Multiple Sclerosis (MS) is a kind of autoimmune disease which affects brain, spinal cord and optic nerves or central nervous system. Like in other autoimmune diseases where immune system starts attacking healthy tissues of the body, in this disease too, it attacks the protective covering (myelin sheath) of the nerve fibres that disrupts or bars communication between brain and other body parts.

Multiple Sclerosis means there are scar tissues in multiple areas. When myelin sheath is damaged, it leaves a scar, lesions or sclerosis. Because of this, the brain stem, the cerebellum (controlling movement and balance), spinal cord, optic nerves, white matter in the brain is affected.

 

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The person with Multiple Sclerosis may have paralysis in legs, slurred speech, vision loss, problems with sexual, bowel or bladder function etc. The milder and more common symptoms include blurred vision, unsteady gait, numbness in limbs.  According to WHO, most people with MS have a normal or near-normal life expectancy. In rare cases, MS is so malignantly progressive it is terminal.

Multiple Sclerosis progresses differently in different people and its symptoms may also differ depending on the affected nerves. Most people will experience relapsing-remitting disease course. Patients may have new symptoms or relapses that develop over weeks and improve partially or completely. Then there are remission which can last for months or even years.

The disease is called secondary progressive MS when a person with relapsing-remitting disease starts to develop steady progression of symptoms, with or without remission, around 10-20 years of its onset. As the symptoms progress, the mobility may become affected.

In primary progressive MI, people suffering from it do not have any relapses and would experience a gradual progression of their symptoms.

Types of Multiple Sclerosis

Clinically Isolated Syndrome

This happens when one experiences single episode of neurological symptoms that last for 24 hours and more.  Around 60-80% people who experience a single episode of MS are likely to develop the disease a couple of years later in their life. However, it might be possible that you may never experience another episode in life. It may also happen that you might not have realised when you experienced your first episode, and second episode onwards, it turns into a relapsing-remitting MS.

Relapsing-remitting MS (RRMS)

In this kind of Multiple Sclerosis, there are periods of recovery in between fresh flare ups of the diseases or new attacks with new symptoms. In most of the cases, this is the kind of MS that is seen in the beginning. As the disease progresses, after a decade or so, the symptoms become steadier and worsen. Genetic factors may play a key role in the disease that may get triggered due to environmental factors.

Primary Progressive MS (PPMS)

This form of Multiple Sclerosis develops very slowly but is different from the Relapsing-remitting Ms in a way that there is no remission phase. However it may happen that there are phases when there are slight improvements or when symptoms do not worsen or deteriorate very slowly. About 15% people are affected by this type of MS.

Secondary Progressive MS (SPMS)

This form of MS is generally seen in people who are initially diagnosed with Relapsing-remitting MS around 15-20 years of symptoms onset. There are fewer or no remission periods and symptoms get worse gradually.  There is more weakness, more trouble concentrating, problem with bowel and bladder etc.

Symptoms of Multiple Sclerosis

1. Stiff muscles, spasms and weakness

One of the initial symptoms of MS would be tightness is muscles or pain. You may feel extreme weakness in the muscles which causes difficulty in movement. As the disease progresses, the weakness increases constantly.

2. Pain

MS causes damages to central nervous system which may cause stabbing pain or tingling, burning, or squeezing sensation in limbs, face or trunk. Since it may also make your muscles weak, it may put pressure on lower back or hips and cause pains in back, neck or joints.

3. Vision problems

MS also affects your optic nerves and eye problems are in fact one of the first few troubles that affect patients. One may have pain in eye or loss of vision in the eye. There may be colour blindness or flashes of lights can be seen when moving eye.

4. Cognitive problems

People affected by MS might suffer from a variety of cognitive problems from memory to planning trouble.  MS particularly affects short term memory and there may be a problem processing new information.  They may have difficulty concentrating on things and have a short attention span. Such people also may have difficulty in planning things and problem solving or reasoning.

5. Bladder and bowel problems

People may suffer from frequent urination or have constipation.  There may be a sudden urge of passing urine which could lead to unintentional passing of urine.

6. Speech problems

People with this disease may have problem in formation of words and would suffer from slurring of speech. They may also have problems in swallowing food.

7. Sexual problems

Both men and women may lose their sexual libido once affected by Multiple Sclerosis. Men may have erectile dysfunction or problems with ejaculating when having sex. Women too may find face problems with vaginal lubrication and sensation.

8. Mental health issues

This may not be as widely reported as it should be considering mental health issues like depression and anxiety is difficult to diagnose in people with MS. Besides it is not clear whether these issues arise out of constant stress of living with MS or is a direct symptom. People with MS also experience mood swings, meltdowns, or sudden bursting of tears or other emotions without any apparent reason.

9. Coordination troubles

People with MS have an unsteady gait and they may find it difficult to balance their movements also because of muscle weakness. Their limbs may be shaky or they may experience dizziness.

10. Fatigue

Fatigue can interrupt with day to day activities of those suffering from this problem. This is more pronounced towards the end of the day, in hot weather, during illness etc.

Tests for Multiple Sclerosis

1. There is no specific blood test for MS, but to rule out other diseases with similar symptoms of MS, blood tests may be recommended by the doctor.
2. A test called Spinal tap or lumbar puncture is done where cerebrospinal fluid is removed from the spinal canal for lab analysis. This is basically done to see abnormalities in antibodies related to MS.
3. An MRI is also done to discover lesions in brain and spinal cord area.
4. In evoked potential test a visual or electrical stimuli is used. A visual moving pattern, or short electrical impulses are applied to nerves in legs or arms. Electrodes measure how quickly the information travels down your nerve pathways.

Risk factors

While no specific cause has been found behind the disease, genetic factors and environmental factors definitely play a role. The disease generally occurs between 20-40 years, but can affect even younger and older people. Women are more likely to get it compared to men. Also, people of Northern American descent are at a higher risk of the disease than people of Asian, African or Native American roots. The disease is also associated with low levels of Vitamin D and people who have other autoimmune diseases such as thyroid, psoriasis, type 1 diabetes etc.

Living with Multiple Sclerosis is definitely challenging and because of the disease, multiple complications may arise like various kinds of infections, cardiovascular diseases and the lifespan of those affected are on an average 7 years shorter than normal people. The condition however is not fatal in itself and people suffering from it may die out of the complications arising out of it. People who have mild forms of MS have good prognosis for longevity.