What is Multiple Sclerosis
Multiple sclerosis (MS) is considered an autoimmune disease that results in an abnormal immune system response in an individual’s body. This abnormal response damages Central Nervous System (CNS) tissues in a person’s brain, brain cortex, optic nerves or spinal cord.
Immune cells which normally attack foreign substances called antigens such as a flu virus cross from the blood stream into a persons Central Nervous System and begin to attack neuron cells. Known as an exacerbation or more commonly an “MS Attack” immune cells attack a substance called myelin causing the tissue to swell and break apart. Myelin is a fatty substance that insulates tissue known as an axon.
If you consider a paradigm the myelin sheath is like an insulator covering an electrical wire. The Axon is similar to the actual copper wire. Myelin protects the axon and also assists in conducting electrical impulses between connecting nerve cells. The effect is that the electrical signals passing through nerves are weakened. If the axon itself is severed no electrical signals can pass at all.
Due to the loss of electrical signal strength, other nerves may not receive proper signal strength, interpret signals incorrectly or not at all. The loss and misinterpretation of signals result in the wide variety of symptoms associated with multiple sclerosis.
This process of destruction of myelin is known as demyelination. Continued attack by the immune system cells can result in permanent damage to the axon or a complete severing of the axon.
As neuron cells are damaged areas of scar tissue are left behind. These damaged areas where scars exist are referred to as plaques or lesions.
The definition of multiple sclerosis is multiple scars.
Multiple sclerosis is a chronic, sometimes disabling disease of the central nervous system (CNS), the brain and spinal cord. Over 400,000 people estimated in the United States alone are affected by the disease and some 2.5 million people estimated globally.
Every person with multiple sclerosis has a unique pathology due to what areas of the Central Nervous System are damaged. Not too long ago MS was often misdiagnosed due to the wide range of symptoms that can occur as a result of the progression of the disease. Today it is estimated that as many as 10% of people who have MS still remain misdiagnosed.
Multiple sclerosis is considered a chronic disease as currently no cure for the disorder exists.
Because the exact antigen or reason for these immune-mediated attacks remains unknown, many experts prefer to label multiple sclerosis as and Immune Mediated Disease .vs an Autoimmune Disease.
Why do People Acquire Multiple Sclerosis?
While much has been learned about multiple sclerosis over the past 30 years in large part due to advances in technology the exact causes of the disease remain a mystery. Links, however, have been shown in clinical research to low vitamin D, melatonin levels and even some clues as to genetics. Research continues and there is a sized effort globally in many nations to find the causes and cures to multiple sclerosis.
Most of the scientific community considers multiple sclerosis to be attributed to immune system malfunction hence the term autoimmune disease. There is, however, a smaller segment of the scientific community who believes that MS is caused by a viral agent, namely Epstein-Barr virus. This is the same virus known as “herpes 4” that causes infectious mononucleosis. The theory is that the virus invades neuron cells and spreads. The immune system thus attacks the neurons attempting to destroy the viral agent. If this is the case then multiple sclerosis would not be an autoimmune malfunction but instead the result of a foreign pathogen, Epstein-Barr virus.
When and Where Does Multiple Sclerosis Occur?
Multiple Sclerosis tends to appear between the ages of 20 to 40 years of age. However, this does not mean that it only happens within that age range. People are diagnosed with Multiple Sclerosis in all age segments. I was diagnosed in my 40’s and pediatric multiple sclerosis also exists in children at times quite early in life.
Women are more predisposed to being diagnosed with MS than men in the most common type of multiple Sclerosis at a rate of near 3 to 1.
Stranger, Multiple Sclerosis is much more prominent in the upper and lower latitudes of the planet. It is commonly considered that this may be due to a farther distance from the Sun. Sunlight is a bountiful source of vitamin D creation within our bodies.
Additionally, exact amounts of the distribution of the disease globally remain largely unknown due to poor reporting from some regions around the world. Efforts are underway to try and get a complete global model of multiple sclerosis global distributions.
