The Beginner’s Guide to Multiple Sclerosis
Multiple Sclerosis (MS) is a chronic and disabling disease that affects the central nervous system (CNS). MS causes demyelination of the neurons in the brain and spinal cord. Neurons are coated in myelin sheaths, which are vital for communication.
For unknown reasons, the myelin sheaths begin to deteriorate, which decreases the ability of neurons to transmit information throughout the body.
The Progression of Multiple Sclerosis
MS is suspected to be autoimmune, and often behaves in a pattern similar to other autoimmune diseases. Medical professionals subdivide MS based on its expected course. The majority of individuals with MS experience periods of improvement (remission) that alternate with increased symptoms (relapse).
A purely progressive course of illness is possible. For these individuals, their symptoms do not periodically remit and progressively become worse. A progressive course may begin at the onset of MS, or begin after several years of remission and relapse. Individuals with the progressive form of MS may experience periodic exacerbation of symptoms.
The longitudinal course of MS varies significantly for each individual. Some individuals may live decades with minor impairments, whereas others may develop profound disabilities in a matter of years.
Multiple Sclerosis Symptoms
The initial symptoms of MS are often vague and can be attributed to numerous other conditions. Fatigue, cognitive problems and trouble with balance and coordination are common.
As MS progresses, the effects on the nervous system become more apparent. Decreased sensation in the extremities can be painful and compromise the ability to pick up objects or walk. The nerves that are responsible for internal functions can become impaired. Individuals with MS may slowly lose the ability to control bladder and bowel functions.
In advanced stages of MS, individuals may have problems with breathing or experience the inability to chew, swallow or properly digest food. The symptoms that manifest during MS will depend on the nerves that are affected, and the extent to which they are affected.
Diagnosing Multiple Sclerosis
A diagnosis of MS may take time. Several diagnostic tests can be used to determine if damage to the CNS has occurred. However, diagnosing MS requires observation of distinct areas of damage over time.
An individual who shows symptoms that are consistent with MS will need to be evaluated for other conditions that can cause similar symptoms. An MRI is used to observe damage or changes within the brain. Slowing of information processing along the nerves may be diagnosed using evoked potentials.
If new areas of damage are observed at least one month apart, and other conditions have been ruled out, a diagnosis of MS is made.
Treatment for Multiple Sclerosis
Treatment for MS includes medications that can help slow the progression of the disease and to manage specific symptoms. Several disease-modifying medications have FDA approval and are specifically indicated for use in MS patients. Medications are available in oral, injection and infusion forms, with some medications being indicated for MS with a specified course.
Disease-modifying medications decrease the activity of immune cells within the body, that are believed to be the cause of demyelination. Many patients who receive disease-modifying medications show a slower progression of MS, or a decrease in the intensity of flares of disease activity.
Since disease-modifying agents act as an immunosuppressive, patients require consistent monitoring and must remain vigilant for signs of infection or illness.
Other medications commonly used in the management of MS include serotonin-norepinephrine reuptake inhibitors (SNRIs), which are indicated for the treatment of depression and nerve pain.
Various antispasmodics are used to decrease urinary urgency and symptoms related to overactive bladder. Botox injections are used in a similar manner, and can be used to target specific muscle groups to reduce spasms.
Constipation is a common occurrence in individuals with MS. Over-the-counter laxatives are recommended to be used sparingly. Fiber supplements may improve intestinal motility and can be used regularly to minimize constipation.
Physical therapy can be an integral part of treatment for individuals who have developed physical limitations resulting from the progression of MS. The role of physical therapy is to minimize limitations that can lead to long-term disability.
Mobility devices such as motorized wheelchairs may increase independence for individuals with impaired mobility.
In extreme cases where vital functions are impaired, individuals may need oxygen or other respiratory support. Feeding tubes are an option to provide nutritional support if swallowing has been compromised.
Medical research continues to fully understand the underlying causes of MS and develop improved treatments, or a cure. Individuals with MS may consider participating in clinical trials if standard treatments have inadequately managed their condition.
Additional Multiple Sclerosis Resources
The National Institute of Neurological Disorders and Stroke (NINDS) and the National Multiple Sclerosis Society (NMSS) provide a wealth of information for those affected by MS and for the general public.
1) National Multiple Sclerosis Society
2) National Institute of Neurological Disorders and Stroke
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