Multiple Sclerosis – Signs, Symptoms, and Treatment

What is Multiple Sclerosis (MS)?

Multiple Sclerosis (MS) is the most common autoimmune disease impacting the central nervous system (CNS) which includes the brain, optic nerve, and/or spinal cord. It is estimated that at least 1 million Americans have this disease. MS can impact virtually anyone at any age of life, but classically MS tends to be found most commonly in females with Western European ancestry aged 20-40.

MS involves an inflammatory attack on the fatty covering (myelin) surrounding the neurons (nerve cells) of the CNS. If we think of the neurons as wires and the myelin as the surrounding insulating cover, MS-related inflammation strips off this covering and results in the wire having a “short circuit.” This damage results in the neuron becoming dysfunctional and the signal that the neuron was carrying gets distorted or blocked. As a result of this dysfunction, a patient with MS may experience symptoms that can include vision changes, sensory changes, weakness, impaired balance, and many others.

What are the types of MS?

Broadly speaking Multiple Sclerosis can be divided into two different types: Relapsing MS and Progressive MS. Primary Progressive MS, and Secondary Progressive MS are subtypes of Progressive Multiple Sclerosis.  

The most common subtype is called Relapsing MS (RMS). In this type of MS, periodically and unpredictably, the patient with MS experiences episodes of neurologic dysfunction (called relapses) that typically last for weeks at a time and then generally have some type of recovery.

Another type of MS is Progressive MS. In this type, neurologic deficits accumulate slowly generally over years with a subtle change over time. Patients with Progressive MS can also have superimposed relapses just like patients with Relapsing MS.

When patients have progressive accumulation of symptoms at their disease onset we call this Primary Progressive MS (PPMS) and when patients have a slow accumulation of symptoms after having first years of predominantly relapses, we call this Secondary Progressive MS (SPMS).

What Causes MS?

To date there is not one specific cause of MS, meaning that it has not definitively been linked to only one environmental exposure, one vitamin deficiency, or one inherited gene. Patients, once diagnosed, often want to know  the risk of other family members having the disease. Although when looking at the risk of MS occurring in siblings or children of patients with MS is somewhat higher than the general population, the overall risk of other family members getting MS remains quite low in most cases.

An analogy to help visualize this is to think of MS as a type of soup.  Soup is not composed of only one ingredient, rather a combination of many ingredients mixed together in the right proportions at the right time.  This is similiar to the development of MS.

What are the signs and symptoms of MS?

There is not one specific symptom that is unique to MS. Given the nature of the disease and the fact that the immune system attacks causing inflammation anywhere in the central nervous system, symptoms depend on where the damage has occurred. This means that one patient with MS may have completely different symptoms than another and leads to every patient’s unique journey and experience with MS.

However, there are some common symptoms that patients with MS can experience:

• • Vision changes (examples include painful blurry vision out of one or both eyes, double vision)
  • Sensory changes (essentially various type of sensory issues including numbness, pins and needles, burning)
  • Weakness
  • Balance issues (dizziness)
  • Walking changes
  • Bladder/sexual dysfunction
  • Fatigue
  • Cognitive changes

Most commonly in MS, symptoms appear over the course of several days and worsen over time, then remain present for several days to weeks to months, and slowly improve.  Since there is no one specific MS symptom and symptoms can occur in conjunction with other neurological disorders, diagnosing MS can be challenging. 

How do doctors diagnose MS?

There is no specific test that is used to diagnose MS. Rather the diagnosis of MS is usually a process that requires a combination of the following:

• Listening to a patient’s history
• Examining the patient to determine if any abnormalities exist on their exam
• Getting MRIs of brain and spinal cord  (as past areas of MS related damage can be seen on MRI even if years or decades old)
• Getting blood work (In MS blood testing is normal, rather this is often done to rule out other issues that can masquerade as MS)
• Performing Lumbar Puncture (MS often leaves markers in the spinal fluid that can let neurologists know that there has been past inflammation in the central nervous system)

It is important to remember that a diagnosis of MS is not made based on one symptom, one MRI finding, or one lab test but rather it is a combination of all of these things synthesized together.

How do doctors treat MS?

There are two main areas of focus in treating Multiple Sclerosis. 

The first area focuses on preventing new symptoms, relapses, MRI changes, and ultimately trying to prevent permanent disability. These treatments accomplish this by influencing the immune system and are classified as immunosuppressive or immunomodulating medications. They are commonly called disease modifying therapies or DMTs. DMTs come in various forms from self-administered injections, oral pills, or IV infusion-based treatments. DMTs also come in various strengths. Thus, is it not a one-size-fits-all approach to MS treatments, but rather a process that requires a conversation that is guided by a neurologist to pick the most appropriate therapy for the patient at that time.  Irrespective of the DMT chosen, none of them are geared at treating symptoms, the focus with DMT is to prevent new or worsening issues from arising.

The second area of focus in treating MS is symptom control.  Residual symptoms can be common and impact quality of life, so it is important to help our patients gain control. These treatments are not immunosuppressives but rather focus on symptoms and can include various medications that can help treat fatigue, muscle spasms, bladder dysfunction.

Where to get treated for MS

MS is a chronic illness that can vary from person to person, making each case unique. The therapies used to treat MS continue to grow causing not only patients, but also neurologists, to face the challenge of staying up to date. To have effective care MS patients need to seek care at facilities that recognize the unique needs of each MS patient and stay well-versed in the growing complexity of available treatments. The best option for this a dedicated MS center.

At Neuroscience Group, we offer the comprehensive care of Multiple Sclerosis. Neuroscience Group is recognized by the MS society as one a few comprehensive care centers in the state of Wisconsin. From start to finish our patients have access to the area’s only neuroimmunology trained neurologist, are cared for by MS certified nurses and physical therapists,  and can have in-house testing including lab and MRI. Our patients also are able to receive treatment in an infusion suite designed with the needs of the MS patient in mind.

If you feel that you are suffering from symptoms of Multiple Sclerosis, contact Neuroscience Group today to get started with treatment.