The medical term sclerosis refers to abnormal hardening of body tissue. In multiple sclerosis, there is a development of hard areas called "plaques" along a neuron's axon (part of a nerve cell), hence the name.
Multiple sclerosis (MS) is a potentially disabling autoimmune disease that affects the brain and spinal cord (central nervous system). MS eventually disrupts the transmission of information within the brain and between the brain and body. It can cause problems with muscle control, balance and vision.
Multiple sclerosis is a lifelong disorder that can be managed, but not cured. The prognosis varies and is difficult to predict. MS does not always result in severe paralysis. Two-thirds of people with MS can walk. Most people get around with assistance, such as a cane, walker, wheelchair or scooter. About 25 percent of people with the condition eventually need a wheelchair. The average life expectancy of a person with MS is 5 to 10 years lower than an average person, but the gap is getting shorter day by day.
What causes multiple sclerosis?
The exact cause of multiple sclerosis (MS) is still unknown. Scientists believe that MS is triggered by a combination of environmental and genetic factors. In MS, the body’s immune system attacks the protective myelin sheath that covers the nerve fibers. When the protective myelin is damaged, the nerve fiber gets exposed causing the nerve signals to slow down or get blocked. As the disease progresses, nerve functions deteriorate. The damage can occur in any part of the brain, optic nerve or spinal cord.
The following factors may increase the risk of developing multiple sclerosis:
- Age: MS can occur at any age but is mostly diagnosed in people aged 20 to 40 years old.
- Sex: MS affects women two to three times more than men.
- Family history: If one of the parents or siblings has had MS, the risk increases.
- Certain infections: Exposure to viruses, including human herpesvirus type 6 (HHV6), mycoplasma pneumonia and Epstein-Barr virus (EBV), may increase risk.
- Vitamin D deficiency: This affects the functioning of the immune system.
- Vitamin B12 deficiency: The body uses vitamin B to produce myelin.
- Certain autoimmune diseases: The risk of developing MS increases if a person has other autoimmune disorders, such as thyroid disease, rheumatoid arthritis, pernicious anemia, psoriasis, type 1 diabetes or inflammatory bowel disease.
What are the signs and symptoms of multiple sclerosis?
Symptoms may vary with people because of the location of affected nerve fibers and the severity of the disease. Nerves in any part of the brain or spinal cord may be damaged causing multiple sclerosis symptoms to appear in many parts of the body.
- Loss of balance
- Muscle spasms
- Numbness or abnormal sensation in any limb
- Problem walking
- Problems with coordination and making small movements
- Tremors in one or more arms or legs
- Weakness in one or more limbs
- Electric-shock sensations that occur with certain neck movements (Lhermitte’s sign)
Eye and vision symptoms
- Prolonged double or blurred vision
- Eye discomfort
- Uncontrollable eye movements
- Partial or complete loss of vision, usually one eye at a time
- Constipation and stool leakage
- Difficulty urinating
- Frequent need to urinate
- Urine incontinence (leakage)
Speech and swallowing symptoms
- Slurred speech
- Trouble chewing and swallowing
Other brain and nerve symptoms
- Crawling or burning sensation in the arms and legs
- Decreased attention span and memory loss
- Dizziness and vertigo
- Facial pain
- Hearing loss
- Heat sensitivity
- Problems with reasoning and processing information
- Sexual dysfunction (both males and females)
- Sudden paralysis
- Tingling or pain in parts of the body
Different types of multiple sclerosis
There are four types of multiple sclerosis (MS).
- Clinically isolated syndrome (CIS): This is a single, first episode with symptoms lasting for at least 24 hours.
- Relapse-remitting MS (RRMS): This is the most common form affecting about 85 percent of people with MS. RRMS involves episodes of symptoms, followed by periods of remission when symptoms go away partially or totally.
- Primary progressive MS (PPMS): Symptoms worsen progressively, without relapses or remissions. About 15 percent of people with MS have PPMS.
- Secondary progressive MS (SPMS): Initially, people experience episodes of relapse and remission, and then the disease progresses steadily.
What are the complications of multiple sclerosis?
Multiple sclerosis (MS) may lead to the following:
How is multiple sclerosis treated?
There is no known cure for multiple sclerosis (MS). Treatment focuses on slowing down the progression of the disease, reducing the severity and controlling symptoms.
Treatment options for MS include
- Reducing the severity of attacks: Severity can be reduced by using corticosteroids or plasmapheresis (plasma exchange).
- Medication to slow progress: Medications include infusion, injectable and oral medicines. Medicines are more effective in treating relapsing-remitting forms than other types of MS.
- Medications to manage symptoms: Medication to alleviate muscle spasms, urinary problems, fatigue or mood problems.
- Supplements: Vitamins D and B12 or other supplements.
- Complementary and alternative approaches: Acupuncture or cannabis to help manage muscle problems.
- Rehabilitation and physical therapy: These improve a person’s ability to perform and include physical therapy, speech and swallowing therapy, occupational therapy, cognitive rehabilitation and vocational rehabilitation.
- Spinal devices: These reduce pain and spasticity in the legs.
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UpToDate: "Evaluation and Diagnosis of Multiple Sclerosis in Adults." https://www.uptodate.com/contents/evaluation-and-diagnosis-of-multiple-sclerosis-in-adults