Charlotte, NC
Bibhusan Basnet, MD
Aakiriti Karki, MD
Gauri Adhikari, MD
Multiple Sclerosis (MS) is a lifelong and unpredictable disease that impacts the central nervous system, including the brain, spinal cord, and optic nerves. Since the central nervous system governs everything our body does, this condition ranks among the most common disabling neurological diseases. It most commonly affects people in their 20s to 40s, with women being four times more likely to develop the condition.
In Multiple Sclerosis, our immune system erroneously attacks the myelin, the protective fatty covering of nerve fibers in the central nervous system. As this myelin gets destroyed in various areas, it forms scar tissue known as sclerosis or plaques. The absence of myelin to shield these nerve fibers disrupts the flow of impulses to the brain. This disruption can cause a range of challenging symptoms for individuals dealing with MS.
The specific reason behind MS has yet to be made clear. However, studies indicate that genetic and environmental factors contribute to its development.
While MS is not an inherited disorder, having a relative with MS may increase your risk due to genetic factors.
You cannot get infected with multiple sclerosis. However, certain viruses can trigger the activity of MS in the body. The most common virus associated with MS is Epstein-Barr Virus (EBV), which causes Infectious Mononucleosis. About 95% of people with infectious mononucleosis are affected by MS, showing the relationship of increased risk with the EBV virus infection.
Low levels of Vitamin D have been associated with multiple sclerosis. As you move farther from the equator, Vitamin D levels tend to decrease due to reduced sunlight exposure, whereas closer proximity to the equator allows for greater sunlight exposure and higher natural production of Vitamin D in the body, which may be beneficial in MS prevention.
Smoking increases the risk and the progression of the disease. Quitting smoking before or after MS diagnosis can delay the progression and, thus, the disability associated with MS.
Childhood or adolescent obesity, especially in girls, has been linked to a higher risk of MS. Additionally, for individuals already diagnosed with MS, obesity may increase the chances of experiencing relapses or developing more plaques.
MS is an unpredictable disease, and there are mainly four types of MS:
8 out of 10 diagnosed cases are RRMS, making it the most common type of MS. Like the name suggests, the symptoms come in the form of an attack or worsening of symptoms (relapsing) after weeks, months, or even years of disease inactivity (remission).
Individuals who are diagnosed with SPMS usually have had prior MS attacks but then begin to notice a gradual and steady decline in their overall function and symptoms over time. If left untreated, many people with severe relapsing-remitting MS may ultimately progress to develop secondary progressive MS.
This type of multiple sclerosis is not very common. From the beginning, neurological function slowly worsens, with no noticeable periods of improvement or worsening. Thus, the disability accumulates over time.
It is the rarest kind of multiple sclerosis that gets worse over time and has sudden relapses that can happen during the disease.
The symptoms of multiple sclerosis can vary greatly in terms of severity, duration, and unpredictability. No two individuals with MS experience identical symptoms, and each person’s symptoms can evolve or fluctuate over time. The most common symptoms include:
For many people, the first sign of multiple sclerosisis trouble seeing. You might notice symptoms like blurry vision and difficulty distinguishing between red and green. Your eyes may also hurt when moving. Pain and vision loss can occur because of swelling in the optic nerve.
Approximately 80% of individuals encounter significant impairment in their ability to function effectively due to physical fatigue. Even if you are not physically active, this symptom may stand out most.
You might feel pain in two distinct ways with multiple sclerosis. One is Neuropathic pain, which may feel like a sharp stabbing pain in the face or feelings of burning, pins and needles, or being squeezed in the trunk and limbs. Musculoskeletal pain is another type of pain, which includes back, neck, and joint pain. You might feel a constricting sensation around your torso, sometimes called the “MS hug.”
Walking challenges are common in MS and can involve muscle weakness affecting tasks like lifting or walking. You might develop balance issues, including unsteadiness and difficulty maintaining an upright posture. Additionally, you might encounter unusual sensations like numbness, tingling, or a sensation akin to pins and needles.
Spasticity means your muscles can feel tight and may contract on their own, making movement more challenging. The spasticity in MS may feel as mild as muscle tightness to more severe painful contractions, especially in the legs.
You might struggle to find the right words or remember what to do at work or home. Making decisions or keeping up with tasks and conversations may take time and effort. This could affect your job or school, possibly leading to disciplinary action, falling grades, and social difficulties.
You may find that constipation and loss of bowel control are common concerns with multiple sclerosis. You might notice symptoms like getting up several times at night to urinate, urinating more often than before, feeling the urge to rush to the toilet to avoid accidents, and experiencing urine leakage or accidents.
Emotional changes are expected in individuals with MS. Many experience periods of depression, which may stem from the condition or the stress of managing a chronic illness, or both. Anxiety is also prevalent due to the unpredictable nature of MS. Additionally, MS can occasionally trigger abrupt and intense mood swings, such as sudden bouts of crying, laughter, or anger.
The diagnosis of multiple sclerosis involves a combination of clinical evaluation, medical history review, neurological examination, and specific diagnostic tests.
