What Is Multiple Sclerosis (MS) And How Does It Affect You?

Multiple sclerosis (MS) is a chronic (long-term) and complicated condition in which your immune system assaults your own body. This is referred to as an autoimmune reaction.

The immune system targets and damages the fatty material (myelin) that insulates your central nervous system's nerves when you have MS (the brain, spinal cord and optic nerves). Demyelination is the term for this process.

Myelin that is healthy functions similarly to the insulation that protects an electric cord. It preserves your nerve fibres while allowing them to send and receive impulses (messages) rapidly and efficiently.

Inflammation and scarring are caused by demyelination (the term "multiple sclerosis" means "many scars"). The ability of your nerves to transfer messages between your brain and other areas of your body is harmed when these scars, also known as plaques or lesions, grow.

While there is currently no cure for MS, researchers are making significant advances and discoveries concerning the treatment and management of the disease on a daily basis.

MS Affects People In Different Ways

Demyelination can happen anyplace in the brain and spinal cord. As a result, everyone's MS experience is different. MS patients might have a wide range of symptoms and be impacted differently at different times of their lives.

The brain works to heal the tissue and resolve the inflammation when demyelination occurs. It can also divert messages to other sections of your brain while doing so. It's similar to being on the freeway and getting diverted to a different road or path due to construction.

Even though the brain attempts to repair injured tissue, it is frequently ineffective, and some nerve tissue is irreparably destroyed. This causes brain atrophy, or a reduction in brain volume over time.

Natural ageing causes a minor amount of brain atrophy in healthy persons, but brain atrophy happens at a substantially higher rate in many patients with untreated MS. Current MS treatments are aimed at preventing new central nervous system lesions from occurring, which can lead to irreparable brain damage and atrophy. The goal of current research is to identify techniques to restore damaged myelin and avoid MS symptoms.

MS Is Fairly Common

MS is a condition that affects a large number of people.

• MS affects around 2.8 million people globally.
• Women account for three-quarters of all MS patients.
• In young people, multiple sclerosis is the major cause of disability.
• MS is most commonly diagnosed in people between the ages of 20 and 40, though it can also strike children.

Types of MS

MS can develop in a variety of ways. Knowing what type of MS you have will help you better understand how your MS will progress and make more informed treatment decisions.

The following are the different types of MS:

Relapsing-remitting MS (RRMS)

Relapsing-remitting MS (RRMS) is the most frequent kind of MS. It is marked by well-defined attacks (known as active disease activity) followed by periods of total or partial recovery (referred to as non-active disease activity, or remission). The disease does not appear to progress during periods of remission. All symptoms may go away (non-worsening) at this point, or some may persist or become permanent (worsening). RRMS is the most common type of MS. It affects about 85 percent of patients with MS.

Secondary progressive MS (SPMS)

Secondary progressive MS (SPMS) is diagnosed when a relapsing remitting (RRMS) phase is followed by a 'progressive' phase in which the disease progresses and worsens with time. Throughout this phase, attacks and partial recoveries are possible. Because it does not follow a predetermined route and is difficult to pinpoint, the transition from RRMS to SPMS can be a difficult phase in the diagnosis for both the patient and the neurologist. The procedure takes several years for most people, and decades for others.

Primary progressive MS (PPMS)

Primary progressive MS (PPMS) is a kind of MS that develops over time and has a progressive (constantly deteriorating) course. It's marked by increasing handicap and, in most cases, no periods of remission (recovery) or acute bouts. PPMS is diagnosed in 10–15 percent of patients with MS.

You may also hear your neurologist refer to your MS as active, inactive, or not active, especially while discussing treatment options. New lesions leading to clinical relapses, new MRI (magnetic resonance imaging) findings, or disease progression are all examples of active disease. Your MS is stable and there is no sign of ongoing disease activity if you have inactive or non-active disease.

What Are The Signs And Symptoms Of MS?

MS symptoms vary and are unpredictable, depending on which area of the central nervous system is damaged and how severe it is. There are no two cases of MS that are alike.

Symptoms can change from day to day, and they can interact with one another. MS symptoms can be both visible and invisible to others around you.

