Mastering Multiple Sclerosis

You’re in pain and you feel numbness in your feet. You feel tired all the time. You also have blurry vision. You could have multiple sclerosis.

Multiple sclerosis (MS) is a disease in which the immune system attacks the body’s nervous system, mistaking it for an invader. The attack is centered on the myelin sheath that acts as insulation around the nerves. When the myelin is damaged, nerve impulses are short-circuited.

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. About 5 to 10 percent of patients have mild disease after having MS for 15 years.  It is more common in women than men. The condition strikes most often in young adulthood.

Symptoms of MS include motor weakness, numbness or tingling, lack of coordination, impaired vision, incontinence and other nervous system problems. Some people experience periods of temporary recovery; for others, the disease progresses steadily.

MS is often painful. Sometimes exacerbations or attacks will happen only once or twice in a lifetime, followed by long periods of remission. Or they can be frequent, with short periods of remission between attacks. MS rarely causes death. There is no cause or cure of it.

According to the Cleveland Clinic, there are four types of MS:

·       Clinically isolated syndrome (CIS): When someone has a first episode of MS symptoms, health care providers will classify it as CIS. Not everyone who has CIS goes on to develop MS.

·       Relapsing-remitting MS (RRMS): This is the most common form of MS. People with RRMS have flare-ups—also called relapse or exacerbation—of new or worsening symptoms. Periods of remission follow (when symptoms stabilize or go away).

·       Primary progressive MS (PPMS): People diagnosed with PPMS that slowly and gradually worsen without any periods of relapse or remission.

·       Secondary progressive MS (SPMS): In many cases, people originally diagnosed with RRMS eventually progress to SPMS. With secondary progressive MS you continue to accumulate nerve damage. Your symptoms continue to progressively worsen. While you may still experience some relapses and flares (when symptoms increase), you no longer have periods of remission.

Experts are still unsure what exactly causes MS. Some factors that may raise the risk of developing MS include:

·       Exposure to certain viruses or bacteria: Some research suggests that being exposed to certain infections (such as the Epstein-Barr virus) may trigger MS later in life.

·       Where you live: Your location may play a role in your risk of developing MS. Certain parts of the world have higher rates of the disease than others. Areas that are farther from the equator tend to have higher rates of MS. That maybe because these areas receive less intense sun. People in these regions have lower levels of vitamin D, a potential risk factor for developing MS.

·       How your immune system works: MS is an autoimmune disease. Experts are working to figure out what causes some people’s immune cells to mistakenly attack healthy cells.

·       Gene mutations: Having a family member with the disease raises your risk of developing MS. It is unclear how and which genes play a role in triggering MS.

If MS progresses, worsening symptoms may lead to complications such as: Difficulty walking that may result in using a cane, walker or wheelchair; Loss of bladder and bowel control, memory problems and sexual difficulties.

Getting an accurate diagnosis can be difficult. Some people see multiple providers for years before receiving a diagnosis. Identifying and treating MS as soon as possible may slow the disease’s progression.

If a primary care provider suspects you have MS, then you may be referred to a neurologist. A neurologist is a doctor who specializes in treating conditions that affect the nervous system, which includes your brain and spinal cord.

There isn’t a definitive test that provides a MS diagnosis. Your provider will perform a physical examination along with blood and imaging tests like MRI, which may show any possible lesions (areas of damage) in the brain. Lesions can show up as a result of damage to the myelin sheath surrounding the nerves. A spinal tap (lumbar puncture) may also need to be done.

If these tests are inconclusive, then your provider may recommend an evoked potentials test. This test checks your nerve function by measuring electrical activity in the brain and spinal cord.

While there is no cure for MS, treatment focuses on managing symptoms, reducing relapses (periods where symptoms worsen) and slowing the disease’s progression. Your treatment plan may include:

·       Disease-modifying therapies (DMTs): These drugs help reduce relapses (also called flare-ups or attacks). They slow the disease progression. And they can prevent new lesions from forming on the brain and spinal cord.

·       Relapse management medications: If you have a severe attack, then your neurologist may recommend corticosteroids. The medication can quickly reduce inflammation. They slow damage to the myelin sheath surrounding your nerve cells.

·       Physical rehabilitation: MS can affect your physical function. Staying physically fit and strong will help you maintain mobility.

·       Mental health counseling: Getting emotional support is critical to successfully managing this condition.

There are certain lifestyle choices you can make to slow flare-ups. You can eat a healthy diet, get regular exercise, manage stress effectively and not smoke and limit your alcohol intake. These choices may slow disease progression and optimize your health overall.

For some people, MS does lead to disability and some loss of physical and mental ability. But thanks to advancements in treatments, those with this disease may go on to lead productive and full lives.