Multiple Sclerosis – Overview, Diagnosis and Management

Overview

Multiple sclerosis is a disabling disease of the central nervous system that disturbs the flow of nerve impulses within the brain and between the brain and body. In MS, the protective sheath around the nerves (myelin sheath) gets damaged due to an unusual autoimmune response in the body which causes the demyelination of nerves. The myelin sheath provides insulation to the nerves so they can transmit nerve impulses smoothly. Its demyelination slows down the transmission of nerve impulses and causes the nerves to fatigue quickly as they lose a lot of energy due to lack of proper insulation. Due to this, loss of neural conduction occurs, which results in movement dysfunction, loss of sensation, vision problems and many other symptoms.

MS is a lifelong disease, and if not diagnosed and managed on time, can also lead to severe disability. People with MS have slightly decreased life expectancy on average than people without this disease. MS is the most common disability among younger adults, but it can occur at any age. Majority of the cases of MS are treatable, and the person can lead a healthy life.

What are the Symptoms?

Symptoms of MS can vary from person to person, and there is no evidence suggesting an exact list of early signs or symptoms. Early symptoms experienced by one person may never occur in someone else.  The most common symptoms of MS include:

• Fatigue
• Weakness in movement
• Difficulty in walking
• Visual disturbances
• Paresthesia (pins and needles sensation)
• Numbness
• Tremor
• Muscle stiffness and spasms

Some other symptoms can also appear in some cases such as:

• Cognitive dysfunction (difficulty in thinking)
• Chronic or acute pain
• Depression

A specialist such as a neurologist can diagnose MS correctly. Keep in mind that these symptoms not always indicate the presence of MS, and it can also be some other condition. Consult your GP if you think you have symptoms of MS. Your GP might refer you to a specialist if they think your condition needs further investigation.

What are the Causes?

Multiple sclerosis is an idiopathic disorder i.e. the exact cause of the disease is still unknown. Although it is not clear why the body’s immune system attacks the myelin sheath and causes inflammatory process, research suggests that it might be caused due to a mixture of genetic, environmental and lifestyle factors. Some factors are known to be the possible causes of MS such as:

Genetic factors: Although MS is not a hereditary disease and it does not directly transfer from parent to children, but your chances of developing MS slightly increases if any of your close relatives such as parent or sibling, has the disease.

More common in females: MS affects women 2 to 3 times more than men, although the reason for this is still not known.

Smoking: Smoking highly increases the risk of developing MS. According to research, being a current smoker increases the risk of MS by 83% compared to non-smokers (Peng Zhang et al.; 2016).

Viral infections: Some viral infections such as the Epstein-Barr virus infection triggers the immune system which might lead to MS in some people.

How to Diagnose?

Multiple sclerosis is hard to diagnosis because there are no specific markers for confirming the presence of this disease. Physical examination is done first by taking a medical history and asking about the frequency of attacks. If the doctor suspects the presence of MS, they might suggest a number to different tests to rule out other pathologies and to further confirm the diagnosis.

Several criteria have been developed previously to diagnose MS, among which was “McDonald criteria” which was first developed in 2001 and lately revised in 2017. This criterion contains the guidelines to use the MRI and spinal fluid analysis to diagnose MS in an efficient way.

Neurological Examination

After the physical exam, your GP might refer you to a neurologist who will out a neurological examination like checking for muscle strength, reflexes, balance and coordination and vision problems. These tests might indicate nerve damage related to MS.

MRI Scan

Magnetic resonance imaging (MRI) gives detailed images of the brain and spinal cord and it is less invasive than x-rays and CT scans as it does involve the use of harmful radiations. The two most important things to check on the MRI are: abnormal findings that might rule out MS i.e. indicate any other pathology such as brain tumour, and also check for demyelination of nerves in either the brain or spinal cord. The MRI can provide accurate details of the presence of demyelination.

Lumbar Puncture

Lumbar puncture or spinal fluid analysis is a technique used to draw a sample of the patient’s spinal fluid by inserting a needle in the lower back. The fluid is then analyzed for the presence of antibodies (IgG antibodies), proteins (oligoclonal bands) and an unusually high level of white blood cells, all of which indicates a disease-fighting state inside the brain and spinal cord.

How to treat MS?

There is no complete cure for MS but it can be managed by treating it symptomatically through medications, exercise and different therapies according to the symptoms. A team of healthcare professionals can work together to provide the right treatment plan for the patient according to their needs. This might include a neurologist, a physiotherapist, a speech and language therapist and some other professionals. Also, it’s better to consult an MS specialist (a neurologist who has more experience with MS patients) as they can diagnose you more accurately and can prescribe medications for you. Symptoms such as fatigue, tremors, pain, muscle stiffness, muscle weakness, balance problems etc all can be managed through different regimes as directed by the GP.

 Treating Fatigue

Fatigue is the most common symptom in MS which can be managed by the drug amantadine. Also, fatigue can be reduced by daily exercise, energy-saving techniques and developing a healthy sleep pattern.

Treating Muscle spasms and Stiffness

Muscle spasms and stiffness can be effectively treated with physiotherapy such as stretching exercises that will help to release the stiff muscles and give a relaxing effect.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278620/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351877/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806598/