About Multiple Sclerosis
Multiple sclerosis is a disease that commonly affects young adults, but it can also occur in children and adolescents. MS causes different symptoms related to central nervous system dysfunction. It happens when the body’s immune system attacks and damages nerve cells and their connections in the brain and spinal cord. This process is called an “autoimmune response.” The primary pathology is the destruction of the layer of protein called myelin which forms the protective sheath around nerves. Myelin destruction results in a delay in transmitting signals through the nervous system.
Symptoms of Multiple Sclerosis
Multiple Sclerosis can cause different symptoms but not necessary for every patient to have all these symptoms.
- Numbness, tingling, and feeling like “pins and needles.”
- Muscle weakness or spasms
- Vision problems, eye pain, and odd eye movements
- Dizziness or imbalance
- Trouble walking or speaking
- Problems controlling bowels or bladder
- Sensitivity to heat, which makes symptoms worse
- Foggy mind
Forms of Multiple Sclerosis
- Relapsing-Remitting – This means the symptoms of MS come and go. When the symptoms flare up, it is called an “attack” or “relapse.” These attacks can last for days to weeks and usually get better slowly. In between attacks, people often feel pretty normal. But some people have problems that last even after an attack gets better. Relapsing-remitting is the most common type of MS.
- Secondary Progressive – Some people who start relapsing-remitting MS get to a point where the symptoms steadily worsen even when they do not have attacks. This is called “secondary progressive” MS.
- Primary Progressive – This means the symptoms steadily get worse from the beginning.
Diagnosis of Multiple Sclerosis
The most common required test is Magnetic resonance imaging (MRI) of the brain and spinal cord. MRI is an imaging test that creates pictures of the inside of your body. This test can show whether your brain or spinal cord show signs of MS. Even so, this test might not be able to show right away if you have MS. In many cases, doctors can diagnose MS only after seeing how symptoms and test results change over time.
Other additional tests may be needed to diagnose MS. These might include:
- A lumbar puncture (sometimes called a “spinal tap”) – During this procedure, a doctor puts a thin needle into your lower back and removes a small amount of spinal fluid. Then they check the fluid for signs of MS.
- A test called “evoked potentials” or “evoked responses” – Is a way for the doctor to look at the electrical signals in your brain and spinal cord. It involves sticking small “electrodes” to your skin. The doctor can then measure the nerve signals in your brain while you look at lights, listen to sounds, or feel a mild electrical current.
- In other cases, blood tests are needed to check for diseases that can be similar to MS.
Treatment of Multiple Sclerosis
Currently, there is no curative treatment. However, medications are available to slow disease progression, prevent flare-ups, and control symptoms. There are different medicines to treat MS depending on the type of MS.
- Treating attacks – High doses treat acute attacks of corticosteroids commonly used as an intravenous infusion to reduce inflammation quickly.
- Preventing attacks – People who suffer a relapsing-remitting form of MS are advised to use medications that reduce the possibility of relapsing.
These are called disease-modifying therapies (DMTs). Many drugs are available in different forms: oral, subcutaneous shots, intramuscular shots, and intravenous infusions. In certain cases, disease-modifying therapy might also help some people with secondary progressive or primary progressive MS. Choosing the best suitable medicine usually occurs after a discussion between the doctor and the patient regarding the more convenient and effective option in his case.
Apart from DMTs, other medications may be needed to treat symptoms of MS. Physical therapy and rehabilitation also play a crucial role in the management of MS.
Multiple Sclerosis and Pregnancy
Special considerations are taken while treating women with MS who are of childbearing age. Women planning for pregnancy should tell their doctor to choose the suitable medicine as many drugs used in treating MS can affect the pregnancy or can not be used during breastfeeding.
How to Reduce Flare-Ups (Relapses)
In addition to disease-modifying therapies, which effectively reduce relapses, a healthy lifestyle is very important. Eating a healthy balanced diet, quitting smoking, drinking plenty of water, and getting daily exercise to stay fit and active.
Multiple Sclerosis Outcome
Patients with MS are advised to stay positive. Although not curative, available disease-modifying therapies can alter the negative impact of the disease. Most people with MS continue to have productive, active lives. Research is going on, and almost every year, a new MS drug is approved, giving hope to MS patients and their families.
Dr. Mohamed Salah Ahmed Gamea
Burjeel Hospital, Abu Dhabi