Do you have these symptoms? Let's talk about Multiple Sclerosis (MS)!

Do you sometimes feel like you're losing your balance or your vision is suddenly blurry? Or do you feel like you're losing your balance when you walk? There are times when you wonder if these things are just passing, or if they're the beginning of something bigger? Today we're going to talk about a condition that's a bit complicated, but it's very important to be aware of. That's Multiple Sclerosis , or MS for short.

What is Multiple Sclerosis?

Simply put, multiple sclerosis (MS) is a condition in which your own immune system attacks your brain and spinal cord , which is your central nervous system . This is called an autoimmune condition .

Think of the nerves in your body as electrical wires. These wires have a protective sheath around them, right? Similarly, our nerve cells have a protective sheath called myelin . These myelin sheaths help signals travel through the nerves quickly and accurately. This communication is essential for everything we see, feel, and move our bodies.

Now, what happens to someone with MS is that their own immune system mistakenly attacks these myelin cells . It's like our own army attacking our own country. This damages the myelin sheaths. Then those nerve messages don't travel properly, get stuck in the middle, or go the wrong way. This damage can happen in the brain, the spinal cord, and sometimes even in the nerves that connect to the eyes.

There is currently no cure for MS. However, there are many effective treatments to minimize the damage and control the symptoms. So don't worry.

What are the main types of MS?

MS affects everyone differently, so doctors divide it into several types based on your symptoms. These are not different diseases, just the way the disease manifests itself.

There are four main types:

1. Clinically Isolated Syndrome (CIS): This is the first time MS symptoms appear. But there is not enough evidence to definitively confirm that it is MS. These symptoms are caused by damage to myelin. Not everyone with CIS will develop MS, but some may develop MS in the future.

2. Relapsing-Remitting Multiple Sclerosis (RRMS): This is the most common type of MS . About 85% of people with MS fall into this category. What happens is that new symptoms suddenly appear, or old symptoms get worse. This is called a "relapse" or "attack." Then, over time, these symptoms decrease or disappear completely. This is called a "remission" period.

3. Secondary Progressive Multiple Sclerosis (SPMS): Many people with RRMS eventually develop SPMS. At this stage, nerve damage gradually accumulates and symptoms gradually worsen. Relapses may occur, but periods of remission, or periods of symptom relief, are shorter.

4. Primary Progressive Multiple Sclerosis (PPMS): In this type, symptoms gradually worsen from the beginning. There are no clear relapses and remissions like in RRMS.

In addition to these four main types, there are several very rare variants of MS:

• Tumefactive Multiple Sclerosis: This is a form of multiple sclerosis that causes demyelination in large areas of the brain. These may look like tumors. A biopsy may be needed to determine if this is a brain tumor.
• Balo's Concentric Sclerosis: In this condition, myelin damage appears like concentric rings on an MRI scan, hence the name.
• Marburg Variant Multiple Sclerosis: This is a very rare, severe form of MS. Symptoms progress rapidly and can be fatal if left untreated.

How common is MS?

Studies conducted in countries like the United States show that nearly a million adults are living with MS. There are people with this condition in Sri Lanka as well.

What are the early symptoms of MS?

The first symptoms of MS can include:

• Vision changes: Blurred vision in one eye, pain (this is called optic neuritis ), double vision, and possibly loss of vision.
• Muscle weakness: Usually on one side of the face or body, or below the waist.
• Numbness or unusual sensations: This can also usually occur on one side of the face or body, or below the waist. It can feel like a tingling sensation, or it can feel like nothing at all.

What are other symptoms of MS?

Here are some other common symptoms that can be caused by MS:

• Fatigue: Not just tiredness, but unbearable, overwhelming fatigue.
• Clumsiness
• Dizziness
• Difficulty controlling bladder function: frequent urination, inability to control urination.
• Loss of balance and coordination
• Cognitive function difficulties: This refers to a decrease in the ability to think, remember, concentrate, learn, and make judgments.
• Mood changes: irritability, depression, anxiety.
• Muscle stiffness and muscle spasms / tremors

The important thing is that these symptoms vary from person to person. What you have one day may be different from what you have the next. You may have several of these symptoms, but not all of them at once.

Is it possible to live normally with MS?

