Multiple sclerosis (MS)

Symptoms Of Multiple Sclerosis

Multiple sclerosis can cause a wide range of symptoms and affect any part of the body. Each person with the condition is affected differently and the symptoms can be unpredictable. Some people have mild symptoms while others may have severe trouble in doing their daily tasks. These problems may come and go or persist and worsen over time.

The most common signs and symptoms of Multiple Sclerosis are:

Fatigue

Fatigue or tiredness is one of the most common symptoms of MS. It can significantly interfere with daily activities and tends to get worse towards the end of each day. 

Vision Problems

Vision problems are usually observed in 1 out of 4 individuals. This is usually the first noticeable symptom. The person may experience eye pain, temporary loss of vision in the affected eye, and decreased vibrancy of colors. 

Muscle spasms, stiffness, and weakness

MS can cause the muscles to become stiff and resistant to movement. 

Mobility Problems 

MS can make walking and moving around difficult, particularly if a person is experiencing muscle weakness and stiffness. The person may experience symptoms like difficulty in balancing and coordination, shaking of legs, dizziness, and vertigo. 

Musculoskeletal pain

People with MS may find it difficult to walk or move around. This can cause pressure on the joints, resulting in back pain, neck pain, and other joint pain.

Bladder problems 

Loss of bladder control is an early sign of MS. The person may find difficulty in emptying her/his bladder and get an urge to urinate suddenly. 

Sexual problems 

MS can affect the sexual activity of both men and women. In men, it leads to erectile dysfunction and may even lose the ability to ejaculate. In women, it includes difficulty in reaching orgasm, as well as decreased vaginal lubrication and sensation.

Bowel problems 

MS can cause bowel dysfunctioning and the person might experience constipation (difficulty in passing stool), and bowel incontinence (not being able to control bowel movements and stool leaks from the rectum without warning). 

Difficulties in thinking, learning and planning 

Some people with MS may experience difficulties in thinking, learning and planning. This can include:

1. Slowness in processing information 

2. Problem in understanding visual information

3. Problems in learning new things

4. Getting stuck on words 

Mental issues 

People with MS may experience periods of depression and anxiety. It’s not clear whether it is caused by the disease itself or the result of the stress of having to live with a long-term condition. 

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Types Of Multiple Sclerosis 

Multiple sclerosis (MS) affects each person differently. The most common types of MS are:

• Clinically isolated syndrome (CIS)

• Relapsing-remitting MS (RRMS)

• Primary-progressive MS (PPMS)

• Secondary-progressive MS (SPMS)

Clinically Isolated Syndrome (CIS)

CIS refers to a single episode of neurologic symptoms that lasts at least 24 hours and is caused by demyelination (loss of the myelin that covers the nerve cells) in the central nervous system (CNS). CIS can either be classified as monofocal or multifocal.

• Monofocal episode: When a person experiences a single neurologic sign or symptom, for example, an optic neuritis attack (when swelling damages the optic nerve) which is caused by a single lesion.

• Multifocal episode: When a person experiences more than one sign or symptom, for example, optic neuritis followed by numbness in the legs which is caused by a lesion at multiple locations. 

Relapsing-remitting MS (RRMS)

This is the most common type of multiple sclerosis. Approximately 80 to 85 percent of MS patients are initially diagnosed with RRMS type of multiple sclerosis. The episode of attack faced is called relapse or exacerbation which is followed by periods of partial or complete recovery. RRMS can be further characterized as:

• Active (evidence of new MRI activity over a specified period of time)  

• Not Active 

• Worsening (a confirmed state of disability following a relapse) 

• Not worsening 

Primary-progressive MS (PPMS)

This form of MS progresses slowly yet steadily from the time of its onset. The symptoms stay at the same level of intensity without decreasing, and there is no remission period. Approximately 10 percent of the MS population is diagnosed with primary-progressive MS (PPMS). 

 PPMS can be further characterized as:

• Active and not active 

• Worsening and not worsening 

Secondary-progressive MS (SPMS)

SPMS may involve a period of relapsing-remitting activity, with symptoms flaring up followed by recovery periods. People originally diagnosed with RRMS progress to SPMS. With secondary-progressive multiple sclerosis, a person continues to accumulate nerve damage.

Causes Of Multiple Sclerosis

The exact cause of the development of MS is not known. It is considered an autoimmune and inflammatory condition caused by a combination of genetic and environmental factors. 

In MS, the myelin sheath covering the nerves in the brain and spinal cord becomes inflamed. These patches of inflammation can disrupt the messages traveling along the nerves. If the attacks are frequent and repeated, it can eventually lead to permanent damage to the underlying nerves. 

