Multiple Sclerosis: Signs, Symptoms, Causes, & Treatment

What Is Multiple Sclerosis?

Multiple sclerosis, commonly known as MS, is a debilitating disease of the central nervous system—the brain and spinal cord. When a person has MS, the immune system attacks the protective layer (called myelin) around the nerve fibers in the spinal cord. As a result, there is a disruption in the communication between the brain and the rest of the body.

The impact on someone diagnosed with MS differs depending on which nerves are damaged. For this reason, each case of MS is unique and symptoms vary widely among different people. Unfortunately, all people with MS experience ongoing pain in various parts of their bodies. The pain usually feels like a burning or stabbing sensation, called “neuropathic pain,” which occurs due to damage to the nerve sheaths. The severity and frequency of the pain, also known as MS flares, will vary from person to person, but studies show that 50% of people with MS will not be able to walk unassisted within 15 years of being diagnosed.

Types of MS

Although MS can manifest in varied ways with a wide range of symptoms, there is a generally accepted classification of the disease into three types:

• Relapsing-Remitting MS: Approximately 85% of people with MS have this type. It is characterized by periods of symptoms (both new and old) for a few days or weeks, which then improve or disappear completely. The subsequent period of remission can last for months or even years before another relapse begins. With relapsing-remitting MS, when the symptoms return, they are usually similar in severity to previous episodes.

• Secondary-Progressive MS: Once symptoms begin to worsen - which happens to 60-70% of people with relapsing-remitting MS - it is called secondary-progressive MS. With secondary-progressive MS, you are likely to see more difficulties with mobility and walking, but the rate at which the disease progresses varies from person to person.

• Primary-Progressive MS: Approximately 10-15% of people with MS are diagnosed with primary-progressive MS. This type differs from the other two types in that as soon as the symptoms start, there are no periods of remission and relapse. Instead, people experience continual, progressively worsening symptoms, beginning with difficulty walking and expanding over time.

What Causes MS?

MS is an autoimmune disorder, in which the body’s immune system mistakenly attacks itself. With MS, the body is attacking its own nerves (more specifically, the myelin sheath which covers and protects the nerves in the brain and spinal cord).

We do not yet know why this happens only to certain people. Current findings indicate that MS is likely caused by a combination of factors that include:

• Immunology: The immune system attacks the central nervous system, causing damage and inflammation. It remains unknown why this happens, what exactly causes the immune system to attack the body, or even which specific cells in the immune system are responsible, and research is ongoing.

• Environment: MS occurs more often in people who live farther from the equator, although the reason for this is unknown. To help identify environmental factors that contribute to the onset of the disease, researchers are studying clusters of people with MS who live in similar environments.

• Previous infections: There is growing evidence that certain viral or bacterial infections, such as the one that causes mononucleosis, may contribute to the risk of developing MS.

• Genetics: People often wonder, is MS hereditary? While the disease itself is not passed down from parents to children, there is evidence of genetic factors related to the risk of developing MS. This means that regardless of whether your parents have MS, certain genes you inherited may lead to an increased risk of developing the disease.

Multiple Sclerosis Signs and Symptoms

MS is tricky because the variety and intensity of symptoms differs so much between individuals. There is no such thing as a true “text-book” case of MS, but there are some common symptoms, including:

• Fatigue
• Difficulty walking due to weakness, spasticity, or loss of balance
• Numbness or tingling in the face, body, or extremities
• Stiffness and involuntary muscle spasms
• Muscle weakness
• Vision problems
• Dizziness
• Bladder and/or bowel dysfunction
• Sexual dysfunction
• Chronic pain and/or itching
• Cognitive and/or emotional changes
• Depression

Most MS patients begin experiencing symptoms in their 20’s or 30’s, and, according to the National Institute of Neurological Disorders and Stroke, the most common early symptom of MS is vision disturbance.

The symptoms are generally similar in all three types of MS, as the difference between the types is related to frequency and severity of symptoms rather than the symptoms themselves.

Symptoms of MS in Women

The MS symptoms listed above are equally common in men and women, but there are several symptoms that are specific to women. Because women are two to three times more likely than men to get MS, doctors suspect that certain hormones play a role in causing the disease. Research shows that women may be more likely to get MS due to their lower levels of testosterone, or because of hormonal fluctuations.

There are three main types of MS symptoms that are specific to women. They include:

• Menstrual problems: Women with MS may see an increase in their symptoms while they have their periods because of decreased estrogen levels during that time. The symptoms that are likely to become more severe are weakness, imbalance, depression, and fatigue.

• Pregnancy-related symptoms: MS does not cause infertility, and many women actually find that their MS symptoms improve during pregnancy and then return again following delivery.

• Menopause: Studies show that MS symptoms in women are likely to get worse after menopause due to the drop in estrogen levels.

How Is MS Diagnosed?

Because MS symptoms are so varied and mimic many other conditions, being diagnosed with MS usually involves a process of elimination and ruling out other diseases.

The diagnostic process typically includes the following:

• Blood tests: Simple blood tests can rule out a multitude of diseases with similar symptoms. New developments are underway to create testing for specific biomarkers that are associated with MS.

• MRI: This imaging test looks for damage caused by multiple sclerosis, referred to as MS lesions, to the brain and spinal cord.