This is a bit difficult to say, because what is "normal" varies from person to person. With MS, you can have periods of remission . That means periods when your symptoms go away and you can be pretty much the same as you were. You may even forget you have MS, until your symptoms come back. What this "normal" feels like, and how much it feels, can vary depending on the type of MS and the stage of the disease.

What causes MS?

The main cause of MS is the destruction of myelin (demyelination) . As we've discussed before, myelin is the protective covering around the nerve cells (neurons) in your brain and spinal cord. It's what sends messages between your brain and the rest of your body, controlling things like vision, sensation, and movement.

Your immune system's job is to protect you from things that are harmful to your body, like bacteria and viruses. But in MS, your immune system becomes overactive and mistakenly thinks that healthy myelin (and sometimes the nerve cells underneath it) is a threat. When the immune system attacks this healthy myelin, it damages it. This is called demyelination .

A doctor can use an imaging test, such as an MRI, to find evidence of this myelin damage. They may call it a scar, lesion, or plaque . Where myelin is damaged, messages between nerve cells don't travel properly. That's what causes the symptoms of MS.

Experts still don't know exactly why some people develop MS, but research suggests that these things may increase the risk of developing MS:

• Smoking
• Exposure to toxins: For example, exposure to secondhand smoke, pesticides.
• Low levels of vitamin D
• Exposure to a virus: For example, Epstein-Barr virus or mononucleosis .
• Obesity during childhood
• Genetic predisposition: This means that if someone in your family has this disease, or if you have genes that predispose you to developing the disease, you are more likely to develop this disease.

Who is at higher risk of developing MS?

You may be at higher risk of developing MS if you:

• If you are between 20 and 40 years old.
• If you have Northern European ancestry.
• If you are a woman (women are more likely to develop MS).

But remember, MS can affect anyone. In rare cases, it can also affect children .

What complications can occur due to MS?

If MS symptoms worsen or become progressively worse, complications such as:

• Difficulty walking without help.
• Loss of bowel or bladder control .
• Memory loss .
• Sexual dysfunction .
• Depression and anxiety .

How is MS diagnosed?

There is no single test that can definitively diagnose MS. Instead, a doctor will conclude that you have MS after conducting a physical exam, a neurological exam, and several other tests .

During an examination, your doctor will learn more about your symptoms and medical history. Tests may include blood tests, MRI (Magnetic Resonance Imaging) scans of your brain and spinal cord, and an examination of your spinal fluid .

It can take some time to get a definitive diagnosis of MS. You may need to see your doctor several times before you know for sure. This is because the symptoms of MS can be similar to those of several other common diseases. While a delay in diagnosis can be frustrating, getting an accurate diagnosis can help your doctor treat your symptoms properly.

What tests are used to diagnose MS?

Diagnostic tests help your doctor rule out other conditions that have similar symptoms to MS. Tests may include:

• Blood tests and urine tests
• Magnetic Resonance Imaging (MRI) test
• Optical Coherence Tomography (OCT) test: This checks for damage to the optic nerves.
• Lumbar Puncture: This involves taking a sample of spinal fluid from the spine and examining it.
• Evoked Potential (EP) test: This measures how fast nerve impulses travel.

Who diagnoses MS?

If your primary care provider suspects that you may have MS, they will refer you to a neurologist . A neurologist is a doctor who specializes in treating diseases of the nervous system, which includes the brain and spinal cord.

Can MS be completely cured?

Unfortunately, there is currently no way to completely cure MS.

What are the treatments for MS?

The main goals of multiple sclerosis treatment are to minimize further damage, control symptoms, and prevent complications . Your treatment plan may include:

• Medications
• Physical therapy, occupational therapy, or speech therapy
• Mental health counseling

Other ways to manage symptoms vary depending on how the disease affects you. They may include:

• Wearing glasses or taking medication for vision problems.
• Deep Brain Stimulation for Muscle Tremors.
• Using assistive devices such as a cane, walker, or wheelchair for walking difficulties.
• Antiseizure medications or antispasmodic medications for pain (e.g. , gabapentin or nortriptyline ).
• Medications such as donepezil for cognitive symptoms.
• Alternative therapies such as acupuncture and yoga .

If your body doesn't respond well to certain medications during an MS attack, your doctor may recommend plasma exchange (plasmapheresis) . This is more effective in reducing the damage from an existing attack than in preventing further attacks in the long term.

You can also talk to your doctor about whether there are any clinical trials you can participate in. Clinical trials are tests on people to find new treatments for MS and other diseases, either new drugs or new ways to use existing drugs.

