Multiple Sclerosis
Multiple Sclerosis Overview
Multiple sclerosis (MS) is a chronic, unpredictable disease of the central nervous system (CNS), which is made up of the brain, optic nerves and spinal cord. Many experts believe that MS is an autoimmune disease in which the body’s immune system launches a defensive attack against its own tissues.
In MS the attack is on myelin, the substance that surrounds and insulates the nerve endings of the central nervous system. The loss of myelin interferes with the transmission of nerve signals, which produces the neurological signs and symptoms of MS including speech and mobility problems. MS is not contagious and is not directly inherited. It affects women more than men.
Two-thirds of those with multiple sclerosis remain able to walk, though many need an aid like a cane or crutches. Others will eventually need a scooter or wheelchair due to fatigue, weakness, balance problems, and as a way to conserve energy. No two people experience the disease the same way and symptoms vary considerably.
While there is no known cure for MS, various medications have been shown to slow the course of the disease itself. Other drugs help alleviate symptoms like bladder problems, fatigue, cognitive issues and sexual dysfunction.
People with MS often live a normal life span, though some struggle with productivity and other challenges due to the increasing limitations that the disease prevents. According to the National Multiple Sclerosis Society progress in research to identify a cure for the disease is very encouraging.
Wellstar neurologists specialize in treating people with MS. Our physicians are experienced, compassionate and focused on helping patients get the best possible treatment, learn to manage symptoms and live full and productive lives.
Types of MS
There are four primary types of multiple sclerosis.
- Relapsing Remitting Multiple Sclerosis is usually diagnosed during a patient’s 20s or 30s.
- Progressive Relapsing Multiple Sclerosis gets steadily worse from the onset.
- Primary Progressive Multiple Sclerosis may first present with leg weakness or problems with walking.
- Secondary Progressive Multiple Sclerosis starts with the Relapsing Remitting type.
Symptoms
The first symptoms of the disease (such as blurred or double vision, red-green color distortion or blindness in one eye) often appear between age 20 and age 40. Other common symptoms include:
- Muscle weakness in the arms and legs
- Problems with coordination and balance
- Slurred speech
- Tremors
- Numbness and tingling
- Extreme fatigue, especially in the afternoon or related to warmth
- Partial or complete paralysis
These symptoms may be permanent or they may come and go; when the disease is severe symptoms persist on a permanent basis. People with MS may experience other complications such as:
- Muscle stiffness or spasms
- Paralysis, usually of the legs
- Bladder, bowel or sexual problems
- Mental changes including depression and forgetfulness
- Epilepsy
If you have any of these or are concerned about other symptoms, make an appointment to see your Wellstar physician or neurologist. The sooner you can identify or rule out a diagnosis of MS the better.
Risk Factors
Although the exact causes of multiple sclerosis are not known, researchers have concluded that certain factors increase the chance of getting it. Genetic and environmental factors play a role, as do gender and geography. Risk factors include:
- Sex. Women are about twice as likely to get MS as men.
- Family history. Having a parent or sibling with MS increases your chances of getting it by one to three percent, compared to the risk among the general population, which is one tenth of one percent. Research has found that genetics is not the only factor.
- Some viruses. Having Epstein-Barr and other viruses may be linked with MS.
- Ethnicity. Caucasians, especially those whose families can be traced to Northern Europe, are at highest risk. Individuals of African, Asian or Native American descent have the lowest risk. Children who move from a high-risk area to a low-risk area (or the opposite) adopt the risk level of that area. But this is not the case for adults.
- Other autoimmune diseases. There appears to be a slight increase in risk for those who have diseases including type 1 diabetes, thyroid disease or inflammatory bowel disease.
There are many mistaken ideas regarding contributors to MS. For example, there is no scientific evidence that factors like injury, shock, pregnancy or vaccinations cause the disease.
Multiple Sclerosis Prevention
Multiple Sclerosis cannot be prevented. However there are many steps patients can take to reduce or lessen symptoms and to live more successfully with MS. Other actions can help improve overall health and reduce the chance of getting other diseases.
According to the National Multiple Sclerosis Society, “Wellness is a dynamic state of physical, emotional, spiritual and social well-being that can be achieved even in the presence of a chronic illness or disability.” Wellstar physicians endorse the following general recommendations. Your doctor will make specific recommendations as part of an overall treatment plan.
- Exercise. Moderate aerobic exercise can help manage symptoms like fatigue, weakness and bladder and bowel difficulties. Exercise can also improve cardiac health, stamina and mood. Stretching improves flexibility and mobility, while decreasing stiffness.
- Eat well. A balanced, low-fat, high-fiber diet contributes to overall health and bowel function. A healthy diet can help patients stay in good shape and be ready to meet the challenges they will face.
- Manage stress. While the exact link between stress and MS symptoms is not clear, experts agree that too much stress is not good for anyone.
- Avoid other complications. Like everyone else, people with MS are susceptible to diseases like cancer, heart disease and stroke. Get regular checkups from your Wellstar physician and follow recommendations for screening tests and vaccinations. While some people with MS are concerned about the safety of vaccinations, research shows that most vaccines are safe. Be sure to discuss this with your physician if you have concerns.
