Multiple Sclerosis (MS): Symptoms, Causes, Risks, Types, Diagnosis, Treatment and Complications

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women with a wheelchair that have Multiple sclerosis

1Overview

The central nervous system (CNS) is an important part of the body. It mainly contains the brain, the spinal cord and the numerous nerves throughout the body. The brain plays a pivotal role in the control of many bodily functions such as movement, speech, thoughts, memory, awareness, and sensation.

The spinal cord, on the other hand, serves as the pathway of the signals back and forth between the nerves and the brain. It’s connected to a section of the brain dubbed as brainstem. Just like any other system in the body, the CNS can experience a wide array of diseases that can affect the quality of life of those with the conditions.

One condition that affects the CNS in multiple sclerosis (MS). Multiple sclerosis is a debilitating disease affecting the spinal cord and the brain. It’s also an autoimmune disease, wherein the body’s immune system attacks the healthy cells in the body.

In this case, the immune cells attack the myelin sheath of the brain and spinal cord. This is a protective sheath that covers nerve fibers. When this happens, and the myelin sheath becomes damaged, it leads to a problem with the communication between the various parts of the body and the brain. When the condition progresses, it may lead to permanent damage of the nerves.

There is still no cure for multiple sclerosis. Treatments available today may help manage the symptoms felt by the people affected by the condition.

According to the Multiple Sclerosis Foundation, the worldwide prevalence of MS is about 2.5 million people. In the United States, it is estimated that more than 400,000 people are living with this condition. Also, approximately 200 new cases are being diagnosed every week in the United States. The prevalence rate of MS is higher in places which are farther from the equator.

2Symptoms

The symptoms of multiple sclerosis vary greatly from one person to another. Also, the disease can affect any part of the body since it targets the brain, the body’s control center.

  • Numbness or weakness in one or more extremities or limbs.
  • Persistent double vision
  • Partial or complete vision loss
  • Fatigue
  • Problems with bladder and bowel control
  • Difficulty walking
  • Tingling or pain in some parts of the body
  • Muscle spasms or stiffness
  • Problems with coordination and balance
  • Thinking, planning and learning difficulties
  • Tremors
  • Unsteady Gait
  • Electric-shock sensations (Lhermitte sign)
  • Dizziness

3Causes

Multiple sclerosis is an autoimmune condition wherein the immune system detects healthy cells as foreign threats. In this case, the immune cells target the brain and spinal cord. However, just like any other autoimmune conditions, the exact cause is still unknown.

In the case of MS, the immune system attacks the myelin, a fatty substance that protects and coats the nerve fibers in the spinal cord and brain. When the myelin sheath is damaged, the messages that travel along the nerve may be slowed or blocked.

It is still unclear why or how this happens, but here are possible causes:

Immunologic Factors – In MS, there is an abnormal immune-mediated response that targets the myelin sheath around the nerve fibers.

Environmental Factors – It is a known fact that based on statistics, MS is more common in people who live farther from the equator. This has led the scientists to suggest that disease patterns involved in the prevalence of MS are linked to variations in demographics such as age, gender and ethnic groups, geography, infectious causes and migration patterns.

As a result, they found that people born in high-risk areas for MS and then move to another area, but with lower risks for the disease, when they are 15 years old and below, have a lower risk compared when they were in the old location.

Furthermore, some scientists suggest the role of vitamin D in the development of MS. The individuals living closer to the equator are more exposed to the sun throughout the year, compared to those who live farther to the equator. Hence, the scientists suggested that it has something to do with the levels of naturally-produced vitamin D. Higher levels of this vitamin may help protect the body against autoimmune diseases.

Infectious Factors – Some studies have linked various infectious agents like viruses, bacteria and other microorganisms in the development of MS. Various microbes, including those causing measles, Chlamydia pneumonia, Epstein-Barr, human herpesvirus-6 and canine distemper, have been studied as possible causes of MS.

4Risk Factors

Though the exact cause of the illness is still unknown, some people are more susceptible to the disease than others. Here are the risk factors of MS:

Genetic Factors – MS is not hereditary but having first-degree family members like a sibling or a parent who has MS may dramatically increase someone’s risk of developing the illness.

Age – MS can occur at any age but it’s seen more in people between 15 and 60 years old.

Certain infections – Some viruses and bacteria have been linked to MS.

