Multiple Sclerosis (MS)
Multiple Sclerosis (MS) is a chronic neurological disorder that affects the central nervous system, including the brain and spinal cord. MS destroys the covering around nerve fibers called the myelin. Myelin is a mixture of protein and fatty acids—a fatty substance—that protects nerve fibers. When the immune system attacks and damages myelin, it blocks or completely stops the messages being sent through nerve impulses down the body. Sclerosis refers to the areas of scar-like tissue that result from the attack on myelin by the immune system. The name ‘multiple sclerosis’ comes from the multiple scars (plaques or lesions) that develop in the nervous system.
MS affects people differently, with a wide range of symptoms and disease progression. Some individuals can see or move with perfect ease, while others struggle to walk or experience significant memory loss. While there is no cure, medication is available to control the symptoms, limit the frequency of attacks, and delay disease progression.
Early Symptoms and Progression
Disease onset in multiple sclerosis is often marked by the appearance of common symptoms such as numbness in the arm or leg, double vision, and chronic fatigue. These symptoms of multiple sclerosis can be mild or relatively nonspecific. Some people may only experience mild symptoms that resolve fully or partially.
The disease usually begins between the ages of 20 and 40, and women are more likely to develop MS than men. Symptoms can become more intense over time or affect additional regions of the body.
In more severe cases, the signs can progress to tremors, muscle stiffness, impaired balance, and speech difficulties. Impaired thinking, characterized by slowing down and a lack of focus, also occurs in some individuals. The signs intensify as damage to the nervous system and the site worsens. Increases in body temperature, such as during hot weather or exercise, can temporarily worsen MS symptoms—a phenomenon known as Uhthoff’s phenomenon. Heat can exacerbate symptoms, making hot summers especially challenging for people with MS.
Types of Multiple Sclerosis
MS exists in many forms, depending on the pattern of symptom worsening and the frequency of relapses. The most common type is relapsing remitting multiple sclerosis (RRMS), also called relapsing remitting MS, which is characterized by episodes of new or worsening symptoms (known as an MS attack or relapse) followed by periods of partial or complete recovery (remission). These are referred to as relapsing forms of MS.
Primary Progressive MS
Primary progressive MS is another form, marked by a gradual worsening of symptoms from the onset without distinct relapses or remissions. Progressive MS is a category that includes both primary progressive MS and secondary progressive MS.
Secondary Progressive MS
Secondary progressive MS, also called secondary progressive multiple sclerosis, typically follows an initial relapsing-remitting course and is characterized by steadily worsening symptoms with or without occasional relapses, minor remissions, or plateaus.
Diagnosis of clinical MS often follows a clinically isolated syndrome (CIS), which is a first episode of neurological symptoms. Early identification of clinical MS is important for prognosis and treatment decisions.
Causes and Risk Factors
The cause of multiple sclerosis (MS) is not fully understood, but it is believed to result from a combination of genetics, environment, and immune system factors that lead to an increased risk of developing the disease. MS is not inherited directly, although having relatives with MS increases your risk marginally. Research suggests that hundreds of genes and gene variants combine to create vulnerability to MS. Researchers also believe that some viral infections, especially the Epstein-Barr virus (EBV), are most consistently linked to the development of MS in genetically predisposed individuals.
Some risk factors have a higher chance of developing MS. They are:
- Age & Sex
More than half of all the diagnoses are between the ages of 20 and 50, and twice as many women as men are diagnosed with MS.
- Location
Individuals who reside farther from the equator have a higher incidence of MS, possibly due to reduced sunlight and consequently lower vitamin D levels. People who spend more time in the sun and have higher levels of vitamin D are less likely to develop MS.
- Lifestyle
Behaviors such as smoking cigarettes, poor diet, and low physical activity can increase susceptibility to developing MS and influence disease progression and disability scores. Obesity during adolescence and young adulthood is a risk factor for MS.
- Infections
Some viruses, including Epstein-Barr (EBV), have been included as potential causes in susceptible patients.
These risk factors do not predict that one will get MS, but can influence its frequency and severity.
Significant Symptoms to Look Out For
Common symptoms of multiple sclerosis can vary widely among individuals, but recognizing these symptoms of multiple sclerosis is important for early diagnosis and management. These include:
Numbness or tingling, usually in the face or arms & dizziness or vertigo. Difficulties with balance and walking are common, often due to ataxia.
Double or blurred vision—visual problems are common symptoms of multiple sclerosis and are often caused by inflammation of the optic nerve (optic neuritis), which can also result in eye pain and color distortion.
Weakness, stiffness, or spasms in the muscles, which may be severe enough to affect walking or standing.
Persistent fatigue that is not improved by rest—fatigue is a common symptom and may be both physical and cognitive.
Loss of memory or confusion—cognitive impairment affects up to 75% of people with multiple sclerosis.
