Multiple Sclerosis

Multiple sclerosis (MS) is a condition in which the immune system attacks myelin, the sheath that wraps around nerve cells. The symptoms of MS can vary widely, depending on the nerves that are affected. Some common MS symptoms are extreme fatigue, numbness and tingling, vision problems, and weakness or balance problems.

In the most common form of multiple sclerosis, symptoms come and go (known as relapsing remitting MS). These symptoms can run the gamut from mild tingling to more severe vision loss.

MS is a disease of the central nervous system, meaning it affects the brain and spinal cord. In the most common type (known as relapsing remising MS or RRMS), symptoms come and go. These can run the gamut from mild tinging to more severe vision loss.

However, MS is tricky. Because so many other conditions can cause similar symptoms, it's tempting to think you have it when you don't. On the other hand, it can take years or even decades for people with MS to be diagnosed. In fact, only a doctor can perform the appropriate tests to confirm whether your symptoms are indeed MS.

There are four types of MS and experts stress that MS is a continuum, beginning with initial symptoms and continuing through the different phases of the disease. Here are the four types, as sketched out by the National MS Society.

Clinically isolated syndrome (CIS): This is a first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system. Demyelination occurs when myelin, which is the protective coating of nerve cells, experiences damage. When this happens, neurological problems can occur. The episode must last for at least 24 hours but it's important to note: This may or may not confirm a MS diagnosis though if CIS is paired with a brain lesion (as confirmed by a brain MRI), you have a high likelihood of an episode happening again and a further diagnosis of relapsing-remitting MS (RRMS).

Relapsing-Remitting MS (RRMS): This is the most common and is accompanied by clearly defined relapses of new or increasing neurologic symptoms. These attacks may be followed by a partial or complete remission when symptoms may disappear or may continue. During remission, there is no progression of the disease.

Primary progressive MS (PPMS): This MS diagnosis affects 15 percent of people with MS and leads to worsening neurologic function without relapses or remissions. PPMS can be quantified as active (an occasional relapse and/or new MRI activity) or not active which means there hasn't been any progression.

Secondary progressive MS (SPMS): This follows an initial relapsing-remitting diagnosis. Some people who have been diagnosed with RRMS will transition into SPMS which means that you're experiencing a progressive worsening of neurologic function over time. SPMS can be quantified as active or not active.

MS symptoms are all a result of damaged nerves sending mixed signals to different part of the body. Here are some of the most common ones:

Fatigue: Some 80 percent of people with MS will experience fatigue at one point or another, but fatigue can have many causes. Some people experience "MS lassitude," a very severe fatigue that occurs daily that tends to get worse as the day wears on.

Numbness: Numbness (or a lack of sensation in various parts of the body) is often one of the first symptoms that prompts a person with MS to the doctor. Numbness can occur in the face, the body, or the arms and legs, and can interfere with walking, holding on to objects, and even chewing, if the numbness affects the face.

Tingling: Tingling is related to numbness and it feels like your arm, fingers, or toes are falling asleep, yet never quite waking up.

Balance and coordination issues: Movement problems are a hallmark of MS. People may report feeling suddenly weak in one limb or they may find objects slipping easily out of their hands. If there's damage to the cerebellum, the part of the brain that controls balance, you might also be unsteady on your feet and prone to falling.

Spasticity: Spasticity can involve both stiffness as well as involuntary muscle contractions. As a symptom of MS, it's most common in the legs and may manifest as a mild feeling of tightness in the muscles or as more severe pain. In extreme cases, spasticity can cause a person's body to become distorted and twisted, almost as if they're folded up like a pretzel. The symptom often goes hand-in-hand with weakness of the limbs or other parts of the body.

Vision Problems: Like numbness, vision problems are one of the most common early symptoms prompting a person to visit the doctor. The problem can manifest as double vision, eye pain, blurred vision, or a scotoma (it looks like a hole in your vision).

Pain: The majority of people with MS experience pain related to their MS, which is often the direct result of nerves damaged by the disease. If this is the case, you may feel severe burning sensations in your legs, feet or hands, or might imagine a knife is stabbing the side of your face because the nerves on that side are inflamed.

Bladder issues: Bladder problems can manifest in two seemingly opposite ways. Some people have difficulty emptying their bladder while others feel like they have to go to the bathroom constantly.

