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Multiple Sclerosis (MS): Types, Symptoms, Treatment, Diagnosis, Causes, Outlook

What is Multiple Sclerosis (MS)?

Multiple Sclerosis (MS) is a chronic illness involving your central nervous system. The immune system attacks myelin, which is the protective layer around nerve fibers. This causes inflammation and scar tissue, or lesions. This can make it hard for your brain to send signals to the rest of your body.

Types of Multiple Sclerosis (MS)multiple-sclerosis


Relapsing-remitting MS (RRMS)

RRMS involves clear relapses of disease activity followed by remissions. During remission periods, symptoms are mild or absent and there’s no disease progression. RRMS is the most common form of MS at onset.

Clinically isolated syndrome (CIS)

CIS involves one episode of symptoms lasting at least 24 hours. These symptoms are due to demyelination in your central nervous system.

The two types of episodes are monofocal and multifocal. A monofocal episode means one lesion causes one symptom. A multifocal episode means you have more than one lesion and more than one symptom.

Although these episodes are characteristic of MS, they aren’t enough to prompt a diagnosis. If lesions similar to those that occur with MS are present, you’re more likely to receive a diagnosis of RRMS. If these lesions aren’t present, you’re less likely to develop MS.

Primary-progressive MS (PPMS)

Neurological function becomes progressively worse from the onset of your symptoms if you have PPMS. However, short periods of stability can occur.

Progressive-relapsing MS was a term previously used for progressive MS with clear relapses. This is now called PPMS. The terms “active” and “not active” are used to describe disease activity.

Secondary-progressive MS (SPMS)

SPMS occurs when RRMS transitions into the progressive form. You may still have noticeable relapses, in addition to gradual worsening of function or disability.

Symptoms of  Multiple Sclerosis (MS)

People with multiple sclerosis (MS) experience a wide range of symptoms. Due to the nature of the disease, symptoms can vary widely from person to person. They can also change in severity from year to year, month to month, and even day to day.

Two of the most common symptoms are fatigue and difficulty walking.

About 80 percent of people with MS report having fatigue. Fatigue that occurs with MS can become debilitating, affecting your ability to work and perform everyday tasks.

Difficulty walking can occur with MS for a number of reasons:

  • numbness of your legs or feet
  • difficulty balancing
  • muscle weakness
  • muscle spasticity
  • difficulty with vision

Overwhelming fatigue can also contribute to the problem. Difficulty walking can lead to injuries due to falling.

Other fairly common symptoms of MS include:

  • speech disorders
  • tremor
  • cognitive issues involving concentration, memory, and problem-solving skills
  • acute or chronic pain

Treatment for Multiple Sclerosis (MS)

No cure is available for MS, but multiple treatment options exist.

If you have RRMS, disease-modifying medications are designed to slow disease progression and lower your relapse rate.

Self-injectable disease-modifying drugs include glatiramer (Copaxone) and beta interferons, such as:

  • Avonex
  • Betaseron
  • Extavia
  • Plegridy
  • Rebif

Oral medications for RRMS include:

  • dimethyl fumarate (Tecfidera)
  • fingolimod (Gilenya)
  • teriflunomide (Aubagio)

Intravenous infusion treatments for RRMS include:

  • alemtuzumab (Lemtrada)
  • natalizumab (Tysabri)
  • mitoxantrone (Novantrone), which is for severe MS only

Disease-modifying drugs aren’t effective in treating progressive MS.

Your doctor can prescribe corticosteroids, such as methylprednisolone (Medrol) and prednisone (Deltasone) to treat relapses.

Other treatments may ease your symptoms and improve your quality of life. Because MS is different for everyone, treatment depends on your specific symptoms. For most, a flexible approach is necessary.

Early signs of Multiple Sclerosis (MS)

MS can develop all at once, or the symptoms can be so mild that you easily dismiss them. The following are three of the most common early symptoms of MS:

  • Numbness and tingling of the arms, legs, or one side of your face. These sensations are similar to the feeling of pins and needles you get when your foot falls asleep, but they occur for no apparent reason.
  • Uneven balance and weak legs. You may find yourself tripping easily while walking or doing some other type of physical activity.
  • Double vision, blurry vision, or partial vision loss.These can be an early indicator of MS. You may also have some eye pain.

It isn’t uncommon for these early symptoms to go away only to return later. You may go weeks, months, or even years between flare-ups.

These symptoms can have many different causes. Even if you have these symptoms, it doesn’t necessarily mean that you have MS.

Diagnosing Multiple Sclerosis (MS)

Your doctor will need to perform a neurological exam, a clinical history, and a series of other tests to determine if you have MS.

