Multiple Sclerosis

Within the CNS, the immune system can become inflamed which causes thinning or the destruction of sections of the myelin sheath—the fatty substance that surrounds and insulates the nerve fibers—as well as the nerve fibers themselves. This damage disrupts the ability of parts of the nervous system to communicate.

Much like a row of dominoes with some missing, when myelin or nerve fibers are damaged or destroyed by MS the messages within the CNS are altered, slowed or completely blocked. It is this damage to the CNS that produces the variety and severity of neurological symptoms associated with MS.

Those damaged areas of the myelin sheath develop scar tissue which gives the disease its name: multiple sclerosis or multiple areas of scarring.

Multiple sclerosis is the most common autoimmune disorder of the central nervous system. It affects at least two to three times more women than men of the 2.3 million people known to be affected globally by the disease in 2015.

People often begin displaying symptoms between the ages of 20 and 40. The progress, severity and specific symptoms of MS vary from person to person. Usually, the disease is mild, but some people lose some or all of the ability to write, speak, or walk.

While the cause of MS is still unknown, scientists believe the disease is triggered by an as-yet-unidentified environmental factor in a person who is genetically predisposed to respond. It may be or may trigger an autoimmune disease, which happens when the immune system attacks healthy cells in the body by mistake.

MS, like many neuromuscular diseases, does not currently have a cure. However, there are various medications or treatments that may help improve function, prevent new attacks (sometimes called exacerbations), increase mobility and lengthen life. Plus, there are a number of new treatments and diagnostic methods under development.

The symptoms of multiple sclerosis are variable and unpredictable because they are dictated by the locations of the lesions within the affected person’s nervous system.

So no two people have the exact same symptoms, and each person’s symptoms can change or fluctuate over time. One person might experience only one or two of the possible symptoms throughout their lifetime while another person can experience many more.

Some of the more common symptoms include:

• Fatigue
• Walking (Gait) Difficulties (weakness, spasticity, loss of balance, sensory deficit and fatigue)
• Numbness or tingling of the face, body, or extremities (arms, legs, toes, and fingers)
• Spasticity (a feeling of stiffness as well as involuntary muscle spasms)
• Weakness
• Vision Problems (blurred vision, poor contrast, and pain with eye movement)
• Dizziness and Vertigo
• Bladder and Bowel Problems
• Sexual Problems
• Pain (acute sensitivity to extremely hot or cold temperatures that can cause pain, specifically an electrical sensation that runs down the back when bending the neck)
• Cognitive Changes (processing information, learning and remembering new information, organizing and problem-solving, focusing and accurately perceiving their surroundings)
• Emotional Changes

There are other less common symptoms reported by people with MS. Even though these are less common, they are still important factors in managing and living with MS.

• Slurred speech, stuttering and loss of volume
• Swallowing problems
• Tremors or uncontrollable shaking
• Seizures
• Respiration problems
• Itching, burning, or “pins and needles” feelings

It is important to note that most of these symptoms can be managed very effectively with medication, rehabilitation, and other management strategies. Effective symptom management by an interdisciplinary team of healthcare professionals like the team at Semmes Murphey Clinic is one of the key components of comprehensive and ongoing MS care.

Secondary symptoms are the “trickle-down” effects of the disease on your life. These symptoms can cause social, vocational and psychological complications.

For example, if you are no longer able to drive or walk, you may not be able to hold down your usual job. The stress and strain of dealing with MS often alter social networks and sometimes fractures relationships. Problems with bladder control, tremor or swallowing may cause people to withdraw from social interactions and become isolated.

While secondary symptoms can be treated, the optimal goal is to avoid them by treating the primary symptoms.

Initially, symptoms usually occur in two main patterns:

• Relapsing and Remitting: episodes of sudden worsening that last a few days to months, called relapses, exacerbations, bouts, attacks, or flare-ups, followed by improvement (85% of cases), or
• Progressive: a gradual worsening over time without periods of recovery (10–15% of cases).

A combination of these two patterns may also occur or people may start in a relapsing and remitting course that becomes progressive later.

Currently, there are no specific laboratory tests or physical findings that can, by themselves, conclude that a person has MS.

In fact, people with MS often complain that it took a long time to receive their diagnosis. With the variety of symptoms occurring months or perhaps a year apart, patients often see numerous physicians until the symptoms add up and they are referred to a neurologist for a proper diagnosis.

The physicians at Semmes Murphey Clinic employ well-established tests and criteria to determine if a person meets an MS diagnosis, including:

• A careful medical history
• Review of presenting symptoms
• A neurologic exam, and, if necessary
• Various tests such as magnetic resonance imaging (MRI)

While there currently isn’t a cure, there are various treatments to slow the progression of MS and help control symptoms.

More than a dozen therapies have been approved by the FDA to treat different forms of MS. They have proven helpful in preventing the progression of MS, lessening attacks or exacerbations and preventing disability.

A neurology team can also help lessen the effects of attacks or exacerbations with medications, physical therapy or lifestyle changes. Rehabilitation programs are designed to help patients improve or maintain their ability to perform effectively and safely at home and at work.

It is important for patients to evaluate the different options with their neurologist to decide which therapy is best. These medications have significant side effects as well as administration issues.

Many MS patients seek relief through alternative therapies and complementary medicine although the benefits of these are unproven.

A complex disease requires a comprehensive approach. The model of comprehensive MS care involves the expertise of many different healthcare professionals — each contributing in a unique way to the management of the disease and the symptoms it can cause.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.