What Is the Main Cause of Multiple Sclerosis?

A combination of factors triggers multiple sclerosis (MS), which include:

1. Age: MS can develop at any age but commonly occurs around the 20s and 40s. However, younger and older populations may also get affected.
2. Sex: Women are two to three times more likely to acquire relapsing-remitting MS than men. 
3. Family history: Having a parent or sibling with MS can increase your risk of MS.
4. Certain infections: Epstein-Barr virus that causes infectious mononucleosis may cause MS.
5. Ethnicity: Certain ethnicities, especially those of Northern European descent, are at the highest risk of MS. People of Asian, African, or Native American ethnicity are at the lowest risk of MS.
6. Climate: MS is most common in countries with temperate climates, including
   • Canada
   • The northern United States
   • New Zealand
   • Southeastern Australia
   • Europe
7. Vitamin D: Inadequate exposure to sunlight or low vitamin D levels may have a connection with developing MS.
8. Certain autoimmune diseases: Your risk of MS increases if you already have other autoimmune diseases such as
   • Thyroid disease
   • Pernicious anemia
   • Psoriasis
   • Type I diabetes
   • Inflammatory bowel disease
9. Smoking: Smokers have a higher risk of symptoms of MS than nonsmokers.

The prominent feature of multiple sclerosis (MS) is that symptoms occur months or years apart and affect different organs. Symptoms vary on an individual basis.

The most common symptoms include:

• Vision loss, double eye vision, blurred vision, and pain in eye movement
• Fatigue occurs in nearly 80 percent of people
• Walking difficulties
• Numbness of the face, arms, and legs
• Muscle spasms in the leg
• Deterioration of unused muscle that leads to muscle weakness
• The spinning of the head and light-headedness
• Sexual problems
• Constipation
• Loss of control of bowels
• Loss of control of bladder
• Chronic pain and itching were noted in 55 percent of people
• Memory loss
• Analytical and problem-solving ability starts diminishing
• Significant depression, mood swings, irritability, and other emotional changes

Less common symptoms seen include:

• Dysarthria (slurring speech) and dysphonia (loss of volume)
• Dysphagia (difficulty swallowing)
• Tremor (vigorous shaking)
• Seizures (sudden uncontrollable vigorous jerking)
• Breathing difficulty
• Hearing loss or impaired hearing

Secondary symptoms that occur as a complication of the above symptoms include:

• Loss of control bladder leads to urinary tract infection
• Physical inactivity or immobility leads to pressure sores, muscle weakness, and poor posture

There are four types of multiple sclerosis (MS), based on the relapse rate and time to disease progression:

1. Relapsing-remitting multiple sclerosis (RRMS): A recurrent attack is the characteristic of RRMS, which resolves completely on treatment with no relapse. The relapse period may last for weeks to years.
2. Secondary progressive MS: It occurs when people with RRMS develop an exacerbation of the disease. It does not respond to the currently available treatment.
3. Primary progressive MS: Primary progressive MS accounts for approximately 10 percent of people with MS in which the function diminishes gradually without relapses.
4. Progressive-relapsing MS: In this, intermittent relapses overlay the progressing disease. It accounts for five percent of the total MS cases.

Ten complications associated with multiple sclerosis include:

• Muscle stiffness or spasms
• Paralysis, typically in the legs
• Problems with bladder, bowel, or sexual function
• Mental changes, such as forgetfulness or mood swings
• Depression
• Epilepsy
• Speech problems
• Loss of vision
• Double vision
• Difficulty swallowing

At present, multiple sclerosis (MS) is not curable; however, with effective treatments, physicians can modify the disease progression, manage symptoms, improve function, and address emotional health. The drugs can even make sure you have no further flare-ups (acute symptoms) and pain.

Treatment options for MS attacks include:

• Corticosteroids are prescribed to reduce nerve inflammation and autoimmune reaction.
• Plasma exchange or plasmapheresis is recommended when steroids aren’t beneficial. The liquid part of the blood plasma is taken and separated from the blood cells. These separated blood cells are mixed with albumin and reinjected into the body.

Medications modifying the disease progression and reducing exacerbations include:

• Interferon therapies
• Glatiramer acetate
• Natalizumab
• Alemtuzumab
• Cladribine
• Fingolimod
• Dimethyl fumarate
• Diroximel fumarate
• Teriflunomide
• Siponimod
• Ocrelizumab

Physical therapy may be beneficial to manage symptoms of MS and build muscle strength. Along with physical therapy, other ways by which a physician would manage the symptoms of MS include:

• Muscle relaxants include baclofen, tizanidine, and cyclobenzaprine
• Medications to reduce fatigue include amantadine, modafinil, and methylphenidate
• Medications to increase walking speed include Dalfampiridine
• Other medications include medications to treat depression, pain, sexual dysfunction, insomnia, and bladder or bowel control problems

Lifestyle changes that can help relieve signs and symptoms of MS include:

• Getting plenty of rest and treating any underlying sleeping disorder
• Eating a balanced diet
• Relieving stress by getting engaged in yoga, tai chi, massage, meditation, or deep breathing
• Cooling down by avoiding exposure to heat, and using devices such as cooling scarves or vests can be beneficial.