A life-threatening disease that potentially disables the spinal cord and brain (central nervous system) is known as multiple sclerosis.
What happens in Multiple Sclerosis? (1)
A protective sheath known as Myelin covers the nerve fibers in our body, which causes poor communication between body parts and the brain. This leads to the complete deterioration or damage of nerves.
Signs and symptoms
Signs and symptoms of multiple sclerosis depend upon the severity of the disease. People with severe multiple sclerosis are unable to walk on their own and need some support. These symptoms also show variations in various persons. Signs mostly depend upon the amount of deterioration and location of nerve damage. More often, the movements of a person get affected by multiple sclerosis. Such as
- Weakness and numbness in more than one limbs of one side of the body, trunk, or legs.
- Sensations of electric shock in which the patient suddenly bends the neck in forwarding condition, also known as (Lhermitte signs)
- Tremor, unsteady gait, or lack of coordination.
Some less common symptoms include vision problems such as:
- Complete or partial vision loss
- Pain in eyes while moving them
- Double vision for long duration
- Blur vision
Some other symptoms include:
- Slurred speech
- Pain and tingling in parts of the body
- Problems with bowel, bladder, and sexual function
Course of disease
People mostly experience a relapsing-remitting course of the disease. Relapse is a period in which the person suffers from new symptoms, which develop for weeks and gradually cure completely or partially. In remission, the disease becomes dormant and the person experiences no new symptoms. This period comes after relapses and lasts up to several years.
The causes of multiple sclerosis are yet not well-defined. Any cause that destroys the immune system is thought to be the cause of multiple sclerosis as well. Its onset is not person-specific. However, certain environmental factors and genetics are considered as a cause of multiple sclerosis.
Certain factors in a person can increase the risk of developing multiple sclerosis.
It is not age-specific. But most cases are reported in the people between ages of 20 and 40 years. However, older and younger people can also get MS.
Women are multiple times vulnerable to MS than men.
- Family history
An individual is more prone to MS if any of his siblings or parents has MS.
Several infections are associated with MS, such as Mononucleosis caused by Epstein-Barr.
No specific test is designed to diagnose MS. Differential diagnosis is made by ruling out other conditions that might be the reason for similar symptoms.
- Blood test
A blood test determines other diseases that are thought to be the cause of similar symptoms.
- Lumbar puncture (spinal tap)
In this test, a sample of cerebrospinal fluid is taken from the spinal canal. This sample is sent to a laboratory to analyze any dysfunctioning in the MS-associated antibodies.
It reveals the locations of MS lesions on the spinal cord and brain. In an IV solution of contrast, the material is injected into the patient. This solution highlights lesions of MS.
- Evoked potential tests
A stimulus is given to the patient and his response to that stimulus is recorded in form of electrical signals. Stimulus can be visual (moving visual patterns) and electrical (small electrical shocks)
Diagnosis is more obvious in people with the relapsing-remitting phase than people with progressive disease and uncommon symptoms. The former one can be easily diagnosed with only MRI but the latter needs to undergo evoked potential, spinal tap, and additional imaging.
MS cannot be cured permanently. Its treatment is based on reducing the frequency of attacks, managing symptoms, and slowing the disease progression.
Treatment for MS Attacks
Corticosteroids, such as intravenous methylprednisolone and oral prednisone are meant to reduce inflammation of nerves. It may impart side effects such as fluid retention, mood swings, elevated sugar level in the blood, elevated blood pressure, and insomnia.
This method is also called plasma exchange. In this method, the plasma is separated from the blood. The plasma-excluded blood is then mixed with the albumin and administered back into the patient’s body. This method is useful when the condition is severe, symptoms are new, and the patient does not respond to corticosteroids.
Treatments to modify MS progression
FDA-approved disease-modifying therapy for progressive MS is Ocrelizumab. Moreover, some other oral and injectable medications are also available to treat MS attacks.
- Injectable treatment
- Interferon Beta medications
These are the most commonly prescribed medicines. These are administered subcutaneously and reduce the severity and frequency of a relapse. Reaction at the site of injection, liver damage, and flu are common side effects.
- Glatiramer acetate
It is also given subcutaneously. It reduces attacks by acting upon the immune system and blocking its attack on the myelin sheath. Skin allergy at the site of injection is a common side effect.
- Oral treatments
It reduces the frequency of attacks and is given orally once a day. It usually slows down the heart rate so a patient must check his heart rate after the first dosage.
- Dimethyl fumarate
It is given twice a day. Its side effects can be diarrhea, flushing, less WBC count, and nausea.
- Diroximel fumarate
Like dimethyl fumarate, it is also given twice a day but it can cause fever after its first dose.
It can alleviate the relapse rate by taking it orally once a day. It can cause hair loss and liver damage. It may also cause some birth defects in the fetus.
Required results can be achieved by taking it once a day. It is an approved medicine for primary progressive MS. Some of its side effects are low WBC count, liver problems, viral infections, heart rate fluctuations, vision problems, and headaches.
Treatment for MS signs
- Physical therapy
The physical therapist recommends several exercises that improve the mobility of the patient.
- Muscle relaxants
MS patient experiences muscle stiffness. In that case, muscle relaxants (tizanidine, baclofen) may reduce symptoms.
- Fatigue reduction
MS-associated fatigue can be reduced by amantadine and modafinil. Some antidepressants can also serve the purpose.