Multiple Sclerosis: Symptoms and Treatments

In Multiple Sclerosis (MS), the body’s own immune system attacks the myelin sheaths that surround and protect the nerves. There is no cure for MS, but some symptoms can be controlled.

Symptoms/Diagnosis

The symptoms of MS vary from one person to the next, and their intensity can vary in the same person. The symptoms are also affected by the type of multiple sclerosis the person has. In general, the symptoms of MS are:

  • Fatigue that is not improved by resting.
  • Clumsiness.
  • Incontinence.
  • Constipation.
  • Sometimes, problems with hearing and vision.
  • Numbness, tingling and a loss of sensation.
  • Mood swings.
  • Memory problems.
  • Problems concentrating.
  • Sometimes, problems swallowing.
  • Speech difficulties.
  • Vertigo and dizziness.

In order to make a diagnosis of MS, the physician must:

  • Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
  • Find evidence that the damage occurred at different points in time AND
  • Rule out all other possible diagnoses

The Revised McDonald Criteria, published In 2017 by the International Panel on the Diagnosis of Multiple Sclerosis, include specific guidelines for using MRI and cerebrospinal fluid analysis to speed the diagnostic process. The MRI can be used to look for a second area of damage in a person who has experienced only one attack (also called a relapse or an exacerbation) of MS-like symptoms — referred to as clinically-isolated syndrome (CIS). The MRI can also be used to confirm that damage has occurred at two different points in time. In some circumstances, the presence of oligoclonal bands in a person’s cerebrospinal fluid analysis can be used instead of dissemination in time to confirm the MS diagnosis.

Treatment

There is no specific test to diagnose multiple sclerosis. The doctor needs to make a diagnosis from listening to the patient’s description of their symptoms and taking a medical history. The doctor may order tests to check the patient’s blood, spinal fluid and urine, and order scans of their central nervous system. This might reveal changes in the brain or the spinal cord that help with a diagnosis of MS. Sometimes, the patient’s doctor needs to call in a neurologist to make a diagnosis.

The doctor will prescribe drugs called disease-modifying agents to help control the symptoms. They also slow down the progression of the disease or try to avert any complications. Drugs that help slow the progression of MS include injectable types of interferon. Other injectable drugs include Copaxone, Glatopa, Plegridy, Avonex, Betaseron, Extavia, Rebif and Zinbryta.

The only Oral medicines that can slow down the progression of MS include Aubagio, Gilenya and Tecfidera. Having an oral treatment option makes much more convenient for the patient and less expensive to administer. Although companies like Rebif offer autoinjectors to make it easier to self administer. 

There are also infused medicines. These medicines are introduced into the body through a catheter inserted into the patient’s vein. MS medicines delivered this way include Lemtrada, Novantrone, Ocrevus and Tysabri.

Doctors treat patients who are having severe relapses with intravenous corticosteroids that are delivered over three to five days. The patient is then put on oral prednisone. Corticosteroids may help end the relapse, but they do nothing to treat the disease itself.

Other medications are used to target the patient’s specific symptoms. One medicine that’s used to control urinary incontinence is Botox. Prozac is used to treat the patient’s fatigue and depression, and their pain is treated with such drugs as Dilantin and Klonopin. Viagra is prescribed for sexual dysfunction, and constipation is treated with stool softeners such as Colace, Dulcolax, Milk of Magnesia and mineral oil.

Physical Therapy The MS patient may have physical therapy along with drug therapy to ease the symptoms of the disease. This includes the use of a treadmill stationary bike, rowing machines, stretching or other aerobic exercises. These can improve the strength of the patient’s arms and legs, and help them retain their balance and improve their self-esteem. Other MS patients benefit from aquatic therapy and yoga.

Plasma Exchange Plasma exchange, or plasmapheresis is much like kidney dialysis in that the blood of the patient is “cleansed.” In the case of plasmapheresis, the plasma of the patient’s blood is replaced with plasma from a donor. Plasmapheresis is used to treat flare-ups. The thinking behind it is that there are substances in the patient’s own plasma that are attacking the central nervous system and causing the flare-ups.

During plasmapheresis, the patient relaxes in a chair. A specialist inserts a catheter into a vein of each arm. The patient’s blood comes out of one tube and goes into a machine that filters out their plasma. The blood is then combined with new plasma or a plasma substitute and is returned to the patient through the other tube. As with kidney dialysis, this process takes about two to four hours.

Types of Multiple Sclerosis

Clinically Isolated Syndrome (CIS)

CIS is a first episode of neurological symptoms caused by inflammation and demyelination in the central nervous system. The episode, which by definition must last for at least 24 hours, is characteristic of multiple sclerosis but does not yet meet the criteria for a diagnosis of MS because people who experience a CIS may or may not go on to develop MS.

When CIS is accompanied by lesions on a brain MRI (magnetic resonance imaging) that are similar to those seen in MS, the person has a high likelihood of a second episode of neurological symptoms and diagnosis of relapsing-remitting MS. When CIS is not accompanied by MS-like lesions on a brain MRI, the person has a much lower likelihood of developing MS.

This is not really a type of MS, but is a precursor to MS for many people. 

Relapsing-remitting MS (RRMS)

RRMS, the most common version of MS, is characterized by clearly defined attacks of new or increasing neurological symptoms. These attacks, also called relapses or exacerbations, are followed by periods of partial or complete recovery (remissions). During remissions, all symptoms may disappear, or some symptoms may continue and become permanent. However, there is no apparent progression of the disease during the periods of remission. At different points in time, RRMS can be further characterized as either active (with relapses and/or evidence of new MRI activity) or not active, as well as worsening (a confirmed increase in disability over a specified period of time following a relapse) or not worsening.

Approximately 85 percent of people with MS are initially diagnosed with RRMS.

Secondary progressive MS (SPMS)

SPMS follows an initial relapsing-remitting course. Most people who are diagnosed with RRMS will eventually transition to a secondary progressive course in which there is a progressive worsening of neurological function over time. SPMS can be further characterized at different points in time as either active or not active, as well as with progression or without progression. Because of the need for the RRMS diagnosis to begin with, an individual is not usually given this diagnosis in the beginning, making this more of a second stage of RRMS.

Primary progressive MS (PPMS)

PPMS is characterized by worsening neurological function from the onset of symptoms, without early relapses or remissions. PPMS can be further characterized at different points in time as either active (with an occasional relapse and/or evidence of new MRI activity) or not active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapse or new MRI activity) or without progression.

PPMS never lets up int he way that RRMS does. There are times the individual is stable, but they are usually always facing worsening conditions without any remission or relapse. 

Approximately 15 percent of people with MS are diagnosed with PPMS.

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