Multiple sclerosis (MS) is a potentially disabling autoimmune disease that affects the brain and spinal cord (central nervous system). MS disrupts the transmission of information within the brain and between the brain and body. It can cause problems with muscle control, balance and vision.
Since there is no single test to diagnose MS, diagnosis often depends on ruling out other conditions with similar signs and symptoms. Furthermore, diagnosis requires evidence of demyelination in more than one area of the brain, spinal cord or optic nerves. A doctor would perform physical, eye and neurological examinations, take medical history and order other tests.
Diagnostic testing may include the following:
- Blood tests: Helps rule out other conditions that have similar symptoms to MS.
- Evoked potentials test: This test stimulates nerve pathways to analyze electrical activity in the brain caused by touch, light and sound.
- Lumbar puncture (spinal tap): Done to find oligoclonal bands (OCBs) to diagnose MS, find abnormalities in cerebrospinal fluid and rule out infectious diseases.
- MRI scan: Detects active and inactive lesions in the brain and spinal cord.
- Optical coherence tomography (OCT): Checks for thinning around the optic nerve.
To make a diagnosis of MS, the physician must:
- Find evidence of damage in at least two distinct areas of the central nervous system (CNS): the brain, spinal cord and optic nerves
- Find evidence that the damage occurred at different points in time
- Rule out all other possible diagnoses before confirming it is MS
What are the signs and symptoms of MS?
Symptoms may vary with people because of the location of affected nerve fibers and the severity of the disease. Nerves in any part of the brain or spinal cord may be damaged causing multiple sclerosis (MS) symptoms to appear in many parts of the body.
- Loss of balance
- Muscle spasms
- Numbness or abnormal sensation in any limb
- Problem walking
- Problem with coordination and making small movements
- Tremors in one or more arms or legs
- Weakness in one or more limbs
- Electric-shock sensations in the upper body that occur with certain neck movements (Lhermitte’s sign)
Eye and vision symptoms
- Prolonged double or blurred vision
- Eye discomfort
- Uncontrollable eye movements
- Partial or complete loss of vision, usually one eye at a time
Bowel and bladder symptoms
- Constipation and stool leakage
- Difficulty urinating
- Frequent need to urinate
- Urine incontinence (leakage)
Speech and swallowing symptoms
- Slurred speech
- Trouble chewing and swallowing
Other brain and nerve symptoms
- Crawling or burning sensation in the arms and legs
- Decreased attention span and memory loss
- Dizziness and vertigo
- Facial pain
- Hearing loss
- Heat sensitivity
- Problems with reasoning and processing information
- Sexual dysfunction (both in males and females)
- Sudden paralysis
- Tingling or pain in parts of your body
What are the types of MS?
There are four types of multiple sclerosis (MS), including:
- Clinically isolated syndrome (CIS): This is a single, first episode with symptoms lasting for at least 24 hours.
- Relapse-remitting MS (RRMS): This is the most common form, affecting about 85 percent of people with MS, and involves episodes of symptoms, followed by periods of remission when symptoms go away partially or totally.
- Primary progressive MS (PPMS): Symptoms worsen progressively without relapses or remissions, and affect about 15 percent of people with MS.
- Secondary progressive MS (SPMS): Initially, people experience episodes of relapse and remission, and then, the disease progresses steadily.
What are the complications of MS?
Multiple sclerosis (MS) may lead to the following:
- Muscle stiffness or spasms
- Paralysis, typically in the legs
- Mobility issues
- Cognitive impairment
- Difficulty swallowing
- Need for catheterization due to urinary incontinence
- Pressure sores
- Urinary tract infections
- Problems with bladder, bowel or sexual function
- Inability to care for self
Treatment of MS
There is no known cure for multiple sclerosis (MS). However, treatment focuses on slowing down the progress of the disease, reducing the severity and controlling symptoms.
Treatment options for MS include:
- Reducing the severity of attacks: Severity can be reduced by administering corticosteroids or plasmapheresis (plasma exchange).
- Medication to slow progress: Include infusion, injectable and oral medicines. Medicines can more effectively treat relapsing-remitting forms than other types of MS.
- Medications to manage symptoms: Medications are prescribed for muscle spasms, urinary problems, fatigue or mood problems.
- Supplements: Vitamin D and B12 or other supplements.
- Complementary and alternative approaches: Acupuncture or cannabis may help with muscle problems.
- Rehabilitation and physical therapy: These improve a person’s ability to perform and include physical therapy, speech and swallowing therapy, occupational therapy, cognitive rehabilitation and vocational rehabilitation.
- Spinal devices: These are used to reduce pain and spasticity in the legs.
MS prognosis outlook
Multiple sclerosis (MS) is a life-long incurable disorder. The prognosis varies and is difficult to predict. MS does not always result in severe paralysis. In fact, two-thirds of people with MS can walk. Most people get around with assistance, such as a cane, walker, wheelchair or scooter. About 25 percent of people with the condition eventually need a wheelchair.
The average life expectancy of a person with MS is 5 to 10 years lower than an average person.
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Olek MJ, Howard J. Evaluation and Diagnosis of Multiple Sclerosis in Adults. UpToDate. https://www.uptodate.com/contents/evaluation-and-diagnosis-of-multiple-sclerosis-in-adults
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