Constipation: The most common bowel problem related to MS is constipation and this occurs because the nerves and muscles aren't moving things efficiently through the GI system.

While experts haven't zeroed in on one cause of MS, it's believed that it's prompted by a multitude of factors. Some of these include:

Smoking: Smokers and ex-smokers are more likely to get MS than people who never smoked, and the more cigarettes you've had, the greater your chances of a diagnosis.

Age: You can be diagnosed with MS at almost any time, but it's most likely to strike from age 20 to 50.

Low Vitamin D: Our bodies produce D in response to sunlight, so people who live closer to the earth's poles are more likely to get MS than those who live closer to the equator.

You have another autoimmune condition: Autoimmune diseases tend to cluster, so if you have one, you may develop others.

Gender: The disease is much more common in women, research shows.

Even experts are stumped by MS, the tricky autoimmune disease that affects women two to three times more often than men.

To add to the confusion, there's no diagnostic test for the disease, and one patient can experience wildly different symptoms from another.

What experts do know? MS occurs when the body starts to attack its own central nervous system, and certain factors can raise one's risk of developing the disease.

There's no question that MS is frustrating, with varying and often unpredictable symptoms that seem to throw curve balls at people with MS.But in less than two decades MS has gone from an essentially untreatable disease to one that has almost a dozen medications that slow the progression of the disease (known as immune-modulating medications), in addition to multiple other drugs that relieve symptoms.

Here are other treatments that may be recommended:

Cognitive Rehab: As the hallmark lesions associated with MS accumulate in the brain, cognitive function (such as memory), can suffer. Medications don't seem to affect this aspect of the disease, but cognitive rehabilitation strategies such as memory retraining do.

Speech Therapy: Speech pathologists can help MS patients not only with speech difficulties, such as long pauses or slurred language, but also with a potentially more serious problem: swallowing. Swallowing difficulties, caused by damage in the areas of the brain that control muscles in this area, can potentially lead to choking and even aspiration pneumonia, in which bits of inhaled food trigger lung infections. Simple changes, like altering the texture of food a person is eating, can help.

Tai Chi: The ancient Chinese practice of Tai Chi is being used by some people with MS, even those in wheelchairs, to help with balance and improve proprioception. (Proprioception is how we perceive ourselves in space.). The deep breathing, relaxation, and measured movements of yoga can also help. Some people with MS find that acupuncture is effective, although there have been no formal clinical trials on this topic.

Exercise: Once upon a time, experts recommended against exercise for people with MS, believing that it would exacerbate fatigue and speed progression of the disease. Now we know that exercise is not only not harmful, but can be beneficial to strength, cognitive functioning, and overall quality of life. In fact, a landmark 1996 study found that exercise even improved bladder and bowel control. And just being physically active with shopping and gardening (as much as the disease will allow) can be enormously beneficial as well.

Botox: Injections of this bacterial toxin are typically associated with removing frown lines and wrinkles, but they're now also proving useful in alleviating bladder and bowel problems among people with MS.

Currently there aren't any effective MS prevention measures in place because the cause of MS is still not fully understood. Researchers believe that a combination of factors, both genetic and environmental, contribute to the development of multiple sclerosis.

Genetics: Having a family member with MS raises the risk of developing it. People with a first-degree relative with MS (a sibling, parent, or child) also have a higher risk.

Common Viruses: The Epstein-Barr virus (EBV), a member of the herpes family of viruses, has been linked to MS, although it has not conclusively been identified as a cause of MS. Another virus that's associated with an increased risk of MS relapses is human herpes virus 6, but, again, it has not been shown to trigger the onset of MS.

Vitamin D: The incidence of MS is higher in North America, southern Australia, and northern Europe, suggesting that the farther you live from the equator, the greater your risk for developing multiple sclerosis. Researchers think the link between location and MS risk may be sun exposure or, more specifically, vitamin D levels in the body. Vitamin D is known as the sunshine vitamin because the human body generates it in response to sunlight.

Avoiding smoking: Growing evidence suggests that smoking not only increases the risk of developing MS, but it also increases the severity and hastens the progression of the disease. Given its many health benefits, quitting smoking  — or not starting in the first place — is an obvious step to take for anyone who wishes to lower their MS risk.

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