CONDITIONS
Multiple sclerosis
Multiple sclerosis (MS) a lifelong condition that affects the brain and spinal cord (central nervous system) and can cause serious disability in some cases, while being mild in others. The prevalence of MS in India has increased over the past few years with approximate cases found to be 8.3/100,000.
Multiple sclerosis is most commonly diagnosed in the age group of 20s, 30s and 40s and is about 2 to 3 times more common in women than men.
What are the types of Multiple Sclerosis?
There are three main types of MS:
- Relapsing-remitting MS (RRMS)
- most common type of MS (85% diagnosed with this type)
- temporary flare-ups are common (called relapses) followed by periods of:
- remission (duration without symptoms) or
- RRMS with worsening (increased disability post relapse)
A person’s condition doesn’t get worse during remission.
- Primary-progressive MS (PPMS)
Symptoms gradually worsen after diagnosis but there are no periods of relapses or remission.
- Secondary-progressive MS (SPMS)
Symptoms steadily worsen over time. The SPMS may be seen in a person after the development of early RRMS symptoms.
What are the first/early signs of Multiple Sclerosis?
The first signs of MS are generally changes in the vision (optic neuritis). Symptoms may include:
- Complete or partial loss of vision (usually occurring in one eye at a time)
- Pain while movement of eyes
- Blurry vision
- Double vision
Other common early signs of multiple sclerosis may be:
- Numbness and tingling
- Fatigue
- Loss of balance
- Dizziness
- Stiffness
- Spasms
- Tremors
- Pain
- Bladder problems
- Trouble while passing stools (Bowel trouble)
- Thinking and memory problems
What are the other symptoms of Multiple sclerosis?
In MS, a person’s nerves don’t work normally to help in movement and senses. As a result, there may be symptoms such as:
- Trouble walking
- Vertigo
- Electric-shock sensations happening with certain neck movements, especially while bending the neck forward (Lhermitte sign)
- Feeling tired
- Muscle weakness or spasms
- Blurred or double vision
- Numbness– particularly on one side of the body at a time and in one or more limbs
- Sexual problems
- Tingling sensations
- Pain
- Depression
- Problems focusing or remembering.
What are the causes and risk factors of Multiple sclerosis?
Multiple sclerosis is known to be a disease which is immune mediated (when the body’s immune system attacks its own tissues). In case of MS, the malfunctioned immune system destroys the fatty substance coating and protecting the nerve fibers in the brain and spinal cord (myelin), exposing the nerve fibers and slowing or blocking communication between the brain, spinal cord and the rest of the body.
There are some risk factors that increase chances of development of MS in some people and not in others. A combination of genetics and environmental factors appears to be responsible.
Other risk factors of MS are:
- Age – usually occurring in around 20 and 40 years of age.
- Sex – women are more than 2 to 3 times as likely as men to get diagnosed with relapsing-remitting MS.
- Family history of MS
- Certain infections – Many different types of viruses have been linked to MS including the Epstein-Barr or the human herpesvirus 6 that compromise the immune system.
- Race – People of Asian, African or Native American descent have the lowest risk while White people, particularly those of Northern European descent, are at highest risk of developing MS.
- Climate – more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe. The birth month may also affect the chances of developing multiple sclerosis, as sun exposure in mother may decrease chances of later development of multiple sclerosis in those children.
- Low Vitamin D levels
- Genetic
- Obesity – especially female childhood and adolescent obesity.
- Certain autoimmune diseases – Risk is slightly higher in presence of other autoimmune disorders such as thyroid disease, pernicious anemia, psoriasis, type 1 diabetes or inflammatory bowel disease.
- Smoking
How is Multiple sclerosis diagnosed?
If a doctor suspects MS, they may refer the patient to a neurologist (brain and nervous system specialist) who may take the medical history and examine the person for key signs of nerve damage in brain, spinal cord, and optic nerves.
Because the symptoms of MS are like other nerve disorders, the doctor may suggest multiple different tests to confirm diagnosis. These are:
- Blood tests to rule out diseases cause symptoms similar to MS
- Lumbar Puncture – To analyze the liquid cushioning the brain and spinal cord (cerebrospinal fluid (CSF)). The sample from this fluid may show abnormalities in antibodies associated with MS and also help rule out infections and other conditions with symptoms like MS
- Evoked potential tests – Records the electrical signals produced by the nervous system in response to stimuli that may be visual stimuli or electrical stimuli. This is done by applying short electrical impulses to nerves in the legs or arms, and then, electrodes measure the speed of information travelling down the nerve pathways.
- MRI – to take detailed pictures of the structures of the brain or spinal cord
Optical coherence tomography (OCT) – to detect changes in the retina, which could warn of brain atrophy (deterioration)
What are the treatment options for Multiple sclerosis?
There is no cure for multiple sclerosis and the treatment mostly targets fast recovery from flare-ups, reducing relapses, slowing the progression of the disease, and managing the symptoms.
In people with mild symptoms of MS, no treatment is required. Treatment options include:
Medications
Steroids – to make MS attacks shorter and less severe.
Other drugs such as muscle relaxants, tranquilizers, or botulinum toxin (Botox), are given to ease muscle spasms and treat some other symptoms.
Plasma exchange (plasmapheresis) where the liquid portion in the blood (plasma) is removed, and the remaining blood cells are mixed with a protein solution (albumin) before putting it back into the body. Plasma exchange is used in cases where symptoms are new, severe and haven’t responded to steroids.
Disease modifying therapies (DMTs) are used to lower the relapse rate, help decreasing the rate of new lesion formation and potentially reduce risk of brain damage. Treatment options for relapsing-remitting MS include injectable, oral and infusions medications.
Therapy
A physical therapist can teach a person with MS exercises that will keeps up the strength and balance and helps in managing the fatigue and pain.
An occupational therapist can teach a person several different ways to do certain day to day tasks that may be otherwise difficult for a patient of MS. For eg., a cane, walker, or braces may ease walking if a person has trouble getting around.
What other things can be done to ease MS symptoms?
- Get regular exercise to help improve the strength, muscle tone, balance and coordination.
- Mild to moderate forms of exercise recommended for people with MS include walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi.
- Cool Down – Avoid too much heat to boost energy.
- Swimming or other water exercises are recommended for this and also works if a person has intolerance to heat.
- Avoid stress
- Ask the doctor about trying yoga to ease fatigue or stress.
- Take care of emotional health is important
- Ask family, friends, or a counselor for help with any stress or anxiety that may be felt. It is OK to ask for help.
- Support groups can help in connecting with other people living with MS.
- The Multiple Sclerosis Society of India (MSSI) is a registered voluntary, non-profit organization with a mission to put the MS person first, create awareness, while breaking down physical, emotional, and social barriers. Their website is www.mssocietyindia.org.
References
- Goyal, Vinay. Multiple Sclerosis in India. Annals of Indian Academy of Neurology 21(2):p 95-97, Apr–Jun 2018.
- Multiple sclerosis. Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274
- Multiple sclerosis. WebMD. May 2024. https://www.webmd.com/multiple-sclerosis/what-is-multiple-sclerosis