Some historical researchers believe they have found evidence through historical texts of people long since passed charting MS all the way back to the 1300’s.
If you believe that you may be experiencing symptoms of multiple sclerosis it is important for you to see a neurologist as soon as possible. Do not wait. Early diagnosis of multiple sclerosis is very important to managing the disease progression.
The Types Of Multiple Sclerosis:
Health care professionals have identified several types of multiple sclerosis. In reality, these variances are not differing forms of the disease but severity and progression thereof. Categorization is important as it is used as a marker of how severe the disease currently with a person and time involved in progression as well as what therapies might be used to assist in combating the disease.
Types of Multiple Sclerosis:
- Relapsing-Remitting MS (RRMS)
- Secondary-Progressive MS (SPMS)
- Primary-Progressive MS (PPMS)
- Progressive-Relapsing MS (PRMS)
- Benign MS
- Malignant or Fulminant MS
The most common form of Multiple Sclerosis is relapsing-remitting (RRMS).
Relapsing-Remitting MS (RRMS)
Relapsing-Remitting MS (RRMS) is the most common form of the disease. It is estimated that 80% – 85% of people with Multiple Sclerosis have this form of the disease. The disease often appears when a person is between the ages of 20 – 30 years of age but also may appear later in life. For example, I was diagnosed at 44 years of age.
Relapsing-remitting multiple sclerosis is signified by disease activity resulting in damage to the Central Nervous System (CNS) followed by periods of time with seemingly no activity.
I recently attended a seminar where a neurologist stated that relapsing-remitting is an improper term for RRMS. Remission as a term is often heard in cancer where the disease seems to have stopped. Multiple sclerosis does not move into remission hence the term he stated should be relapsing-reoccurring might be more appropriate.
Attacks or exacerbation’s with RRMS can be quite severe or appear to be quite limited. Symptoms of an attack can be quite variable from weakness to cognition or memory problems, vision loss or impacts, walking problems and more. Some of the more common symptoms are listed below this section.
Relapsing-remitting MS often has a recovery period after an exacerbation. The body begins to repair the impacted areas where myelin damage has occurred. There are many studies that have taken place and are currently taking place in respect to re-myelination. Some research suggests that too much damage cannot be repaired, others suggest that the time required for the body to naturally repair damaged areas takes longer than the frequency of attacks. Stem cell therapy as well as other research to try speed the bodies natural processes of healing and regeneration are well underway.
Complete recovery from an attack may not and often does not occur and time between relapses may vary significantly from person to person.
RRMS seems to affect women more so than men with the statistical known ratio being nearly 3 to 1.
Statistically is has also been said that 50% of people who have relapsing-remitting MS will move on to the next stage of the disease called secondary progressive multiple sclerosis (SPMS). Time to progression to secondary progressive MS also varies, statistically, it ranges from 10-15 years from onset of the disease.
Many disease modifying treatments or therapies (DMT’s) now exist for those enduring life with RRMS.
These therapies target slowing or attempting to stop the progression of the disease. The medications vary in how they attempt to slow progression and effectiveness of the medications vary from individual to individual.
Secondary Progressive MS (SPMS)
With some individuals, treatments intended for relapsing-remitting MS may help however in many people seem to have no effect at all. Most individuals will have problems using their bodies and acuity in ways they were accustomed to once entering into this phase of the disease. SPMS is often accompanied by attacks to a person’s spinal cord resulting in physical disabilities.
Significant research is taking place in respect to secondary progressive MS and some promising medications are currently being explored.
Primary Progressive MS (PPMS)
Primary Progressive MS (PPMS) has no well-defined symptoms of attacks. From the onset of the disease, it gradually continues to get worse over time and there is little to no recovery.
About 10% of those diagnosed with MS have this form of the disease. Further, the treatments that presently exist do not tend to be very effective with this form of the disease.
There are some facets of PPMS that make it different from the other types of the disease. People with PPMS are usually older when they are diagnosed with an average age of 40-50 years of age.
