
The relapse symptoms might disappear without any treatment, although a few symptoms may persist, with repeated episodes over several years. The time between the attacks of disease is called as periods of remission and these can last for years. Some people may progress to secondary progressive MS over the years.
Primary progressive MS
Only 1 out of 10 people may develop MS with a symptoms gradual worsening with time. In this type of MS, periods of remission does not occur although some people might get a period of time in which the symptoms stabilize.
Causes of multiple sclerosis
Multiple sclerosis is caused by an abnormality of the immune system where it attacks the central nervous system of the body itself mistakenly. The layer surrounding and protecting the nerves known as the myelin sheath is damaged and scarred followed by disruption of messages travelling from these nerves.
Although why the immune system acts in this way is not clear however according to most experts a combination of genetical and environmental factors might be involved.
Some risk factors of multiple sclerosis are as follows:
Family history: family history of MS is a common risk factor of this disease. Close relatives such as parents, siblings or children are at a higher risk.
Age: in most people the onset of MS usually occurs during 20 to 40 years of age. Most commonly younger and elder people are affected more.
Sex: it has been observed that women are more likely to get relapsing-remitting MS than men.
Race/Ethnicity: white people are more at risk of developing this disease as compared to Asian or African people.
Infections: some viruses have been found to be associated with MS.
Vitamin D deficiency: people with low levels of vitamin D or people having low exposure to the sunlight are at a greater risk of MS.
Autoimmune disorders: the risk of MS is higher in people having other autoimmune disorders like anemia, psoriasis, thyroid disease, type 1 diabetes or IBD.
Smoking: the risk of getting MS in smokers is higher as compared to non-smokers.
The symptoms of multiple sclerosis include neurological symptoms.
- Neurological symptoms: autonomic, sensory, visual, or motor defects including loss of sensitivity, problems with sensation (tingling, pins and needles), blurred vision, numbness, muscle weakness. Musculoskeletal symptoms: Muscle spasms, difficulty with balance, coordination and motion, visual problems, speech defects and tiredness.
- Bowel symtpoms: diarrhea, incontinence or constipation.
- Urinary symptoms: urinary retention, incontinence or urinary frequency.
- Other symptoms of MS include emotional problems, difficulty in thinking, unstable mood and depression. Uhthoff’s phenomena (symptoms worsen when exposed to temperatures higher than usual) and Lhermitte’s sign (electrical sensation running down the back when the neck is bended) may occur. [ii]
As already stated above that there is no cure of MS but there are several therapies that can be used to aim the symptoms of the disease and prevent further attacks or disability. The medication is usually initiated when two lesions appear on MRI after first attack.
As with all other medical treatments, medications for MS management also have several side effects.
Treatments for MS attacks
Generally there are two ways in which MS attacks can be treated. 1) Corticosteroids and 2) Plasma exchange (plasmapheresis).
- Corticosteroids (oral prednisone or methylprednisolone IV) – reduce the inflammation occurring in the nerves. Its side effects include insomnia, mood swings, fluid retention, increased blood pressure, and increased blood glucose levels.
- Plasma exchange (plasmapheresis) – in this therapy liquid part of the blood i.e. plasma is separated from the blood cells. These blood cells are mixed with albumin (a protein solution) and injected in the body. This process may be done if the symptoms are new or severe or if a person is not responding to steroids.
Treatments for MS symptoms
Physical therapy – stretching and strengthening exercises can help in relaxing the muscles and relieves the muscle spasms.
Mobility aid – can help in managing leg weakness, gait problems and performing daily tasks.
Muscle relaxants – medications like baclofen, tizanidine and cyclobenzaprine can be used to reduce the muscle spasms, relax muscles and reduce stiffness. Another treatment for spasticity is Onabotulinumtoxin.
Medications for fatigue – Amantadine, modafinil and methylphenidate are medications that can be helpful in relieving MS-related fatigue. Some anti-depressants such as selective serotonin reuptake inhibitors can also be used.