Risk Factors of Multiple Sclerosis 

Some of the factors that have been suggested as possible risk factors of multiple sclerosis include:

Age 

It most commonly occurs in people during their 20s to 40s,  although it can develop at any age. 

Sex 

According to the National Multiple Sclerosis Society, MS is at least two to three times more common in women than in men, it has been suggested that hormones may play a significant role in determining susceptibility to MS.

Family history 

According to various family studies, 15–20% of MS patients have one or more affected relatives.

Genes

Multiple sclerosis is not an inherited disease, it is not passed from generation to generation. Although, there is a genetic risk that is inherited. Variations in various genes are involved in increasing the susceptibility of MS. Variation in the HLA-DRB1 gene is the strongest genetic risk factor for developing multiple sclerosis.

Race 

Research has shown that MS occurs in most ethnic groups, including African Americans, Asians, and Hispanics, but is most common among white people of northern European descent.

Location

MS is more common in people at higher latitudes (staying farther from the equator) at a young age. 

Vitamin D deficiency

It has been found in a research study that young children and adults spending more time outside reduced their odds of developing multiple sclerosis. Low levels of vitamin D in the blood have been identified as a risk factor for the development of MS. Vitamin D has been thought to support immune function and may help protect against immune-mediated diseases. 

The symptoms of vitamin D deficiency are subtle, which is why most people do not realize they are deficient in Vitamin D. Here is a list of symptoms you can face during Vitamin D deficiency.

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Smoking 

People who smoke are about twice as likely to develop multiple sclerosis as compared with those who don't smoke. Smoking is associated with more severe disease and more rapid disease progression. 

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Obesity

Obesity in early life increases a person's risk of developing MS and MS-related disabilities.

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EBV infection

Individuals who had a previous infection with epstein barr virus (EBV) infection contribute to the risk of developing MS. The virus might trigger the immune system, leading to the development of MS.

Diagnosis Of Multiple Sclerosis 

It can be hard to diagnose multiple sclerosis, as some of the symptoms can be quite vague or similar to other conditions. Diagnosis of MS is complicated because no single test can positively confirm it. 

History and physical examination

A general practitioner will assess the individual at the time of the appointment. This evaluation involves a complete health history and neurological exam. This includes:

• Movement and coordination 

• Vision 

• Balance 

• Sensory exam 

• Cranial nerves Exam 

• Mental functioning

• Checking the emotional functions 

The doctor will also ask about the frequency of attacks in the last months. An attack is when any MS symptoms show up suddenly. Then after that, the doctor will send for further imaging tests and evaluation with a variety of tools to rule out other possible disorders. It also requires a series of lab tests to aid in diagnosis.

Blood Tests 

Blood tests are performed to rule out other causes of various neurological symptoms. For example, to rule out conditions like neuromyelitis optica ( a rare condition where the immune system damages the spinal cord and the nerves of the eyes) which causes the same symptoms as MS and is often misdiagnosed as MS. 

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Imaging tests

Magnetic Resonance Imaging (MRI) Test
An MRI scan is a painless imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in the body. It helps in checking the damage or scarring of the myelin sheath (the layer surrounding the nerves) in the brain and spinal cord.

Lumbar Puncture
A lumbar puncture is a procedure to remove a sample of your spinal fluid by inserting a needle into the lower back. Spinal fluid is the fluid surrounding the brain and spinal cord, and changes in the fluid are suggestive of problems in the nervous system. A lumbar puncture is performed to provide additional information if there are some abnormalities in the scans. 

Evoked Potential Tests

• Sensory evoked potentials is a painless test that measures the electrical activity in the brain in response to stimulation of sight, sound, or touch.

• The most common test is assessing the functioning of the eyes. A light pattern is shown to the eyes while the brain waves are monitored using small sticky patches of electrodes placed on the head. 

• This test is used in combination with another diagnostic test to assist in the diagnosis of neurological disorders.

Prevention Of Multiple Sclerosis

Currently, there are no known ways to prevent getting MS.

However, a few lifestyle changes might help reduce the risk of getting this condition:

• Maintain a healthy weight

Being overweight or obese in early life increases a person's risk of developing MS. Hence maintaining a healthy weight by regular exercising, consuming a nutritious well-balanced diet, and proper sleep are crucial in preventing the risk of MS.

• Sustain optimum levels of Vitamin D

Exposure to the sun and taking proper vitamin D in diet is an important modifiable environmental risk factor for the development of multiple sclerosis.

Here are a few points which you need to know about vitamin D and why it is important.

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• Avoid smoking 

Smoking and exposure to secondary smoke from other people increase the risk of the development of MS and its progression. Hence avoiding or quitting smoking can not just reduce the risk of MS but also do wonders for your overall health.