Statistically, the numbers between men and women are equal whereas with other types of the disease women outnumber men.
Lastly, PPMS usually results in severe disability earlier than the common form of MS being Relapsing Remitting MS (RRMS).
For some time it was thought that there was little that could be done in trying to manage primary progressive multiple sclerosis. There are some promising new therapies on the near horizon that have shown a positive result in helping manage PPMS. While the efficacy of these new therapies is not as profound as the medications in relapsing-remitting MS for the first time there is real hope that real progress can be made with this type of MS.
Progressive Relapsing Multiple Sclerosis (PRMS)
Progressive Relapsing MS (PRMS) is the least of the common forms of the disease. Relapses or attacks happen at indeterminate rates and times however symptoms continue and get worse between these relapses. As with PPMS, there is a fairly steady progression from the onset of the disease often with acute symptoms yet short times of sparse activity between flare-ups. This type of the disease is rather rare so medical science knows fairly little about it. Perhaps 3% – 5% of those afflicted with MS have this form of the disease. In ways it appears similar to PPMS yet has some facets that differ.
Benign Multiple Sclerosis
This form of MS is less common that the four types discussed above. There are few attacks and little to no disability even after 20 years.
People with benign MS can live seemingly decades without serious symptoms, but many develop more severe symptoms over long periods of time.
Back in 2009 a study was conducted in respect to benign MS. 63 people diagnosed with benign MS showed that some 30% of them worsened over a five year period. Strangely, the study also showed that males with benign MS were almost three times more likely to have worsening symptoms and progression than women.
As is the case with any form of multiple sclerosis the disease is subject to change and statistics make understanding Multiple Sclerosis demographics very variable.
Malignant or Fulminant Multiple Sclerosis
Symptoms of Fulminant MS are similar to those of Relapsing-Remitting Multiple Sclerosis (RRMS). The main difference between the two conditions is speed. Fulminant MS develops rapidly, while RRMS can develop over the course of many years.
Individuals may experience these symptoms quite suddenly and without much warning. After the first onset of symptoms, patients generally experience more relapse episodes and rapid deterioration of their neurological and physical abilities over a short period of time.
Symptoms of Multiple Sclerosis:
Symptoms an individual may experience with Multiple Sclerosis vary significantly. It is said, “Everyone’s MS is different” due to which areas of the Central Nervous System are impacted and the extent of damage incurred. Diagnosis of MS is considerably more refined now than it was in years past but it can still be elusive due to the extremely broad range of visible symptoms as well as those not quite so apparent.
Symptoms may be visible such as muscle spasticity (spasms), walking, tremors, nystagmus (eye control) or what are called silent. Silent MS impacts areas of the brain and/or spinal cord but does not exhibit visible manifestations of the damage resulting from an attack. A person who is known to have MS, for example, will almost certainly have silent MS symptoms and may not even realize an exacerbation even happened. Issues such as vision, cognition, memory recall are examples of silent MS symptoms.
Common symptoms of MS include:
- Fatigue and weakness
- Walking difficulties
- Tingling and numbness
- Spastic Problems
- Bladder Problem
- Bowel Problems
- Vision Problems
- Emotional changes
- Sexual problems
- Cognitive and memory issues
Less common symptoms Include:
- Speech impediments
- Breathing problems
- Hearing problems
Initial symptoms of MS vary. Blurred or double vision, red-green color distortion, or even blindness in one eye are initial indicators. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. Severe feelings of being fatigued and tired. Most people with MS also exhibit called Paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or “pins and needles” sensations. Many individuals experience pain, depression.
Approximately half of all people diagnosed with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked.
In the worst cases, MS can produce partial or complete paralysis.
Diagnosis of Multiple Sclerosis:
While there is an accepted criteria for diagnoses of multiple sclerosis there is no single test at this point in time that is proof-positive.
Not long ago an incorrect diagnosis of MS occurred quite frequently. People diagnosed with MS did not have the disease and others who did were diagnosed as not having the disease.
