I grew up with a bunch of friends in Kolkata back in the day. One of my close friend’s dad was suffering from multiple sclerosis. What I saw was a man who found it difficult to walk, had almost no muscle coordination, and had blurred vision or double vision.
He had pain when he moved his eyes, and his vision was deteriorating as time went by. There was also a lot of fatigue that got worse throughout the day. But the worst was difficulty walking, standing, or feeling like the room was spinning.
It’s not every day that you have a person who is facing a complete breakdown of their faculties, so it was extremely difficult for us to see him go through this. Multiple sclerosis takes no prisoners. Long-lasting and chronic, it attacks the central nervous system. This is a condition in which the body attacks itself by mistake.
Unpredictable and deadly, multiple sclerosis affects people differently. Certain people might exhibit only mild symptoms. Others might lose their ability to see clearly, speak, write or walk, especially when communication between their brain and other parts of the body gets disrupted.
Multiple sclerosis is a disease that causes a breakdown of the protective covering of the nerves. Also called MS, it can result in weakness, numbness, issues walking, vision changes, and other symptoms.
In MS, the immune system attacks the myelin sheath that safeguards nerve fibres in the central nervous system (CNS), resulting in inflammation and nerve damage, resulting in symptoms like numbness, muscle weakness and vision problems. Basically, the immune system treats the myelin sheath as a foreign invader, destroying it.
Multiple sclerosis impacts the brain and the spinal cord by causing the immune system of the body to attack the myelin sheath - leading to heavy central nervous system damage, which interrupts the electrical signals that travel through nerves, resulting in different symptoms like muscle weakness, impaired coordination and more, depending on the location of the damage.
There are four recorded types of MS. You could think of them as a way for your doctor to describe your symptoms.
Clinically Isolated Syndrome (CIS)
This happens when you undergo the first episode of symptoms that suggest MS. However, if you don’t meet the criteria for having MS, doctors might categorise this as CIS. This happens because of inflammation and myelin damage. CIS could develop into a full-blown MS.
Relapse-Remitting Multiple Sclerosis (RRMS)
This is the regular way that MS begins - around 85% of people who are diagnosed with MS have RRMS. This causes flare-ups, relapses or attacks of old or new symptoms. There are periods of remission when symptoms stabilise or disappear.
Secondary Progressive Multiple Sclerosis(SPMS)
In a lot of cases, RRMS progresses to SPMS. In the secondary progressive stage of MS, nerve damage and symptoms get worse. You might still have relapses or flares. However, periods of remission (when symptoms become stable or go away) might not happen.
Primary Progressive Multiple Sclerosis (PPMS)
In certain cases, MS symptoms might start off slowly and gradually get worse over time from the beginning, sans periods of clear relapses or remission.
There are also three rare MS variants which are -
Tumefactive Multiple Sclerosis
One feature of this variant of MS is the formation of large areas of demyelination of the brain, which might show up as a tumour. Sometimes, a sample of brain tissue is required to differentiate this from other issues like brain cancers.
Balo’s Concentric Sclerosis
One feature of this variant of MS is lesions that have concentric rings of myelin damage that show up on an MRI, which lends this condition its name.
Marburg Variant Multiples Sclerosis
This is a rare and aggressive form of MS that has rapid progression, which might result in death if not treated.
Common Physical Symptoms
Fatigue
Fatigue is a common symptom of MS, which can come across as extreme tiredness or physical or mental exhaustion. It can heavily impact daily tasks, relationships and socialising.
You feel exhausted and can’t perform daily tasks. There are physical weaknesses, communication challenges, and issues with swallowing, and it generally requires a lot of time to get your energy back.
Weakness
Feeling weak is a given with MS, especially when it’s a relapse. Muscle weakness can happen in any body part. You might feel as if MS doesn’t permit you to maintain your usual activity level, and your muscles have no strength, or you get tired quickly.
It could also impact your internal health - slowing your metabolism and putting excess pressure on the joints, affecting your balance. Having said that, there’s much you can do to prevent weakness from impacting your health and reverse its effects.
Numbness
Numbness refers to lost, diminished or altered sensation in the body. Numbness in the face, arms, body and legs happens to be one of the most common symptoms of multiple sclerosis. In fact, it might be the first MS symptom you experience.
You might notice that while touching something with your hand, you have less feeling. The sensation in one leg might differ from the other. You might get a pins-and-needles sensation like your limb went to sleep.
Neurological Symptoms
Vision Problems
Common vision problems that you can have when you have MS, include blurred vision, issues with contrast vision, reduced colour perception, double vision (diplopia), blind spots and temporary vision loss, often occurring as “optic neuritis”, which can result in pain behind the eye - such issues crop up because of damage to the optic nerve thanks to inflammation or demyelination in the central nervous system.
Balance Issues
Balance issues are quite a common symptom of MS, often happening because of damage to the brain and spinal cord areas responsible for keeping an equilibrium balance, resulting in feelings of unsteadiness, dizziness and potential falls - such issues might vary in severity and can be managed by physical therapy, medication and assistive devices, depending on the individual case.
Cognitive Changes
Cognitive changes are a common symptom of MS, which can impact learning, attention, memory and more. You tend to forget recent events or things and have issues with concentrating or keeping track of what you’re doing.
You have issues making plans or working out how to achieve your goals. You can’t find the right word and have problems processing information from the five senses.
Emotional and Mental Symptoms
Depression
Depression as a term is commonly applied to a litany of emotional states, ranging from feeling down for a couple of hours to clinical depression, which lasts for months. Depression as a symptom of MS is pretty standard.
