Multiple Sclerosis: Causes, Symptoms, Diagnosis And Treatment

Multiple sclerosis (MS) is a chronic disease ^[1] that affects the brain and central nervous system of the body. It ruptures myelin (an insulating layer around nerves) of the brain cells and spinal cord and interrupts the signal exchange between the brain and different parts of the body. Eventually, multiple sclerosis can cause permanent damage to the nerve cells ^[1] .

Some people will experience mild symptoms while others will experience severe symptoms. Its effect depends upon the amount of nerve damage and the area of the brain where nerves are affected. Let's scroll below to know more about this potentially disabling disease.

What Is Multiple Sclerosis?

The central nervous system consists of nerve fibre which is protected by an insulating cover known as myelin. Myelin allows electric pulses or say, electronic messages to transmit between the brain and the body ^[2] .

Multiple sclerosis is an autoimmune disorder in which the immune system of our body mistakes myelin as a foreign body and attacks it considering it as a virus or bacteria. This causes damage in multiple areas of the myelin hence, leaving a scar, or sclerosis. Medical experts named them as plaques or lesions.

The damage in the myelin sheath interrupts with the signal exchange between the brain and the body ^[3] and generally harms

• the spinal cord,
• eyes (the optic nerves),
• the cerebellum and
• the brain stem.

As more plaques develop during MS, more nerve fibres present in the brain break down and interrupt with the signal process. This results in the disability of certain important functions.

Types Of Multiple Sclerosis

Since the nerve damage varies in each person with MS, the illness caused due to the same also varies. Medical experts have identified some of these types as they are important to predict the severity of the disease and its similar treatments.

There are 4 types of multiple sclerosis ^[4] :

1. Relapsing-remitting multiple sclerosis: Out of the total people suffering from MS, around 85% have relapsing-remitting MS. The first sign of this disease occurs to them in their early 20s and later they experience episodes of MS symptoms from time to time (called relapses) followed by remissions period during which the MS symptoms vanish totally or partially.

2. Primary progressive multiple sclerosis (PPMS): In PPMS, the condition of a person gets worse over time. Around 10-15% of MS-suffering patients will have primary progressive multiple sclerosis. It leads to an earlier disability in compare to the other types.

3. Secondary progressive multiple sclerosis (SPMS): In SPMS, symptoms will be steady at first but typically after 10-20 years, it makes a gradual shift and starts progressing. It becomes hard to handle as the symptoms increase making it tough to treat.

4. Progressive relapsing: It is a rare form of multiple sclerosis affecting less than 5% of people. It is progressive from an early stage and its symptoms worsen along the way. It has no remission period.

Causes And Risk Factors Of Multiple Sclerosis

There are many factors that cause multiple sclerosis. The exact reason for the cause of multiple sclerosis is still unknown to doctors.

1. Genes: Genes can be responsible for MS ^[5] . It doesn't mean that you get it from your parents but the risk factors could be present in your genes. Scientists believe that some people are born with something in their genes that react to the triggers of MS once they are exposed to it.

2. Environment: The environment in which we live can also be the cause of MS ^[6] . This disease is most likely to affect people who reside in certain places or belong to certain ethnic groups. Multiple sclerosis is common in colder regions like Scandinavia and Scotland as they stay quite far from the equator. Smoking ^[15] and deficiency of vitamin D ^[9] can also be the reason for MS.

3. Sex hormones: Sex hormones can affect the immune system or be affected by the same. In women, the two hormones progesterone and oestrogen suppress the immune system while in men, the primary sex hormone testosterone is responsible. Studies show that women are more likely to get exposed to MS and this rate is nearly four times more than men ^[7] .

4. Viruses: Scientists found that viruses ^[8] from the Herpesviridae or Herpes family are responsible for triggering multiple sclerosis. It was found that people who have this disease have a kind of protein in their spinal fluid which is similar to the one found in people who were suffering from a nervous system disorder caused due to the same virus of this particular family. But, the research is still going on to prove it.

5. Autoimmune disorders: If a person has certain autoimmune disorders like inflammatory bowel disease, they are more likely to get affected by this disease ^[1] .

Symptoms Of Multiple Sclerosis

Brain is like a central computer that controls the activities of all parts of the body. When damage occurs in the brain, it likely affects all the body parts and causes multiple symptoms. The symptoms are as follows:

1. Blurry vision/double vision
2. Immobility or less coordination
3. Numbness
4. Depression
5. Poor digestion
6. Muscle spasm
7. Sexual issues like vaginal dryness (women) and erection problems (men)
8. Feeling tired all the time
9. Decrease in focus or concentration
10. An electric shock-like feeling from head to spine
11. Tingling
12. Change in walking pattern
13. Dizziness
14, Speech problems
15. Tremors or shaking of body parts

Diagnosis Of Multiple Sclerosis

The diagnosis of multiple sclerosis can be challenging as there is no specific test to determine it. The symptoms of MS are similar to the symptoms of other diseases and so, they have to be ruled out to confirm if a person has MS or not.