History is a very important aspect of multiple sclerosis. If you have experienced at least two attacks that are at least one month apart, where symptoms appear suddenly or worsen for at least 24 hours, then you likely have MS. Additionally, there must be damage to the myelin in more than one area of the central nervous system, occurring at different times and not caused by another disease.
MRI plays a crucial role in detecting inflammation, demyelination (damage to the myelin sheath), and lesions (plaques) characteristic of MS in the brain and spinal cord. MRI scans provide valuable information for diagnosing MS and monitoring disease activity over time.
A lumbar puncture, also known as a spinal tap, may be conducted to analyze the cerebrospinal fluid (CSF) for abnormalities indicative of MS. This includes elevated levels of specific proteins (oligoclonal bands) or immune cells that signal inflammation within the central nervous system.
EP is a diagnostic test that assesses the sensory pathways in the nervous system by measuring electrical activity in response to specific stimuli. Visual evoked potentials (VEP) use flashing lights or patterns to evaluate visual pat. In contrast, while somatosensory evoked potentials (SSEP) involve electrical stimulation of peripheral nerves to assess sensory pathways, auditory evoked potentials (AEP) use sounds or clicks to evaluate auditory pathways. Electrodes are placed on the scalp that detect and record the responses of the brain to these stimuli, helping to identify abnormalities such as delayed nerve conduction or demyelination, as seen in MS. [3]
Blood tests can’t directly diagnose MS, but they can help rule out other conditions that have similar symptoms. These tests check for things like lupus, Sjogren’s syndrome, deficiencies in vitamins or minerals, certain infections, and rare genetic diseases.
Currently, there’s no cure for MS, but treatments can help manage the condition and reduce the severity of the symptoms. Treatment depends on the stage of the disease and specific symptoms.
DMTs are a cornerstone of MS treatment, particularly for relapsing forms of the disease. They help by reducing the frequency and severity of relapses, delaying disease progression, and decreasing inflammation in the central nervous system. Examples of DMTs include interferons, glatiramer acetate, dimethyl fumarate, fingolimod, and newer agents such as ocrelizumab and siponimod.
During relapses or exacerbations of MS symptoms, corticosteroids may be prescribed to reduce inflammation and speed up recovery. Plasma exchange (plasmapheresis) may be considered in severe relapses that do not respond to steroids.
Rehabilitation programs tailored to individual needs can help maintain mobility, improve balance, strengthen muscles, and address specific functional impairments caused by MS. Occupational therapists assist with adaptive techniques and tools to enhance independence in daily activities.
Adopting a healthy lifestyle can positively impact MS management. Lifestyle changes include maintaining a balanced diet, engaging in regular physical activity, avoiding smoking, and managing stress effectively.
Regular monitoring of disease activity, treatment response, and potential medication side effects is essential. Your neurologist can adjust the treatment plan based on disease progression and individual needs.
Diet plays a role in managing MS and supporting overall health. While there is no specific “MS diet,” a balanced and nutritious eating plan can be beneficial. Recommendations often include focusing on whole foods such as vegetables, fruits, legumes, whole grains, seeds, and nuts, which provide essential vitamins, minerals, antioxidants, and fiber. Omega-3 fatty acids that are found in fatty fish (like salmon and sardines), flaxseeds, and walnuts have anti-inflammatory properties and could be beneficial for people with MS. Adequate hydration is important to help manage symptoms like fatigue and constipation. Some individuals with MS may benefit from vitamin D supplementation if levels are low.
MS and pregnancy can present unique considerations. Generally, pregnancy does not appear to increase the risk of MS relapses, especially during the second and third trimesters when the immune system is naturally suppressed. In fact, many women with MS experience a temporary improvement in symptoms during pregnancy. However, there is a slightly increased risk of relapse in the first few months postpartum. Women with MS need to work closely with doctors to manage symptoms and medications during pregnancy, as some treatments may need to be adjusted or discontinued. Overall, with proper planning and medical supervision, many women with MS can have successful pregnancies and healthy babies.
Living with MS is difficult, but there are strategies and resources available to help manage the challenges effectively. One crucial aspect is adhering to your prescribed medication regimen. As mobility issues arise, assistive equipment like canes or walkers can greatly enhance independence, while rehabilitation activities can maintain or improve functionality. Making adaptations to your home environment, such as installing grab bars or rearranging furniture, can also promote independence and safety. It’s essential to communicate openly with your family and doctors about your needs, which would help you feel supported. By proactively addressing these aspects, you can navigate the complexities of MS with greater resilience and empowerment.
MS cannot be prevented. While the development of MS cannot be predicted or prevented with current knowledge, there are ongoing efforts to identify potential risk factors and understand the underlying mechanisms of the disease. Research into lifestyle factors, such as vitamin D levels, smoking cessation, and maintaining a healthy diet and exercise regimen, may contribute to overall health and potentially reduce the risk of other chronic diseases. However, there is no known definitive way to prevent MS from occurring in individuals predisposed to the condition.