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Specialist to Visit 

The healthcare physician can thus refer the patient to the specialist’s doctor for better evaluation and treatment. These patients can be referred to:

• Neurologists:  A specialist doctor who treats diseases of the brain and spinal cord, peripheral nerves, and muscles. 

• Psychiatrists: A psychiatrist is a doctor who focuses on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders.

• Psychologists: Psychologists are specialists who seek to understand and explain thoughts, emotions, feelings, and behavior.

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Treatment Of Multiple Sclerosis 

Currently, there is no cure for multiple sclerosis. Management of MS includes medication for managing MS attacks, slowing the progression of the disease, and managing its symptoms:

Treatment for MS attacks

Corticosteroids such as oral prednisolone and iv methylprednisolone, are prescribed to reduce nerve inflammation and manage MS attacks.

Plasma exchange: Plasma exchange may be advised in case of new and/or severe symptoms and no response to corticosteroids. In this procedure, the plasma (liquid portion of the blood) is separated from the blood cells. The blood cells are then mixed with plasma from a donor or with a plasma substitute like protein (albumin) solution and injected back into the body.

Treatment to slow progression of MS

Several Disease modifying therapies (DMTs) are available to slow disease progression and reduce the number of attacks in multiple sclerosis. Treatment options include oral, injectable, and infusion medications. Some examples of each class are mentioned below.

Oral Medications

• Dimethyl fumarate

• Monomethyl fumarate 

• Diroximel fumarate

• Fingolimod

• Ponesimod

• Teriflunomide 

Injectables

• Interferon beta

• Glatiramer acetate 

Infusion treatments 

• Mitoxantrone

• Natalizumab

• Ocrelizumab

Treatment of specific MS symptoms 

MS can cause a range of symptoms that can be treated individually. Symptoms differ from person to person. Treatments for some of the main symptoms are discussed below.

• Fatigue 

Many people with MS experience fatigue, and medications like amantadine, modafinil, and methylphenidate are prescribed for dealing with fatigue caused by MS. Fatigue is also managed by light exercise, energy-saving patterns, and keeping healthy sleeping patterns. 

• Visual problems 

MS-related visual problems often improve on their own. However, If symptoms are particularly severe, steroids may be prescribed to help speed up recovery.

• Neuropathic Pain 

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. This type of pain can be treated using antidepressants which are used as painkillers medicines like gabapentin and amitriptyline.

• Muscle stiffness

Muscle relaxants such as baclofen, tizanidine, and cyclobenzaprine may be prescribed to manage painful or uncontrollable muscle spasms.

Other medications may be prescribed for depression, sexual dysfunction, insomnia, and bladder or bowel control issues, increasing walking speed, and other symptoms associated with MS.

Home Care For Multiple Sclerosis 

Eat a healthy diet

Consume a healthy diet rich in fruits and vegetables, healthy fats, and whole grains. Also limit the intake of sugar, high salt, packaged and processed foods.

Add these to your diet

• Omega fatty acids

Omega fatty acids have been found to play an important role in MS patients. The consumption of omega fatty acids from food sources such as walnuts, flax seeds, and fatty fish (including salmon and sardines), or in supplements is linked with decreased morbidity and mortality. 

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• Turmeric 

Some studies have shown that turmeric has potential benefits in treating MS. Turmeric contains high levels of a natural compound curcumin, which has outstanding anti-inflammation and neuroprotective effects. 

Manage stress 

According to some studies, stress can precipitate MS relapses and worsen disability through a variety of mechanisms including excessive inflammatory response and worsening degeneration.

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Do regular exercise 

Regular, moderate physical exercise is good for the body, mind, and mood and this is true for patients with MS. In the case of MS, exercise can improve fitness, endurance, and strength in the arms and legs. Exercise can give other benefits like giving better control over bowel and bladder functioning, along with a boost in mood. 

The best exercises for individuals with MS are: 

• Stretching: It is the best way to maintain your range of motion, and ease symptoms related to muscle tightness or stiffness. Yoga can also be performed for stretching the body for 10- 15 minutes. 

• Resistance training: It helps to maintain muscle strength. This training can be performed twice a week. 

• Aerobic exercise: Also known as endurance activities or cardio exercises of low to high intensity that increase your heart rate, like walking, jogging, or swimming. It is recommended to perform these exercises thrice a week or a total of 120 minutes.

Avoid smoking and limit alcohol intake

Smoking and exposure to secondary smoke from other people increase the risk of the development of MS and its progression. Quitting smoking can help reduce the rate of disability progression. 

The intake of alcohol affects the bladder by increasing urinary urgency and frequency. Even one drink of alcohol depresses the central nervous system and can interfere with certain medications that are commonly used to manage MS symptoms.

