What is Multiple Sclerosis?
Multiple sclerosis is a chronic neurological condition that affects the central nervous system, specifically the brain, spinal cord, and optic nerves. It is considered to be an autoimmune disorder. The symptoms of the medical condition are mild in some, while it may have a far-reaching impact like a sudden loss of vision and severe cognitive abnormalities in some others. These symptoms adversely affect the myelin or the fatty tissue encompassing the nerve fibres. This causes damages in the form of inflammations, scars, lesions, or plaques. Such damages, known as sclerosis, disrupt the conduction of electrical impulses to and from the brain.
Types of Multiple Sclerosis
The medical condition is classified into four categories as below:
- Clinically isolated syndrome (CIS): When the medical condition occurs for the first time, it usually lasts for a single episode with the symptoms manifesting for at least 24 hours.
- Relapse-remitting MS (RRMS): When a single episode of CIS is later followed by a second bout of the symptoms, it is medically termed as a relapse-remitting MS. Here, the symptoms are greater in intensity or are marked by frequent episodes of the health condition after periods of remission. During these phases of remission, the symptoms may reduce completely or partially. This is the most common type of multiple sclerosis.
- Primary progressive MS (PPMS): In this type of MS, the symptoms get aggravated gradually, without remissions or early relapses. However, some patients may experience temporary phases when symptoms worsen before improving.
- Secondary progressive MS (SPMS): For this type of MS, there will be episodes of relapse and remission, with the symptoms worsening gradually.
Multiple Sclerosis Causes
There may be several probable factors behind the development of MS. However, there is conclusive evidence regarding the causes of the medical condition. The probable risk factors are as follows:
- Age: Pernicious anaemia individuals between the ages of 20 years and 40 years are at a higher risk of developing the disease, although it can affect younger and older people as well.
- Gender: Women are more than two to three times more likely to get relapsing-remitting MS as compared to men.
- Genetic history: An individual with either parents or siblings having/had MS are at a higher risk of the health condition.
- Race: People of Asian, African and Native American descent are less likely to develop MS as compared to white people of North American descent.
- Environmental factors: The incidences of MS are observed to be higher in countries with temperate climates like the northern U.S.A., Canada, south-eastern Australia, New Zealand, and Europe than in other parts of the world.
- Smoking: Smokers who have undergone a first episode of the disease are more likely than non-smokers to experience a second episode of relapsing-remitting MS.
- Vitamin D deficiency: Low vitamin D levels are often linked to MS.
- Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
- Certain autoimmune diseases: The immune system of individuals with autoimmune diseases attacks its own tissues. In case of this medical condition, the myelin gets destroyed by the immune system. Hence, individuals with autoimmune diseases like pernicious anaemia, psoriasis, inflammatory bowel syndrome, type 1 diabetes, thyroid disease, among others, are comparatively more prone to developing MS.
Multiple Sclerosis Symptoms
The possible symptoms of MS are:
- Pain and loss of vision as a result of inflammation of the optic nerve
- Double or blurred vision
- Red-green coloured distortion
- Difficulty while walking
- Weakness in the muscles of arms and legs
- Paresthesia or sensations of usual feeling or pain like prickling of pins, numbness, etc.
- Spasticity, or spasms of muscles
- Tiredness and fatigue
- Loss of hearing
- Bowel and bladder diseases
- Changes in sexual functions
- Cognitive dysfunction like affected memory, difficulty in focusing, and poor judgement
Multiple Sclerosis Diagnosis
There are no specific tests to confirm the medical condition. The symptoms of MS may indicate several other health conditions. A diagnostic procedure for this condition typically involves checking the personal and genetic medical history of the patient, along with a neurological examination. These neurological tests concern evaluating the language skills, emotional and mental functions, balance, vision, movements and analysing the five sensory organs. The physician may also refer the patient to an ophthalmologist for a thorough check-up.
The physician is likely to enquire and confirm the following to suspect the presence of this medical condition. These are as below:
- The patient must have had at least two sudden episodes of the symptoms of MS at least once every month, or an episode lasts for more than 24 hours while gradually becoming worse.
- There has to be at least one part of the central nervous system that has been damaged by more than one episode of MS and not by any other medical condition.
The above can be confirmed through certain medical tests as follows:
- MRI: This assists in diagnosing the presence of scars or plaques caused by MS.
- Cerebral spinal fluid analysis: Also referred to as spinal tap and lumbar puncture, this diagnostic test involves evaluating the fluid collected from the spinal column. The fluid is checked for chemical and cellular abnormalities, associated with MS.
- Evoked potentials: Here, the electrical response of the brain to auditory, visual and sensory stimuli to track the speed at which messages are received by the brain.
- Blood tests: These may be recommended to eliminate the scope of the symptoms being caused by neurological diseases.
Multiple Sclerosis Treatment
Multiple sclerosis treatment focuses on keeping the medical condition under check to prevent aggravations. There are no treatments that ensure a cure. The treatment involves improving certain bodily functions that trigger the symptoms of MS – bladder dysfunctions, spasticity, neurological conditions, fatigue and depression.
Multiple sclerosis treatments either concentrate on transforming the immune system to suppress the condition or involve treating the symptoms.
Now, let’s discuss the most common multiple sclerosis treatments. The drugs that can be prescribed are:
- Corticosteroid drugs: The most common treatment for treating relapses of MS, these drugs are generally injected into the veins. They are known to reduce the time pan of relapses and also improve the recovery time from an attack.
- Interferon-beta: This also is administered as an injection under the skin or into the muscle, most commonly for treating relapsing-remitting MS. This may be prescribed for controlling the incidences of relapses, and also lower the risk of worsening of the symptoms and subsequent disability.
- Plasmapheresis or plasma exchange: This procedure involves the removal of the liquid portion of the blood and replacing the same with plasma from donors or a suitable substitute. This can be recommended to reduce flares of symptoms that cannot be effectively treated by corticosteroids.
- Glatiramer acetate (Copaxone): An alternate treatment for relaxing-remitting MS, this is generally prescribed when interferon beta cannot be administered, the patient is allergic to it, or not effective any further.
- Oral fingolimod
- Dimethyl fumarate
Dr. Amit Shrivastava, Senior Consultant – Neurology, Dharamshila Narayana Superspeciality Hospital, New Delhi