Managing Multiple Sclerosis

Your vision is hazy. You suffer from muscle contractions of the neck. Your balance is off. You have tremors that just won’t quit. Your speech tends to slur. And it has been this way for months. You could be suffering from multiple sclerosis.

Multiple sclerosis (MS) is a debilitating disease that affects the central nervous system, particularly the brain and spinal cord. With multiple sclerosis, your immune system attacks the protective sheath (myelin) that covers nerve fibers, causing communication problems between your brain and the rest of your body. The disease can cause permanent damage or deterioration of the nerves.

Signs and symptoms may vary with MS depending on which nerves are affected and how much they are affected. As such, some people with MS may not be able to walk independently while others may experience long periods of remission with few new symptoms.

There is no cure for MS. But symptoms can be managed with the right treatment that works for you. Some symptoms may include weakness or numbness of limbs that typically occurs on one side of the body; electric shock sensations that occur with certain neck movements, like bending the neck forward; having a tremor, lack of coordination and unsteady gait.

You may also experience vision problems like partial or complete loss of vision in one eye, often with pain during eye movement; and blurry or double vision. You may have slurred speech, fatigue, dizziness, tingling or pain in parts of your body, and problems with sexual, bowel, and bladder function.

There are four types of MS:

·       Clinically isolated syndrome (CIS) where someone has a first episode of MS symptoms. Not everyone who has CIS develops into MS.

·       Relapsing-remitting MS (RRMS). This is the most common form of MS. People with RRMS have flare-ups, referred to as relapse or exacerbation of new or worsening symptoms. Periods of remission can follow where symptoms stabilize or go away.

·       Primary progressive MS (PPMS) where people diagnosed with PPMS have symptoms that slowly and gradually get worse without periods of relapse or remission.

·       Secondary progressive MS (SPMS) where in many cases people diagnosed with RRMS eventually progress to SPMS. With secondary progressive MS, you continue to accumulate nerve damage. Your symptoms get worse. While you may experience some relapses or flare-ups where your symptoms may increase, you no longer have periods of remission afterward where your symptoms stabilize or go away.

According to the National Multiple Sclerosis Society, more than 2.3 million people worldwide have a diagnosis of MS. It is estimated that 1 million people over the age of 18 live with a diagnosis of MS in the United States. Prevalence for the disease is higher among women than men. MS occurs across ethnic groups including Blacks, Asians, and Hispanic/Latinos, but it is most common among White people of European descent.

Scientists don’t know what causes MS, but certain factors may trigger the disease. These may include exposure to certain virus or bacteria (such as Epstein-Barr virus); where you live (some experts believe the farther you live away from the equator the more susceptible you are to the disease); how your immune system functions (researchers are trying to figure out why some immune systems attack healthy cells); and gene mutations (having a family member with MS does raise your risk and it is still unclear which genes play a role in MS).

To diagnose MS, your doctor may run blood tests (to rule out other conditions), perform a spinal tap in which a small sample of cerebrospinal fluid is removed from your spinal canal for laboratory analysis, perform an MRI which can reveal areas of MS lesions on your brain and spinal cord, and evoked potential tests which record the electrical signals produced by your nervous system in response to stimuli.

Treatments for MS typically focuses on speeding recovery from flare-ups, slowing progression of the disease and managing symptoms. Treatment for MS attacks consists of corticosteroids and plasma exchange (plasmapheresis) where the liquid portion of your blood is removed and separated from your blood cells. The blood cells are mixed with a protein solution and put back in your body. Treatments to modify progression may include ocrelizumab (Ocrevus) which is the only Food and Drug Administration approved disease modifying therapy.

Treatments for relapsing-remitting MS include injectable and oral medications. Injectable medications such as interferon beta medications and glatiramer acetate (Copaxone, Glatopa) may be used by patients with MS. Oral treatments may include medications such as fingolimod (Gilenya), diroximel fumarate (Vumerity), and cladribine (Mavenclad). Infusion treatments may include medications like ocrelizumab (Ocrevus) and natalizumab (Tysabri). Treatments for MS signs and symptoms may include physical therapy, muscle relaxants, and other medications.

It is extremely important that you indulge in self-care strategies by making sure you have plenty of rest, exercising regularly, eating the healthiest foods (e.g. vitamin D may be helpful for patients with MS), and relieving stress. Activities such as yoga, meditation, acupuncture and other relaxation techniques go a long way towards improving your overall health. Some studies suggest that oral cannabis may be beneficial for patients with MS. Talk to your doctor about the right medication choices for you.