The following are some of the most prevalent MS symptoms:

• Walking, balance, and coordination problems, muscle spasms or tremors, muscle weakness, slurring or slowness of speech, swallowing problems, and dizziness or vertigo are all symptoms of poor motor control.
• Fatigue is a state of intense exhaustion that is typically accompanied with heat sensitivity and can affect your physical, emotional, and mental capacities.
• Visual problems (such as blurred or double vision, changes in depth perception, partial or complete sight loss), changed sensations (such as pins and needles or numbness), neurological pain, heat or cold sensitivity, or discomfort are all examples of sensory difficulties.
• Incontinence (leakage from the bladder or bowel), the need to urinate more or less frequently, urgency, the need to urinate frequently during the night, constipation, or diarrhoea are all symptoms of bladder and bowel dysfunction.
• Sexual dysfunction - might be caused by MS lesions or it can be a side effect of other symptoms.
• 'Brain fog,' poor memory and focus, changes in processing speed and capacity, and impaired cognitive function are all examples of cognitive symptoms.
• Personal and emotional changes, anxiety, depression, and sleeping difficulties are all indicators of depression.

MS is a long-term condition that necessitates ongoing adjustment, management, monitoring, and resiliency. Similarly, it has varying effects and implications on individuals around you at different times.

What Causes Multiple Sclerosis (MS)?

MS has no one cause, however research has discovered a complex interaction between genetics, environment, and lifestyle factors:

• Genetics - in addition to other environmental influences, some genes are thought to play a role in the susceptibility to develop MS.
• Infection — MS has been associated to a number of viruses, including the Epstein-Barr virus, which causes glandular fever.
• Geographical location - MS is more prevalent in locations that are farthest from the equator. The latitudinal gradient is the term for this. The causes for this remain a mystery. There may be a link between ultraviolet light exposure (or lack thereof) and cancer.
• Vitamin D - There is a link between vitamin D levels and MS, according to multiple research. Vitamin D deficiency can raise the chance of having MS and have a detrimental impact on outcomes once diagnosed.
• Tobacco use - Tobacco use increases your odds of acquiring MS or suffering MS progression.

What Is The Procedure For Diagnosing MS?

MS can be difficult to diagnose since some of the early symptoms (such as exhaustion, stumbling, strange feelings, slower thinking, or vision issues) might be caused by a variety of other health conditions. There is no one-size-fits-all test for MS.

If your doctor or neurologist suspects you have MS, they will refer you to an MS neurologist who specialises in the disease. MS neurologists have access to the most up-to-date diagnostic instruments and facilities, as well as an experienced MS care staff. This group can assist you in comprehending your new diagnosis, as well as therapy and management alternatives.

The following tests can be used to diagnose MS:

• Neurological examination - this includes examining the cranial nerves for suspected regions of damage from MS lesions, as well as checking your reflexes, muscle strength, feelings, and eyesight. As part of this physical examination, your walking pace and manner may be measured.
• Blood tests — to rule out other potential reasons of your symptoms.
• MRI - to check for scarring (plaques or lesions) in the brain and spinal cord.
• A lumbar puncture is used to check the amount of cerebrospinal fluid in your body (CFS). CFS testing can back up MRI results and help rule out other conditions.
• Neurophysiology tests are used to monitor the electrical activity of the brain in order to detect abnormalities that aren't visible on an MRI. Evoked potentials tests follow nerve impulses as they flow through them and can be performed on your eyes, hearing, or peripheral nerves.
• If lesions or scarring are discovered on a brain or spine MRI, a neurologist will look for evidence that the scarring occurred over time (often referred to as 'disseminated in time') and in different parts of your central nervous system (often referred to as 'disseminated in space') to confirm a diagnosis of MS.
• The McDonald criteria, which form the basis of international standards to assist neurologists in reliably diagnosing MS, are based on this.

It is advised that delays in diagnosing MS be minimised, and that treatment and ongoing management goals for MS be established early in the disease's course to obtain the best possible outcomes for people with MS.

You will be able to engage in treatment decision-making if you are well-informed about MS. According to research, the best health outcomes arise through a collaborative decision-making process between the patient and the healthcare professional.

What Are Relapses In MS?

A relapse is a brief occurrence of a new symptom or a deterioration of an existing symptom that:

continues for more than 24 hours, cannot be explained by other reasons (such as infection or overheating), and is at least 30 days apart from the prior attack

Relapse symptoms might develop over a period of one to seven days. They can then reach a state of plateau (little or no change) for a few weeks. Your body may then take months to heal. The frequency of relapses, as well as the severity of them, might be unpredictable.

Notify your MS healthcare team, neurologist, or MS nurse as soon as possible if you fear you're having a recurrence. They'll be able to walk you through the relapse and offer you supporting therapy, such as drugs and allied health care involvement/rehabilitation, if necessary.