Diagnostic testing may include the following:

  • MRI scan. Using a contrast dye allows the MRI to detect active and inactive lesions throughout your brain and spinal cord.
  • Evoked potentials test. This requires stimulation of nerve pathways to analyze electrical activity in your brain. The three types of evoked potentials doctors use to help diagnose MS are visual, brainstem, and sensory.
  • Spinal tap (lumbar puncture). Your doctor may use this test to find abnormalities in your spinal fluid. It can help rule out infectious diseases.
  • Blood tests. Doctors use blood tests to eliminate other conditions with similar symptoms.

The diagnosis of MS requires evidence of demyelination occurring at different times in more than one area of your brain, spinal cord, or optic nerves.

It also requires ruling out other conditions that have similar symptoms, such as:

  • Lyme disease
  • lupus
  • Sjögren’s syndrome

Causes of Multiple Sclerosis (MS)

If you have MS, the protective layer of myelin around your nerve fibers becomes damaged.

It’s thought that the damage is the result of an immune system attack. Researchers think there could be an environmental trigger such as a virus or toxin that sets off the immune system attack.

As your immune system attacks myelin, it causes inflammation. This leads to scar tissue (lesions). The inflammation and scar tissue disrupt signals between your brain and other parts of your body.

Is MS hereditary?

MS isn’t hereditary, but having a parent or sibling with MS raises your risk slightly. Scientists have identified some genes that seem to increase susceptibility to developing MS.

Living with Multiple Sclerosis (MS)

Most people with MS find ways to manage their symptoms and function well. You’ll face unique challenges that can change over time. Many people with MS share their struggles and coping strategies through in-person or online support groups.

Having MS means you’ll need to see a doctor experienced in treating MS.

If you take one of the disease-modifying medications, you’ll have to make sure you adhere to the recommended schedule. Your doctor may prescribe other medications to treat specific symptoms.

A well-balanced diet, low in empty calories and high in nutrients and fiber, will help you manage your overall health.

Regular exercise is important for physical and mental health, even if you have disabilities. If physical movement is difficult, swimming or exercising in a swimming pool can help. Some yoga classes are designed just for people with MS.

Studies regarding the effectiveness of complementary therapies are scarce, but that doesn’t mean they can’t help in some way.

The following may help you feel less stressed and more relaxed:

  • meditation
  • massage
  • tai chi
  • acupuncture
  • hypnotherapy
  • music therapy

MS is a lifelong condition. You should focus on communicating concerns with your doctor, learning all you can about MS, and discovering what makes you feel your best.

Dietary recommendations for people with Multiple Sclerosis (MS)

Diet hasn’t been shown to impact the nature of the disease, but it can help with some of your challenges. If you have fatigue, for instance, a diet high in fats and simple carbohydrates won’t help.

The better your diet, the better your overall health. You’ll not only feel better in the short term, but you’ll be laying the foundation for a healthier future.

Your diet should consist mainly of:

  • a variety of vegetables and fruits
  • lean sources of protein, such as fish and skinless poultry
  • whole grains and other sources of fiber
  • nuts
  • legumes
  • low-fat dairy products
  • adequate water and other fluids

You should limit or avoid:

  • saturated fat
  • trans fat
  • red meats
  • foods and beverages high in sugar
  • foods high in sodium
  • highly processed foods

Portion control can help you maintain a healthier weight. Read food labels. Foods that are high in calories but low in nutrients won’t help you feel better.

If you have coexisting conditions, ask your doctor if you should follow a special diet or take any dietary supplements.

Effects of Multiple Sclerosis (MS)

The lesions from MS can appear anywhere in your central nervous system and affect any part of your body.

One of the most common symptoms of MS is fatigue, but it’s not uncommon for people with MS to also have:

  • depression
  • anxiety
  • some degree of cognitive impairment

Mobility issues

As you age, some disabilities from MS may become more pronounced. If you have mobility issues, you may be at an increased risk for bone fractures and breaks due to falls. Having other conditions such as arthritis and osteoporosis can complicate matters.

Mobility issues can also lead to a lack of physical activity, which can lead to other health problems. Fatigue and mobility issues may also have an impact on sexual function.

Outlook for people with Multiple Sclerosis (MS)

It’s almost impossible to predict how MS will progress in any one person.

About 10 to 15 percent of people with MS have only rare attacks and minimal disability ten years after diagnosis. This is sometimes called benign MS.

Progressive MS generally advances faster than RRMS. People with RRMS can be in remission for many years. A lack of disability after five years is usually a good indicator for the future.

The disease generally progresses faster in men than in women. It may also progress faster in those who receive a diagnosis after age 40 and in those who have a high relapse rate.

About half of people with MS use a cane or other form of assistance 15 years after receiving an MS diagnosis. At 20 years, about 60 percent are still ambulatory and less than 15 percent need care for their basic needs.

Your quality of life will depend on your symptoms and how well you respond to treatment. This rarely fatal but unpredictable disease can change course without warning. Most people with MS don’t become severely disabled and continue to lead full lives.

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