What is Multiple Sclerosis?
Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system (CNS), which includes the brain, spinal cord, and optic nerves. The nerves
in the CNS are protected by a fatty material called the myelin, which helps nerve fibers conduct electrical impulses. In MS, when the immune system attacks the
CNS, the myelin is damaged, resulting in the formation of scar tissue called sclerosis or plaques. This damage leads to a disruption in signaling along the nerves
that travel to and from the brain and spinal cord, and produces a variety of symptoms that can range from mild numbness in the limbs to severe paralysis or loss
of vision.
Who Gets MS?
It’s estimated that 400,000 people in the United States and 2.5 million people worldwide are living with MS, and more than 200 people are diagnosed with MS each
week. MS symptoms typically begin between the ages of 20 and 40 years, and rarely occur prior to age10 or after age 60. MS is significantly more common (at least
two to three times) in women than men, and the disease generally occurs five years earlier for women than for men.
What Causes MS?
The underlying cause of MS is unknown, but most researchers believe that the body’s immune system responds abnormally and attacks the CNS, damaging the myelin.
Normally, the immune system defends the body against foreign invaders such as viruses or bacteria. In autoimmune diseases, the immune system attacks the body. In
MS, the myelin is the target of the body’s attack. The disease is thought to result from a combination of factors, including genetics, an immune system
malfunction, and environmental triggers such as viruses, trauma, vitamin deficiency, or exposure to heavy metals.
MS Symptoms
Symptoms of MS are caused by the disruption in nerve signaling from the CNS to other parts of the body as a result of damage to the myelin and the nerve cells.
The frequency and duration of symptoms vary.
Early symptoms of MS can include:
- Blurred or double vision
- Dizziness that does not go away
- Clumsiness or a lack of coordination that make it difficult to stay balanced when walking
- Tingling or numbness in the arms, legs, trunk of the body, or face
- Weak, stiff muscles, often with muscle spasms
Symptoms of MS as the disease progresses:
- Unusual “pins and needles” sensation
- Bladder problems
- Fatigue
- Sexual dysfunction
- Slurred speech
- Tremors
- Changes in the ability to concentrate or multi-task effectively
- Difficulty in making decisions or planning at work or in private life
- Mood changes (e.g., depression)
Types of MS
There are four types of MS. Each type may have a mild, moderate, or severe course, and MS can also change types over time.
- Relapsing-remitting MS (RRMS) is the most common form of MS. About 85% of people with MS are initially diagnosed with RRMS. RRMS is characterized by distinct attacks of reduced brain and nerve function that lasts from days to weeks. After the attack, patients may experience a period of partial or complete recovery, where the disease does not progress. Most patients with RRMS will eventually enter the secondary progressive phase.
- Secondary-progressive MS (SPMS) is followed by an initial episode of RRMS, and the disease worsens over time, with or without the occasional attack, remission, or plateau. There is no recovery between attacks, and about 50% of patients with RRMS will develop SPMS within 10 years.
- Primary-progressive MS (PPMS) is characterized by steadily worsening brain and nerve function without relapses or remissions. This type of MS is not very common, occurring in about 10% of people with MS.
- Progressive-relapsing MS (PRMS) is rare, affecting approximately 5% of patients, and is characterized by a steadily worsening disease state from the beginning. Disease progression continues during the period between disease relapses.
Diagnosing MS
Currently, there is no single test that can identify whether a person has MS or is likely to develop it in the future. Doctors rely on a patient’s medical history, physical exams,
and a variety of laboratory tests to make a positive clinical diagnosis of MS. Laboratory tests used to diagnose MS include:
- Magnetic Resonance Imaging (MRI) – This is a non-invasive test that takes pictures of the brain to identify areas of damage and track the progress of the disease.
- Visual Evoked Potential (VEP) – This test measures how fast the brain responds to visual stimuli. Patients with MS have a slower response time, and this test can provide evidence of disease that does not show up during an exam. This type of test is considered most useful for confirming a MS diagnosis.
- Cerebrospinal Fluid (liquid that surrounds brain and spinal cord) – A spinal tap sample is analyzed to detect levels of immune system proteins and white blood cells. Immune system proteins and white blood cells are also present in other diseases, so this test cannot be relied on as definitive proof of MS.
Treating MS
Although there is no cure for MS, there are numerous medications available that help slow disease progression, treat flares (attacks), manage symptoms, and improve function and
safety.
Treatment for Attacks
The usual treatment for an initial MS attack is a high-dose corticosteroid injection (e.g., methylprednisolone) for three to five days. Steroids work to reduce the severity of the attack by reducing the inflammation caused by the body’s defense system.
Treatment to Reduce Disease Activity and Progression
In addition to corticosteroids, 11 drugs are currently available and approved by the U.S. Food and Drug Administration (FDA) for the treatment of MS. Treatment options include
interferon beta therapy, immunosuppressants, and monoclonal antibodies. These therapies are classified as disease-modifying drugs and are designed to suppress the inflammatory
response in the body.
Medications
Medications are used in MS to modify the disease course, treat relapses, and manage symptoms.
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Disease-modifying drugs that reduce the number of flares (attacks) include:
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Disease-modifying drugs that have been shown to reduce flares (attacks) and slow progression of MS include:
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Symptom management therapies include:
- Ampyra® (dalfampridine) to improve walking speed
- Botox® (onabotulinumtoxin A) to treat spasms in the arms and overactive bladder
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