• Spinal tap: A small sample of spinal fluid is analyzed to rule out infections and other diseases, and to look for any abnormalities which indicate the presence of MS.

• Evoked potential tests: This type of test involves recording the nervous system’s response to visual or electrical stimuli. You may be asked to watch a visual of a moving pattern, or you may feel electrical impulses applied to your arms or legs. The test measures how quickly the information you receive travels along your nerves.

For patients with relapsing-remitting MS, doctors can typically diagnose the disease based on the pattern of symptoms and confirmation of the presence of MS lesions by an MRI. Progressive MS can be more complicated to diagnose, and doctors are more likely to conduct a spinal tap and other tests in addition to an MRI.

Even with the greater complications for patients with progressive MS, most professionals agree that an MRI is the most useful diagnostic tool because it reveals changes in the brain and spinal cord. The changes that the MRI can identify are known as MS lesions. These lesions are a tell-tale sign of MS, although their severity and frequency varies. People with relapsing-remitting MS tend to have more lesions than those with progressive MS, for example.

MS Treatment Options

Unfortunately, there is no cure for MS. However, proper treatment can improve recovery time from MS flares, slow disease progression, and help with symptom management.

Treatments for MS Flare-Ups

MS flares can be treated with corticosteroids, which reduce inflammation of the nerves. Another treatment is plasma exchange, where the plasma (or liquid) part of your blood is separated from your blood cells. The blood cells are then mixed with a protein solution and returned to your body. Plasma exchange is only used in severe cases, or when steroids are not effective.

Treatments to Slow Disease Progression

For people with primary-progressive MS, there is only one FDA-approved medication, called Ocrevus. This is a relatively new drug, but initial results are promising and, based on a clinical trial, can potentially give a person with primary-progressive MS an extra seven years of life without a wheelchair.

For people with relapsing-remitting MS, there are a few possible treatments to slow disease progression. If treatment is started as early as possible, the MS prognosis is even better, and the patient will see a lower relapse rate and fewer new MS lesions. The most common treatment includes injectable beta interferon, which reduces both the frequency and severity of MS flares.

It is important to note that there are significant risks and side effects associated with many of the treatments for relapsing-remitting MS, and your doctor will help you decide which treatment is best for you.

Treatments for MS Symptoms

A physical therapist can teach you how to stretch and strengthen your muscles. As the disease progresses, they can also show you how to use assistive devices and mobility aids so that you can continue to perform daily activities. Your doctor may also prescribe muscle relaxants, medication to help with fatigue or to improve walking.

What You Can Do at Home

With proper disease management, people with any of the three types of MS can live a long and fulfilling life. That being said, in addition to the medical interventions described above, there are also a few simple things that can be done at home to help improve the quality of life.

Some steps you can take include:

• Get plenty of rest as you may tire easily, especially when the pain makes it difficult to walk around.

• Exercise regularly to maintain and improve your strength, muscle tone, balance, and coordination.

• For some people, MS symptoms worsen in the heat, so try to keep cool and avoid exposure to extreme heat.

• Eat a well-balanced diet including extra vitamin D, as some research points towards increased vitamin D decreasing disease activity.

• Stress can increase symptoms, so try yoga, massage, meditation, or any other stress-relieving activity.

When To See a Doctor

It’s a good idea to check with your doctor if you are experiencing any symptoms that you suspect might be multiple sclerosis. If you do have MS, timely diagnosis and treatment can vastly improve your prognosis.

If you are diagnosed with MS, and are experiencing new or worsening symptoms, you should also check in with your doctor. These symptoms could mean that you are transitioning to progressive MS, or have developed new MS lesions.

Risk Factors and Complications

Because there is still so much unknown about MS and what causes it, it is hard to pinpoint specific risk factors. From a statistical perspective, the following groups of people are at a higher risk:

• Age: People between the ages of 16 and 55 are most likely to develop MS, although it can occur at any age.

• Gender: Women are two to three times more likely to develop MS than men, particularly the relapsing-remitting form of MS.

• Family history: MS is not always passed directly from a parent to a child—meaning a parent with MS can have a perfectly healthy child—but if your parents or siblings have MS, you are at higher risk.

• Climate and Geography: MS is more common in colder climates, and in individuals with Northern European descent.

Once diagnosed with MS, it can be hard to predict how and when your symptoms will progress. Some symptoms are more likely than others to become more severe at certain times, such as:

• Muscle stiffness or spasms
• Paralysis
• Severe bladder, bowel, and/or sexual function problems
• Significant forgetfulness and/or mood swings
• Depression
• Epilepsy

When a person is diagnosed with multiple sclerosis, life expectancy may be one of the first concerns that comes to mind. As mentioned above, MS is not a fatal disease. However, there are studies showing that the average lifespan following diagnosis is 25-35 years. Even in those cases, the cause of death is typically not from the MS itself, but rather complications that arise due to immobility, including chronic urinary tract infections, difficulty swallowing and breathing, sepsis, or bacterial pneumonia.

If you suspect that you have MS or are newly diagnosed with the disease, try to remain optimistic - remember that there are many things you can do to maintain a high quality of life! With advances in medical technology and continued emphasis on research, the chances for a normal life will only continue to grow.