Sex – The illness affects women more than men. In fact, women are twice as likely to have the illness as men.

Climate – People living in places with temperate climates like the United States, Canada, southeastern Australia, Europe and New Zealand have an increased risk of developing MS.

Race – Caucasians or white people, especially those of Northern European race is

Smoking – People who are smoking and experience the initial bout of the disease are more likely than nonsmokers to have a second event.

Other autoimmune diseases – People with other autoimmune disorders are more likely to develop MS.

5Types & Related Conditions

Types of Multiple Sclerosis (MS)

Relapse-remitting MS (RMMS) – This type of MS is the most common. It affects about 85 percent of the individuals diagnosed with the disease. Moreover, people with RMMS experience increasing symptoms of MS.

Clinically-isolated syndrome (CIS) – This type of MS is just a single and first episode of MS symptoms. It usually lasts at least 24 hours.

Primary progressive MS (PPMS) – This type of MS is characterized by progressively worsening of the symptoms. There are no remissions or relapses. This is rare and affects just 15 percent of those with MS.

Secondary progressive MS (SPMS) – In this type of MS, the disease progresses after the initial relapse or episode.

Related Conditions

There are related conditions of MS, including:

Acute Disseminated Encephalomyelitis (ADEM) – This condition also affects the myelin sheath. There is a sudden inflammation of the spinal cord, brain, and the myelin.

Balo’s Disease – This is a rare CNS disorder wherein the myelin is damaged.

HTLV-I Associated Myelopathy (HAM) – HAM is a progressive condition that affects the spinal cord. There is chronic myelopathy.

Neuromyelitis Optica (NMO) – This is a disorder wherein the body’s immune cells attack the myelin cells in the spinal cord and optic nerves.

Transverse Myelitis – This is a disorder caused by the inflammation of one segment of the spinal cord.

Schilder’s Disease – This condition is defined as a progressive, rare, degenerative and demyelinating illness of the CNS. This condition usually starts in childhood.

6Diagnosis

There is no single test to diagnose multiple sclerosis. A combination of the following are recommended:

Medical history – The doctor will interview the patient regarding the onset of the symptoms, family history, and past medical history, to determine risk factors that could increase the likelihood of the disease.

Physical exam and neurologic exam – The doctor will conduct a complete physical examination and a neurological examination.

Blood tests – The doctor may also request certain blood tests to help rule out other diseases with similar symptoms as MS.

Imaging tests – Certain imaging tests like magnetic resonance imaging (MRI) and CT scan can be used to determine if there are lesions on the brain and spinal cord.

Evoked potential tests – These tests record electrical signals made by the CNS in response to certain stimuli.

Lumbar tap – A lumbar tap or spinal tap is used to get a sample of fluid from the spinal canal. This will be examined in the laboratory to determine if there are abnormalities in the spinal cord. This test can also help doctors rule out other infections or conditions that may produce similar symptoms as MS.

7Treatment

Currently, there is no cure for MS but some treatments are present to help manage the condition and relieve some of the symptoms. The goals of treatment are to help prevent relapses, relieve individual symptoms and reduce the number of relapses.

Treatment for MS acute attacks

Corticosteroids – These drugs are used to reduce the inflammation and suppress the immune system.

Plasma exchange – Also called plasmapheresis, this treatment involves the liquid portion or plasma of the blood. The cells are mixed with albumin and introduced to the body.

Treatment for Relapsing MS

Drugs

Various medications are used for the relapsing forms of MS. Using medications should be under the supervision of a licensed doctor. Do not take any form of drugs without a doctor’s advice.

Corticosteroids – These drugs are used for MS to reduce the inflammation and suppress the immune system.

Interferon Beta 1a or 1b – These drugs are used to slow the progression of the symptoms.

Other drugs – The other drugs used are Copaxone, Tysabri, mitoxantrone, and Aubagio.

Treatment for the signs and symptoms of MS

  • Physical therapy
  • Muscle relaxants
  • Medicines to reduce fatigue, depression, pain, bladder or bowel control and sexual dysfunction.

8Complications

The disease leads to various complications including:

  • Paralysis of the legs
  • Muscle stiffness or spasms
  • Sexual dysfunction
  • Bladder and bowel control problems
  • Mental changes such as mood swings and forgetfulness
  • Seizures
  • Depression