Maintain optimum Vitamin D levels

Vitamin D is essential for bone, muscle, nerve, and immune system health. Research over the years has shown that maintaining adequate levels of vitamin D may have a protective effect and lower the risk of developing multiple sclerosis. 

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Did you know?

Ginkgo biloba is a promising medicinal herb that may reduce inflammation and fatigue in individuals living with MS. However, caution should be exercised with ginkgo in patients with bleeding disorders or those who are taking nonsteroidal antiinflammatory drugs (NSAIDs) and anticoagulants such as heparin or warfarin.

Alternative Therapies for Multiple Sclerosis

The following therapies can be used to augment conventional treatment modalities. Do consult your doctor before starting any of these alternative therapies:

Stress management 

Stress can make the MS symptoms get worse since it is linked to brain, health, and immune response. Stress management is crucial to practicing good sleep hygiene to maximize the restoration process during sleep. Relaxation techniques like deep breathing, progressive muscle relaxation, listening to music to unwind, and aromatherapy with essential oils like chamomile and lavender can be followed to manage stress. 

Is stress affecting your overall well-being? Try some relaxation techniques to manage stress.

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Yoga 

If an individual is experiencing muscle spasticity, fatigue, pain or difficulty walking, due to MS yoga may offer relief. Yoga also helps in encouraging relaxation, as well as building core strength, strengthening your pelvic floor muscles, decreasing spasticity, and improving balance and coordination

Psychotherapy

Also known as talk therapy, it refers to a variety of treatments that aim to help a person identify and change troubling emotions, thoughts, and behaviors. A psychologist helps the person in modifying or removing existing symptoms and promotes personal growth. 

The goals of psychotherapy are: 

• Alleviate emotional pain or confusion 

• Assist in developing a complete understanding of the psychological issues.

• Establishing coping strategies or skills. 

Acupuncture

Acupuncture typically uses thin needles to stimulate specific areas on the body. This ancient practice may help in getting relief from pain, muscle spasms, numbness, tingling, bladder problems, and depression associated with MS.

Living With Multiple Sclerosis

Right care and support may help people suffering from MS lead long, active, and healthy lives. Self-care is an integral part of daily life which includes taking responsibility for your own health and well-being, with support from people involved in care. Self-care includes engaging in activities like maintaining good physical and mental health, preventing illness or accidents, and effectively dealing with long-term complications. 

Individuals living with MS can deal with the disease by including the following aspects like: 

Get good sleep 

MS can cause sleep problems, including insomnia, frequent nighttime urination, narcolepsy, and leg spasms. Practicing good sleep hygiene can help in battling MS fatigue. There are a few ways to get restful sleep. 

• Try to go to bed and wake up at the same time every day

• Avoid caffeine in the late evening

• Try meditation, yoga, and deep breathing during the day. 

Struggling to fall asleep? Read about some amazing tips that will help you improve your quality of sleep.
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Keep your body active 

Exercise helps in improving muscle strength and fitness, improves posture, and reduces pain and fatigue in people with MS. Individuals participating in aerobic exercise programs are benefited by having improved cardiovascular fitness, increased strength, and better bladder, and bowel functioning. 

Take a nutritious diet 

Diet is an essential part of a person living with MS. Individuals having MS should go for a diet that is rich in fruits, vegetables, whole grains, and lean proteins. 

• A plant-based diet can lower fatigue, and mood swings and help in managing weight and cholesterol levels. 

• Intake of food rich in omega-3 fatty acids including fish oil supplements, walnuts, and flax seeds has been found to reduce the relapse and inflammation rate and improve the quality of life for individuals living with MS.

• Taking enough fiber and drinking adequate water can help ease constipation, which further reduces gut inflammation and helps in fighting MS. 

Talk to a Counselor 

Counseling is a type of therapy that helps people manage emotions and understand thoughts and behaviors. It plays an important part in the management of MS patients

• Coping with stress 

• Managing depression and anxiety 

• Improving communication with loved ones 

 Take care of your emotional and mental well being 

• Engaging in activities that are mentally stimulating contributes to personal growth that helps the mind to stay active, alert, and engaged even in the face of aging or changes caused by MS. 

• Staying connected to feelings, priorities, and values can help calm emotional turmoil by eliminating unnecessary stressors. 

• Relationships and bonding can provide support and opportunities for shared goals and problem-solving. Positive relationships reduce feelings of isolation and promote a sense of emotional well-being in everyday life.

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Join Support groups 

Support groups can help a person to connect with other patients and caregivers and establish a valuable network for exchanging ideas, giving motivation and encouragement. This gives a sense of well-being to the individual having the disease and that you are not alone in this.