Keep track of your symptoms in a journal. Your doctor will benefit from accurate patient information when treating and managing your MS. A recurrence could mean your treatment is no longer effective.

You and your loved ones may experience a range of emotional responses as a result of the episodic (on-again, off-again) character of MS and relapses. During this time, you can get help from specialised MS support services. These services include employment counselling and assistance.

What Is The Treatment For MS?

There are no drugs that can cure MS; instead, they are used to alter the disease's course. There are currently 16 'disease modifying therapies' (DMTs) approved for use in Australia, including RRMS medications, many SPMS treatments, and one PPMS treatment. The Pharmaceutical Benefits Scheme covers the majority of them (PBS). MS treatment for RRMS seeks to:

• Reduce the number of relapses
• Minimise inflammation and prevent new lesions from forming
• Reduce the effect of symptoms on your daily life by reducing brain atrophy and restoring function.
• DMTs can be given by injection, orally as a tablet or capsule, or intravenously at various times. Because some DMTs have serious side effects, expert MS healthcare teams usually handle the DMTs and provide critical safety recommendations and treatment monitoring for persons living with MS and their local health care teams. Early diagnosis and treatment with DMTs have been proven in studies to improve health outcomes in persons with MS.

MS healthcare specialists

If you've been diagnosed with MS, your primary care physician will coordinate your care with the MS specialist team in your area. A neurologist, an MS nurse, and, if necessary, a number of additional allied health practitioners such as an occupational therapist, physiotherapist, psychologist, and continence nurse will make up this team.

Your MS healthcare team will discuss the following with you:

The treatment's goals, and which treatment could be best for you

the benefits and drawbacks of various therapies brain health lifestyle changes you can make to improve your health outcomes.

They will assist you in coping with, adjusting to, and managing your MS. Shared decision-making has been found to be a useful technique in the therapeutic management of patients with MS in studies. This occurs when the MS healthcare team collaborates with the patient to make treatment decisions based on the patient's values, preferences, life experiences, social and family circumstances, and health beliefs. It's a caring partnership.

What Is The Prognosis Of MS?

Multiple sclerosis is not a fatal disease, but it is progressive and degenerative, especially if it is not treated or managed. Many people with MS have long and happy lives if they manage their disease adequately with lifestyle adjustments and, if therapy is available, medication. People with MS are living longer, possibly as a result of breakthroughs in therapy, diagnosis, and a greater knowledge of the impact of a healthy lifestyle. A person with MS might anticipate to live 7-10 years less than individuals who do not have MS. The majority of people find the illness to be highly unexpected, with symptoms changing greatly in form, frequency, and intensity from one person to the next. The prognosis also varies with the type of MS.

Factors that influence prognosis

No two persons with MS have the same symptoms or disease development patterns, and a variety of factors might influence how the disease progresses. These are some of them:

• Treatment
• variables affecting one's way of life
• biological characteristics

Treatment is perhaps the most important component that influences the course of MS in today's world. For all of the major MS types, disease-modifying medicines are currently approved in the United States; these medications have been shown in clinical studies to reduce disease progression, reducing the likelihood of relapse and/or slowing the accumulation of disability.

For MS patients, starting treatment as soon as feasible is strongly recommended.

MS progression can also be influenced by a variety of lifestyle factors. More physical activity, for example, has been related to improved physical and cognitive results over time. Smoking is another lifestyle issue to consider, as several studies have indicated that persons who smoke cigarettes have a more severe case of MS; in fact, it is widely recommended that smokers try to quit or cut back.

Dietary habits have a significant impact on MS, however the intricacies are yet unknown – while there is no "ideal diet" for persons with MS, a diet rich in fruits and vegetables, whole grains, and low in processed foods and refined sugar is often suggested.

Biological factors

The age at which symptoms first appear is a significant determinant in determining the course of MS. In general, the faster the disease progresses, the older the patient is at the time of beginning. Females are more likely to have MS than males, although the disease progresses more swiftly in males. Furthermore, MS is frequently more severe in obese people.

MS's early stages can potentially reveal prognostic information about how the disease will progress. According to a recent study, having a greater relapse rate or a significant rise in disability early on in the course of MS is linked to a higher risk of severe disease progression and cumulative disability. MRI scans can also aid to provide predictive information about the anticipated illness course by measuring inflammation and damage in the nervous system.

References

https://www.ncbi.nlm.nih.gov/books/NBK499849/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241505/