Medications for multiple sclerosis

Medications for multiple sclerosis can reduce the frequency of relapses, reduce the development of new lesions/scarring in the brain and spinal cord, and slow the progression of the disease. The most common types of medications for MS are:

1. Disease-Modifying Therapies (DMTs): DMTs reduce the number of relapses you have, slow the progression of MS, and prevent new lesions from forming in your brain and spinal cord. There are several medications approved by the U.S. Food and Drug Administration (FDA) for long-term MS treatment.

2. Relapse management medications: For severe attacks, medications such as corticosteroids (such as methylprednisolone ) suppress your immune system and quickly reduce swelling. These medications can speed up your recovery time after an attack. They also reduce damage to the myelin sheath around your nerve cells. Your doctor may give you these medications through an IV (intravenously) . Other short-term treatments for severe attacks include IV immunoglobulin therapy or plasma exchange .

DMTs for MS

Here are the DMTs commonly used for MS and their methods of administration:

• Injections into your skin: Beta interferon, glatiramer acetate, or ofatumumab.
• Infusions into a vein (IV): Alemtuzumab, natalizumab, rituximab, ocrelizumab, or ublituximab.
• Oral medications: Cladribine, dimethyl fumarate, diroximel fumarate, monomethyl fumarate, fingolimod, siponimod, ponesimod, ozanimod, or teriflunomide.
• Stem cell transplant

Can multiple sclerosis be prevented?

There is currently no known way to prevent MS.

How to reduce MS symptom flare-ups?

The most effective way to reduce the number of flare-ups, relapses, and attacks you have is to take disease-modifying therapies (DMTs) .

It's also important to live a healthy lifestyle . The decisions you make can help slow the progression of the disease. To stay healthy, your doctor may recommend the following:

• Eating nutritious food.
• Getting enough sleep.
• Engaging in regular physical activity.
• Not using tobacco products.

Dealing with a chronic illness can be mentally challenging. MS can sometimes affect your mood and memory. Working with a neuropsychologist or mental health counselor is an essential part of managing the disease long-term.

What is the outlook for MS?

Multiple sclerosis is a lifelong condition that has no cure . However, current treatment options are very effective in managing symptoms and reducing the frequency of flare-ups. With or without treatment, MS can become disabling over time, making it difficult to perform daily tasks without assistance. Your care team is there to support you throughout your MS journey, taking steps to prevent complications and improve your quality of life.

Does multiple sclerosis affect your lifespan?

You can expect to live a normal life with MS. While older studies showed that MS could shorten your life expectancy by about 10 years, this has improved significantly with advances in treatment options. Only in very rare cases is MS fatal.

Can someone with MS live a normal life?

Yes. MS can be a challenging condition to diagnose and manage, but your care team will help you every step of the way. Even though there is no cure, you can live a fulfilling and active life with MS. From medications to therapy, there are ways to help you maximize your physical and mental functioning. There are even support groups that can help you connect with others who have had similar experiences.

When should you see a doctor?

You should see a doctor if you experience symptoms like these:

• Feeling overly sensitive to heat.
• If you feel unsteady or off balance.
• Difficulty remembering things.
• Especially if you have numbness or tingling in your hands or feet.
• Sudden vision changes.
• If you feel weakness in your arms or legs.

If you have MS and develop new symptoms, or if existing symptoms get worse, tell your doctor.

What questions should you ask your doctor?

You may want to ask your doctor these questions:

• What kind of treatment do you recommend?
• How often should I attend physical therapy?
• Are there any side effects to the medications you prescribed?
• When and how often should I take the medication?
• What symptoms should I look out for?
• Can you give me advice on maintaining good health?
• Are there any support groups you can recommend?

Take-Home Message

Multiple sclerosis (MS) is a frustrating, life-threatening condition. Symptoms can come on suddenly and worsen. MS can also make you more likely to have accidents if you lose your balance.

But, you are not alone. A doctor can help you manage the condition and continue your daily activities safely. As the disease progresses, you may need to make small changes to your lifestyle, such as using a walking aid or wearing glasses. But many people with MS live full and active lives with the help of their care team. If you have any questions about your treatment options, symptoms or complications to watch out for, don’t hesitate to ask your doctors. Being informed and getting the right support is the best way to live successfully with MS.

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