Here're the tests to diagnose multiple sclerosis:

1. MRI (Magnetic Resonance Imaging): It is an imaging test that shows a closer look of the brain to the doctor. On the image, they can look out for any signs of inflammation in the dense areas of the brain. MRI cannot give the exact proof of multiple sclerosis as the spots in the brain due to MS is similar to those of high blood pressure and diabetic patients.

2. Blood test: In order to rule out diseases with symptoms similar to MS, a blood test is done. This test looks out for specific biomarkers which are associated with multiple sclerosis. However, this test does not give the exact proof for MS.

3. Spinal tap (lumbar puncture): In spinal tap, a small sample of spinal canal fluid is checked for some abnormalities in their antibodies which are often linked to MS. This test often helps in diagnosing other infectious diseases whose symptoms are similar to MS.

4. Evoked potential tests: This test is used to determine the damage done by MS to other parts of the body that helps us to see, feel, and hear. In this process, doctors record the electronic signals produced by the brain when a certain stimulus is evoked like watching a certain video, hearing certain clicks, or receiving any short electric pulses in legs or arms. The test measures the speed of electric signals from the brain to the nerves.

Complications Associated With Multiple Sclerosis

Complications associated with multiple sclerosis are as follows:

1. Muscle spasm, known as myoclonus
2. Mental issues like mood swings, amnesia
3. Epilepsy
4. Paralysis, mostly in legs
5. Bowel or sexual dysfunction

Treatments For Multiple Sclerosis

The treatment of multiple sclerosis focuses mainly on speedy recovery from attacks, slowing down the disease, and restricting its symptoms as there is no exact cure for this chronic disease.

1. Treatment for multiple sclerosis attacks

Corticosteroids: They are prescribed to reduce nerve inflammation.

Plasmapheresis: It is also known as plasma exchange. In this process, plasma from the blood cells is separated, then mixed with albumin and placed back into the body.

2. Treatment for multiple sclerosis to reduce the progression

For patients with PPMS, ocrelizumab is the only and best therapy as after the treatment, MS is less likely to progress while in other cases, the disease remains untreated. For RRMS too, several of these therapies are available.

3. Treatment for relapsing-remitting multiple sclerosis

Beta interferons and Glatiramer acetate drugs are injected beneath the skin to slow down the severity of relapses ^[11]

4. Oral treatment methods

Certain oral medicines like dimethyl fumarate, siponimod, teriflunomide ^[12] , and fingolimod is used to reduce relapses and slow its progression.

5. Infusion treatment methods

• Ocrelizumab: This medication is approved to treat both the primary progression and relapse-remitting forms of multiple sclerosis. It is given by an intravenous infusion ^[19] .
• Alemtuzumab: This drug helps in reducing relapses of MS by limiting the nerve damage occurred due to white blood cells ^[20] .
• Natalizumab: This medication restricts the movement of damaged immune cells to the brain and spinal cord through the bloodstream ^[21] .
• Mitoxantrone: This treatment is extremely limited in treating MS as it may result in developing blood cancer ^[22] .

Prevention Tips

There are certain prevention tips to relieve its symptoms. The prevention tips are as follows:

1. Get enough rest
2. Exercise regularly
3. Follow a healthy diet
4. Avoid much heat exposure or using devices that cause the body's heat to rise more.
5. Relieve stress through meditation, yoga, and deep breathing ^[13] .

Living With Multiple Sclerosis

A positive attitude towards life is all one needs to cope with this disease. Here're a few tricks to stay upbeat:

1. Share problems: Share your problems with people as it will help to lighten your mental load.
2. Support group: Contact a support group as they have people living with the same disorder as yours. In this way, you can share common problems and get some ideas to handle it in the best ways.

On 30th May every year, World Multiple Sclerosis Day is celebrated to raise awareness and share stories related to this disease.

3. Counselling: If you don't want to open up to people about your disease, counselling privately is the best one can select ^[14] .
4. Diary writing: Keep a diary and mention all your feelings. In this way, you can express yourself better.
5. Take control of your life: Even you are suffering from this chronic disease, don't rely on others for everything. Take control of a few things in your life and see the change.