What is Multiple Sclerosis (MS)?

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Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves.

Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms. His causes a range of symptoms like blurred vision and problems with how we move think and feel.

In MS, the body’s own immune system mistakenly attacks and damages the fatty material called myelin around the nerves. Myelin is important for protecting and insulating nerves so that the electrical messages that the brain sends to the rest of the body, travel quickly and efficiently.

As the myelin breaks down during an MS attack a process called demyelization patches of nerves become exposed and then scarred, which renders the nerves unable to communicate messages properly and at risk of subsequent degeneration. This means that the brain cannot talk to other parts of the body, resulting in a range of symptoms that can include a loss of motor function (e.g. walking and hand and arm function, loss of sensation, pain, vision changes, and changes to thinking and memory).

Symptoms of MS

Multiple sclerosis (MS) has many symptoms, which can be variable and unpredictable. No two people will experience exactly the same symptoms and these symptoms can be a one-off occurrence, can come and go or change in severity over time.

Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. Symptoms often affect movement, such as:

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or your legs and trunk
• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Hermits sign)
• Tremor, lack of coordination or unsteady gait

Vision problems are also common, including:

• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Blurry vision

Multiple sclerosis symptoms may also include:

• Slurred speech
• Fatigue
• Dizziness
• Tingling or pain in parts of your body
• Problems with sexual, bowel and bladder function 

Disease Course of MS

Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.

Small increases in body temperature can temporarily worsen signs and symptoms of MS, but these aren’t considered true disease relapses.

At least 50% of those with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, within 10 to 20 years from disease onset. This is known as secondary-progressive MS.

The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS. Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses, known as primary-progressive MS.

 

Causes

The cause of multiple sclerosis is unknown. It’s considered an autoimmune disease in which the body’s immune system attacks its own tissues. In the case of MS, this immune system malfunction destroys the fatty substance that coats and protects nerve fibers in the brain and spinal cord (myelin).

Myelin can be compared to the insulation coating on electrical wires. When the protective myelin is damaged and the nerve fiber is exposed, the messages that travel along that nerve fiber may be slowed or blocked. It isn’t clear why MS develops in some people and not others. A combination of genetics and environmental factors appears to be responsible.

Overlapping Symptoms

MS often causes temporary attacks of weakness, blindness, and sensory changes that happen over the course of a couple days. The National Multiple Sclerosis Society reports that common symptoms include fatigue, trouble walking, numbness and tingling, involuntary muscle spasms, weakness, vision problems, dizziness and vertigo, bladder and bowel problems, sexual dysfunction, pain, changes in thinking skills, and depression. Less common symptoms include headache, hearing loss, itching, seizures, tremors, and speech and swallowing problems.

Vitamin deficiency, such as B12, which is crucial for red blood cell formation and neurological function. “Too little B12 can cause the brain to look similar to multiple sclerosis. The white brain matter changes,” says Sutherland. Symptoms of B12 deficiency similar to MS include fatigue, difficulty maintaining balance, depression, and numbness, and tingling in the hands and feet.

Lyme disease is a bacterial infection transmitted by ticks. “It can cause spots on an MRI or spinal fluid abnormalities,” Giesser says. Symptoms similar to MS include fatigue, weakness, and muscle aches.

Human immunodeficiency virus, or HIV, which attacks the body’s immune system, similar symptoms to MS includes weakness, spinal cord problems, fatigue, and spots on an MRI.

Autoimmune conditions such as lupus, which attacks the organs, skin, and nervous system; which attacks the joints, nervous system, and moisture glands; and sarcoidosis, which attacks the lungs, skin, lymph nodes, liver, and nervous system. All of these disorders can present with debilitating fatigue and specific neurological symptoms, such as weakness, visual problems, or sensory changes (such as numbness, tingling, prickling, or burning sensations).

 “These conditions can cause nerve damage in the same areas as MS, and give similar symptoms and findings, but the way the nerve damage is produced is different than in MS,” Giesser says.

CADASIL (aka Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), is an inherited disease caused by a gene mutation that affects small blood vessels in the brain. “I’ve seen these cause neurological symptoms similar to MS, such as migraine headaches, seizures, vision problems, and depression,” Sutherland says.

Brain tumors can cause many symptoms similar to MS, including headaches; vision, hearing, or speech problems; difficulty with balance; and seizures.

Risk factors

These factors may increase your risk of developing multiple sclerosis:

• MS can occur at any age, but onset usually occur around 20 and 40 years of age. However, younger and older people can be affected.
• Women are more than two to three times as likely as men to have relapsing-remitting MS.
• Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
• Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
• White people, particularly those of Northern European descent, are at the highest risk of developing MS. People of Asian, African, or Native American descent have the lowest risk.
• MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia, and Europe.
• Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of MS.
• Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have other autoimmune disorders such as thyroid disease, pernicious anemia, psoriasis, type 1diabetes or inflammatory bowel disease.
• Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.

Complications

People with multiple sclerosis may also develop:

• Muscle stiffness or spasms
• Paralysis, typically in the legs
• Problems with bladder, bowel or sexual function
• Mental changes, such as forgetfulness or mood swings
• Depression
• Epilepsy

Treatment of MS

There are many different ways to treat multiple sclerosis (MS), and you might find some treatments work better than others. Developing a plan with your healthcare team is the best strategy to manage your MS, including any medications.

Medications for MS fall broadly into three groups: those that reduce the risk of relapses and disease progression (also known as disease modifying therapies or DMTs), those that treat an active relapse or those that can help to ease specific symptoms. The types of medications used will depend on a number of factors, including the type of MS and your individual circumstances.

Some available treatments include:

• DMTs, also called immunotherapies, which work by modifying the activity of the immune system to slow the frequency and severity of attacks to the central nervous system. These medications are most often prescribed for people with relapsing-remitting MS, where evidence has demonstrated the greatest impact.
• Corticosteroid medication, which is used to reduce symptoms from an acute relapse, by easing inflammation at the affected site.
• Medications to help with specific symptoms of MS, such as treating incontinence, spasticity, pain or depression

It can be frustrating if treatments aren’t right for you or don’t work as well as you’d like. If this happens, talk to your neurologist, MS Nurse or GP to discuss other options.

It’s also important to let your healthcare team know if you’re using alternative or complementary treatments alongside your drug treatments, to ensure that there are no interactions or possible side effects from their inclusion.

Australian MS Organizations

MS Australia is the national peak body for people affected by MS and is dedicated to advocacy, communications, education, and funding and coordinating multiple sclerosis (MS) research as part of the worldwide effort to solve MS.

The state and territory based MS organizations provide care and support services to people living with MS and other neurological and immunological conditions, including referral advice and information, individual assessments and support, employment support, living arrangements, connection with others and much more.

How to assess for multiple sclerosis?

• Blood tests, to help rule out other diseases with symptoms similar to MS
• Spinal tap (lumbar puncture), in which a small sample of cerebrospinal fluid is removed from your spinal canal for laboratory analysis
• MRI, which can reveal areas of MS (lesions) on your brain and spinal cord.