Overview
Multiple sclerosis (MS) is a central nervous system disease characterized by the immune system attacking the protective sheath (myelin) that covers nerve fibers, resulting in communication problems between the brain and the rest of the body. This damage can cause a wide range of signs and symptoms, including numbness or weakness in limbs, tingling, lack of coordination, unsteady gait, vision problems, fatigue, slurred speech, cognitive problems, and mood disturbances. There is no cure for MS, but treatments can help manage symptoms, speed up recovery from attacks, and modify the course of the disease.
Understanding the disease
Symptoms
Symptoms of multiple sclerosis may vary greatly from person to person and can include numbness or weakness in one or more limbs, tingling, electric-shock sensations, lack of coordination, unsteady gait, partial or complete loss of vision, double vision, vertigo, problems with sexual, bowel and bladder function, fatigue, slurred speech, cognitive problems, and mood disturbances.
Risk Factors
Risk factors for developing multiple sclerosis (MS) include age, sex, family history, certain infections, low vitamin D levels, obesity, autoimmune diseases, smoking, and climate.
Development
Multiple sclerosis (MS) can develop in two main forms: relapsing-remitting and primary-progressive.
- Relapsing-remitting MS: This is the most common form of MS, accounting for approximately 85% of cases. It involves periods of active disease, called relapses or exacerbations, followed by periods of remission when there are no new symptoms. The disease course can be relatively unpredictable, with symptoms worsening over time.
- Primary-progressive MS: This form of MS involves a gradual onset and steady progression of signs and symptoms without any relapses. It accounts for about 10-15% of cases. In primary-progressive MS, the disease worsens over time, with no distinct relapses or remissions. The rate of disease progression varies greatly among individuals with this form of MS. It is important to note that the specific symptoms and progression of MS can vary significantly between individuals, even within the same form of the disease. Some people may experience mild symptoms and a slow progression, while others may experience more severe symptoms and a faster progression. The exact cause of MS remains unknown, and it is believed to result from a combination of genetic and environmental factors.
Assessment and Diagnosis
Triage
You should see a doctor if you experience any symptoms of multiple sclerosis, such as numbness or weakness in one or more limbs, tingling, electric-shock sensations, lack of coordination, unsteady gait, partial or complete loss of vision, prolonged double vision, blurry vision, vertigo, problems with sexual, bowel, and bladder function, fatigue, slurred speech, cognitive problems, or mood disturbances. These symptoms may vary in severity and duration from person to person and may be temporary or permanent. It's important to consult a doctor to determine the underlying cause of your symptoms and receive appropriate treatment.
Diagnosis
To diagnose multiple sclerosis (MS), your doctor will typically begin with a thorough medical history and examination. They may recommend a series of tests to rule out other conditions with symptoms similar to MS. These tests may include blood tests to rule out other diseases, a spinal tap (lumbar puncture) to analyze cerebrospinal fluid and detect abnormalities associated with MS, and MRI scans to reveal areas of MS lesions on your brain and spinal cord. Evoked potential tests, which record the electrical signals produced by your nervous system in response to stimuli, may also be conducted. In most cases of relapsing-remitting MS, the diagnosis is based on a pattern of symptoms consistent with the disease and confirmed by brain imaging scans, such as an MRI. However, diagnosing MS can be more challenging in people with unusual symptoms or progressive disease, requiring further testing with spinal fluid analysis, evoked potentials, and additional imaging. It's important to bring any clinical notes, scans, laboratory test results, or other information from your primary care provider to your neurologist. Additionally, make a list of key medical information, personal information, and questions to ask your doctor. Having a relative or friend accompany you can also be helpful in remembering important information discussed during the appointment.
Management and Treatment
Complications
Potential complications of multiple sclerosis may include muscle stiffness or spasms, severe weakness or paralysis, particularly in the legs, bladder, bowel, or sexual function problems, cognitive issues like forgetfulness or word-finding difficulties, mood problems such as depression, anxiety, or mood swings, and very rare seizures.
Treatment
There are treatments available to help speed the recovery from attacks, modify the course of the disease, and manage symptoms of multiple sclerosis (MS). Some common treatment options include:
- Disease-modifying therapies: These medications can help slow the progression of MS and reduce the frequency and severity of attacks. Examples include interferon beta, glatiramer acetate, and natalizumab.
- Corticosteroids: These medications can help reduce inflammation and shorten the duration of attacks. They are often given intravenously in high doses or administered orally in lower doses.
- Plasma exchange (plasmapheresis): This procedure involves removing blood from the body, filtering out the harmful antibodies that contribute to MS, and returning the red blood cells and plasma back to the body.
- Pain relievers and muscle relaxants: These medications can help manage pain, spasticity, and muscle stiffness associated with MS.
- Physical therapy and rehabilitation: Exercise and physical therapy can help improve strength, coordination, and mobility, as well as manage symptoms such as fatigue and depression.
- Medications for specific symptoms: Depending on the symptoms experienced, medications may be prescribed to manage issues related to bladder and bowel function, sexual dysfunction, cognitive problems, mood disturbances, or seizures. It's important to work closely with a healthcare provider to determine the most appropriate treatment plan based on the individual's specific symptoms and needs.
Preparing for medical consultation
To prepare for an appointment for multiple sclerosis (MS), you should:
- Write down your symptoms: Make a list of all symptoms you're experiencing, including any that may seem unrelated to MS.
- Gather medical information: Bring any clinical notes, scans, laboratory test results, or other information from your primary care provider to your neurologist.
- List your medications: Create a list of all medications, vitamins, and supplements you're currently taking.
- Invite a support person: Consider bringing a family member or friend to the appointment to help you remember information and act as your advocate.
- Prepare a list of questions: Compile a list of questions to ask your doctor, such as inquiring about the most likely cause of your symptoms, tests needed for confirmation, treatment options, expected results, and follow-up requirements. By being well-prepared for your appointment, you can make the most of your time with your healthcare provider and ensure that all your concerns are addressed.