Diagnosing MS can be very difficult, a neurologist who specializes in treating MS should evaluate all symptoms. As many as 10% of people today are still misdiagnosed.
Today Neurologists have the skills and tools necessary to correctly detect MS in nearly all cases of the disease but some remain elusive. The Neurologist performs a neurological examination to assist in evaluating movement and coordination functions, vision impairments, balance, speech functions and other symptom criteria such as a mental and emotional state. While MS cannot strictly be diagnosed through these tests they can be pointers to the disease’s manifestation.
Blood tests are often taken. A blood test cannot diagnose MS but instead can be utilized to help rule out other medical conditions that have symptoms that mimic those of MS such as AIDS, Lyme disease in addition to several others.
The family medical history is also discussed. MS is not considered hereditary however some research has shown genetic links may well exist. The family medical history discussion can help rule out other conditions that again seem mimic multiple sclerosis symptoms.
Evoked Potentials Tests often take place next. These are electrical conductivity tests that assist in determining a person’s nerve pathways are properly functioning. Signals are sent through the nervous system, visual, auditory (sound) and lastly hands and or feet. The time is measured for responses to be read which can then be used to gauge whether there is damage to the Central Nervous System.
A Spinal Tap also is known as Lumbar Puncture may be performed. Cerebrospinal fluid is collected and tested for proteins that are signatures of a multiple sclerosis exacerbations. As the Myelin Sheath is damaged the remnants of the damage may appear in the cerebrospinal fluid which surrounds the brain and spinal cord.
An imaging technique called a Magnetic Resonance Imaging Scan (MRI), will then be performed. The MRI allows for plaques often called lesions to be detected by performing a series of scans that allow for viewing cross sections of the brain and spinal cord.
It is also important to understand that not all Plaques or symptoms may be related to MS. As we age generally into the 40’s and 50’s lesions may well begin to appear that have no connection at all to Multiple Sclerosis but are simply a part of the aging process. As we grow older we may well simply due to the aging process have memory issues, cognition problems, visual sight impacts, walking or muscular degradation and more.
Criteria for a Diagnosis of Multiple Sclerosis:
- Common and uncommon symptoms that point to possible nerve malfunction in the brain and/or spinal cord.
- An MRI scan showing at least two plaques (lesions) in the brain.
- Objective evidence of the disease in the brain or spinal cord upon medical exam
- One episode of MS symptoms and resulting changes on an MRI image
- Evidence from lumbar puncture
- Lack of evidence of other diseases that may mimic MS symptoms
Depending on the region one lives in on the planet diagnostic criteria may vary.
Treatments & Therapies:
Currently, there is no cure for Multiple Sclerosis and as such it is considered a chronic disease.
The current methodology in treatment is preventative towards reducing exacerbations and saving neurons from being damaged.
There exists a variety of treatments for multiple sclerosis however virtually all of them at this point in time is targeted at individuals with the relapsing-remitting form of the disease. These “Disease Modifying Treatments” come in oral pill form, intravenous infusion, and hypodermic injection forms.
All of the medications have potential side effects of which some can be quite severe. It is important to fully discuss options available with your health care team to find which best may suit you.
Disease Modifying Treatments:
Making the decision to seek and engage in a Disease Modifying Therapy (DMT) is a difficult choice to make. Symptoms may not appear to warrant engaging a therapy and a neurologist may well say they do not see the need to be engaged in a therapy. It is important for the diagnosed individual to understand all the risks of not utilizing a DMT as well as the risks involved in the various therapies available.
Either way, it is important to watch out for symptoms emerging and listen to other people who may see something you do not. As noted above some symptoms are visible yet others such as depression, fatigue, concentration, memory recall, cognition, anxiety are not physical manifestations but more silent.
If an individual chooses not to utilize a disease modifying therapy it is still considered wise to have an annual MRI series as the scan can be compared with previous scans to see if there are any visible plaques that did not exist on the previous scan.
Multiple sclerosis is a serious chronic disease and should not be taken lightly.