- Stop smoking. Quit or don’t start and avoid secondhand smoke.
- Stay cool. An increase in body temperature can temporarily worsen MS symptoms. Don’t get overheated, avoid hot tubs and use air-conditioning during hot weather.
Multiple Sclerosis Diagnosis
There is no single symptom, test or physical finding that can definitively confirm a diagnosis of MS. Your Wellstar neurologist will start with a careful medical history to learn more about a patient’s symptoms, birthplace and other possible factors.
The doctor will also conduct an in-depth neurological exam to assess mental, emotional and language functions; balance, movement and coordination as well as a patient’s sensory functioning.
To definitively diagnose multiple sclerosis a physican is required to:
- Find evidence of damage in at least two areas of the central nervous system (brain, spinal cord and optic nerves).
- Find evidence that there was at least one month passed between the time of damage in the two areas.
- Rule out all other possible diagnoses.
These are known as the McDonald Criteria and are regularly assessed and revised by the International Panel on the Diagnosis of Multiple Sclerosis.
Tools and Tests
In some patients medical and neurological tests are enough to confirm a diagnosis. Other times, the doctor will recommend additional tests including:
- MRI (magnetic resonance imaging) can detect the presence of MS plaques or scarring (lesions) in various parts of the central nervous system. Other diseases can cause lesions, which is why your doctor will not make a diagnosis based on the presence of lesions alone.
- VEP (visual evoked potential) tests are considered the most useful way to confirm an MS diagnosis. These tests measure the time it takes the brain to respond to various types of stimulation, such as a test pattern or a test tone. When myelin is damaged (as is the case with MS), response time is slower.
- Cerebrospinal fluid analysis. A spinal tap is conducted to obtain brain/spinal fluid, which is tested for certain proteins and compounds known as oligoclonal bands. The presence of these alone does not necessarily mean someone has MS.
- Blood tests. These help rule out other conditions (including Lyme disease and AIDS) that cause symptoms similar to those of MS.
Multiple Sclerosis Treatment
There is no cure for multiple sclerosis but increasingly sophisticated medications treat the condition by controlling symptoms and reducing the frequency and severity of MS attacks. Other treatments may slow the progression of disability.
Wellstar neurologists agree that early treatment is essential to potentially delaying disability related to MS. Aggressive management of the disease is linked to more favorable outcomes and a better quality of life.
Medications
Nine FDA approved disease-modifying medications are now available. They help reduce the frequency and severity of attacks, reduce the accumulation of lesions (damaged areas) in the brain and may slow the course of the disease overall.
The drugs are:
- Betaseron®
- Avonex®
- Rebif®
- Copaxone®
- Tysabri®
- Novantrone®
- Tectidera®
- Aubagio®
- Gilenya®
Steroid treatments have also proven successful in shortening the duration of acute MS attacks by reducing swelling and inflammation of lesions. You will want to discuss these and other medications in detail with your neurologist who will explain the benefits and possible side effects of those recommended for you.
Some patients prefer not to take medications due to concerns about side effects and risks.
Researchers continue to actively pursue a number of new therapies including the recent discovery that a vaccine used in some parts of the world to prevent tuberculosis (BCG) may help prevent early signs of MS from developing into the full blown disease.
Ask your Wellstar neurologist if you quality for any current clinical trials. These let patients participate in the latest research and take advantage of emerging MS drugs and treatments.
Other Treatments
In addition to medications that address the disease itself, other therapies treat symptoms including pain, bladder problems, fatigue, spasticity, weakness, cognitive problems and sexual dysfunction.
Another type of “treatment” is lifestyle alterations like eating a healthy diet, getting regular exercise and managing stress. Most important is to adhere to the treatment plan agreed to with your doctor.
Rehabilitation to enhance function is an essential part of treatment for many people with MS. If appropriate in your situation, your neurologist will discuss rehab services provided by Wellstar’s expert therapists.
- Physical therapy
- Occupational therapy
- Speech and swallowing therapy
- Cognitive rehabilitation
- Vocational rehabilitation
Alternative Therapies
Some patients find relief from symptoms through a variety of alternative techniques including food supplements, stress management and lifestyle changes. These therapies come from various disciplines and traditions such as yoga, hypnosis, relaxation techniques, herbal healing, Chinese medicine, macrobiotics, naturopathy and others.
Ongoing Care for Multiple Sclerosis
While MS is a challenging condition, many people with the disease live long and satisfying lives as parents, employees and members of their communities. You will likely have many questions for your doctor. We want you to know that the Wellstar neuroscience team is here for you from diagnosis through and beyond treatment.
In addition to doctors and nurses, the team includes experts in areas like emotional and cognitive changes, personal relationships, mobility challenges and getting the assistance you need to live as symptom free as possible.
Smoking Cessation
Wellstar offers smoking cessation programs that educate people about smoking risks, encourage behavior modification to help minimize smoking urges and offer numerous coping strategies. Several different methods for changing smoking behavior are explored so that individuals learn approaches that work best for them.