Changes in bowel or urinary habits—problems with bladder control and constipation are common in people with multiple sclerosis.
Pain is often associated with optic neuritis and trigeminal neuralgia in multiple sclerosis patients. Depression is also common and can intensify symptoms of fatigue and pain.
Other symptoms may include sensory disturbances, speech difficulties, sexual dysfunction, and a wide range of neurological, sensory, and functional issues, reflecting the diversity of MS manifestations.
Since many of these symptoms occur in the context of other disease states, if they do occur and persist, it is advisable to consult a neurologist.
Diagnosis and Evaluation
A diagnosis of multiple sclerosis involves a comprehensive process that includes clinical evaluation, imaging, and laboratory tests. The McDonald criteria are used to establish a diagnosis of MS, combining clinical findings with MRI evidence and, when necessary, cerebrospinal fluid analysis. A neurologist begins with a complete medical history and a neurological exam to screen for coordination, reflexes, vision, and equilibrium. Imaging procedures such as MRI scans find lesions on the brain or spinal cord characteristic of MS.
In some cases, a lumbar puncture is done to study cerebrospinal fluid for abnormalities. Evoked potential testing, which records electrical activity in the brain in response to a stimulus, also aids in diagnosis.
Clinical MS is identified when symptoms and findings meet the established diagnostic criteria, distinguishing it from earlier stages such as radiologically isolated syndrome (RIS) or clinically isolated syndrome (CIS). Since there is no single definitive test, multiple sclerosis diagnosis relies on a pattern of findings over time and across sites within the central nervous system.
Treatment Options
Multiple sclerosis treatment involves a comprehensive approach that focuses on slowing disease progression, managing relapses, and improving quality of life, as there is currently no cure for MS.
Disease-modifying drugs, or DMTs, that decrease flare-ups and disability caused by the disease are the most common medications that are prescribed for most MS patients. DMTs modify the immune system, inhibit inflammation, and reduce damage to nerve fibers. Infusion treatments for MS include monoclonal antibodies like natalizumab and ocrelizumab, which can reduce relapse rates and slow disease progression. Oral treatments for MS include medications like dimethyl fumarate and teriflunomide, which can help manage the disease.
For acute symptom management, corticosteroids such as methylprednisolone are prescribed for three to five days to quickly suppress the immune system and reduce inflammation during MS attacks. Plasma exchange (PLEX) is another option for severe relapses, especially when symptoms do not respond to steroids.
Muscle strengthening, range of motion, and balance, as well as occupational therapy, can be utilized for physical therapy. Physical therapy can help improve muscle strength and ease some symptoms of MS. Occupational therapy can help patients learn how to perform daily living activities and adjust to physical impairment. Using assistive devices like canes or walkers can help people with MS maintain mobility as their condition progresses. Rehabilitation activities can help people with MS maintain or regain functioning and independence. Others might even require speech therapy, counseling, or pain management treatment.
Dietary changes, exercise, and stress reduction are among the most important for symptom control and quality of life. A Mediterranean diet, which is high in fish, vegetables, and nuts, and low in red meat, has been shown to be neuroprotective for people with MS. Stress management programs or relaxation training may help some people with MS manage their symptoms. Vitamin D supplementation is recommended for people with MS, with a daily intake of 2,000 to 5,000 international units suggested.
Engaging a comprehensive healthcare team can improve outcomes for people with MS.
Daily Lift with MS
MS is about learning to accommodate change, some of which is sudden or unexpected. The majority of people with MS do work, have children, and lead normal lives. It is most frequently a new everyday routine, exercise as physical activity, and energy planning.
Psychological support from support groups, therapists, or a friend reduces the isolation that goes with chronic illness. Being up to date, well-supported by a system of health professionals, and willing to share symptoms are all significant parts of staying independent and self-valuing.
Possible Complications
MS can lead to a variety of long-term complications if not treated. They can impact the quality of life of patients and may require other interventions or treatments:
- Walking or balance difficulty
- Severe weakness and fatigue in the muscles
- Mood swings or depression
- Trouble speaking or swallowing
- Bladder or bowel problems
- Sexual dysfunction
The course of complications is very unpredictable. Some remain stable for a good number of decades, while others worsen or resolve with rapid deterioration or improvement of symptoms. The long-term outcome of MS is difficult to predict and varies among individuals. However, many people with MS can expect a normal life expectancy.
When to Seek Help
If you, or the person you are taking care of, continue to experience numbness now and then, unexplained weakness, visual problems, or strange attacks of fatigue, a neurological evaluation can’t wait. It can be prevented by early diagnosis and treatment, and can significantly improve the outcome.
We don’t ignore your symptoms at Chester Neurology—no matter how big or small. Our experienced team is committed to being with you every step of the way, from testing and diagnosis through individualized treatment plans that fit into your life and purposes.
Call us today at (914) 816-1941 or email info@chesterneurology.com to schedule an appointment.
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