According to studies, clinical depression is quite frequent among people with MS than it is in the general population or other chronic illnesses. It is quite common in immune-mediated, neuroinflammatory diseases (rheumatoid arthritis and inflammatory bowel disease).
This shows that inflammation is a contributing factor to depression in these conditions. When it does happen, it deserves the same measured assessment and treatment as any other symptom of MS. If left untreated, depression brings down the quality of life and makes other symptoms feel worse.
Anxiety
Stress and anxiety are often observed as synonyms. However, there is a difference between the two emotions. Stress is a change in someone’s life that can result in emotional and psychological strain. It can be caused by external factors.
Anxiety is the space between the known and the unknown. Our internal reaction often begins as a slight dread or worry and continues to build. Stress usually levels out after it starts.
Anxiety can last for days and is harder to suppress. Anxiety might be caused by anything. Factors like certain medications, lack of oxygen, caffeine, drinking, doing drugs or MS can cause anxiety.
Having listed out the symptoms of MS, we might say that symptoms vary from person to person. What one person might exhibit as a result of MS might not be exhibited by someone else.
Some symptoms are common, like the inability to walk, loss of muscle coordination and more. Some symptoms might not be present in others, like depression, anxiety, or cognitive changes.
The destruction of myelin, or demyelination, results in MS. Myelin is a protective sheath around nerve cells called neurons in the brain and spinal cord. Its responsibility includes moving messages between the brain and the rest of the body to control functions such as movement, sensation and vision.
It is the job of your immune system to protect your body from things that harm it, such as bacteria or viruses. When you have MS, your immune system becomes overactive, mistaking healthy myelin and, occasionally, the nerve cells below the myelin as a threat to the body. The immune system’s attack on the healthy myelin damages it. This is called demyelination.
If you take an imaging test (MRI), your doctor might find evidence of myelin damage. This might be a scar, plaque or lesion. Whenever there is myelin damage, messages don’t pass between nerve cells easily, resulting in MS symptoms developing. Experts are not sure why some people develop MS. According to research, the following might result in an elevated risk of developing MS:-
Exposure to toxins
Exposure to a virus like Epstein-Barr or mononucleosis
Childhood obesity
Genetic predisposition.
Risk factors for MS
You could be more at risk of MS if you are
Between the ages of 20-40
Are of Northern European descent.
Are female.
MS can impact anyone, children included.
How is MS diagnosed?
There is no single diagnostic tool there to gauge the condition. A doctor will diagnose MS after a physical exam, neurological exam and testing. They will learn more about your symptoms and medical history during an exam. Testing might include blood work, an analysis of your spinal fluid, and MRIs of your brain and spinal cord.
An official MS diagnosis might take time. You might need to make multiple trips to see your doctor before you know for sure. This occurs because MS symptoms can mimic several other common conditions.
There might be a delay in an official diagnosis, which might be frustrating. Having said that, getting the correct diagnosis is vital because it assists your provider in accurately treating symptoms.
There are different tests to diagnose MS. Diagnostic testing helps your doctor to rule out similar conditions. These tests might be
Blood and urine tests.
A magnetic resonance imaging test (MRI).
An optical coherence tomography test (OCT).
A lumbar puncture.
Evoked Potential (EP) test.
Is there a cure for MS?
Unfortunately, there is no cure for MS in this day and age.
What does treatment entail?
Treatment for MS means focusing on minimising further damage, taking care of symptoms and preventing complications. Your doctor might come up with a treatment plan that includes.
Medications.
Physical, speech or occupational therapy.
Mental health counselling.
Other kinds of symptom management depend on how MS impacts you. This might include.
Wearing spectacles or ingesting medications for vision symptoms.
Deep brain stimulation for muscle spasms and tremors.
Using assistive mobility devices like a wheelchair or walker.
Antiseizure medication or antispasmodic medications, such as gabapentin or nortriptyline for pain.
Medications like donepezil for cognitive symptoms.
Acupuncture and yoga or other alternative therapies.
Your doctor might put in a word for plasma exchange (plasmapheresis) if your body isn’t responding well to certain medications in the face of MS. This is better for minimising damage from an ongoing attack and preventing additional attacks.
Medications for multiple sclerosis
Medications for MS could reduce relapses, or periods when symptoms get worse or new ones appear, and the development of lesions and scars, as well as slowing the disease’s progression. Common medications for MS are-
Disease-modifying therapies (DMTs) -
DMTs bring down relapses, slow down the progression of MS and prevent new lesions from forming on your brain and spinal cord.
Relapse management medication -
When symptoms worsen, corticosteroids, such as methylprednisolone, bring down inflammation by suppressing the immune system and speeding up recovery time post an attack.
They also slow down damage to the myelin sheath. The doctor might give you this medication intravenously. Other short-term treatments for bad attacks are IV immunoglobulin therapy or plasma exchange.
Disease-modifying therapies -
Common DMTs for MS and their administration types are
Injections into your skin: Beta interferon, glatiramer acetate or ofatumumab.
Infusions into a vein (IV): Natalizumab, rituximab, ocrelizumab or ublituximab, alemtuzumab,
Oral medications (taken by mouth): Dimethyl fumarate, diroximel fumarate, monomethyl fumarate, fingolimod, siponimod, ponesimod, ozanimod, Cladribine or teriflunomide.
While MS might drastically bring down your quality of life, don’t be too worried about the disease or the treatment. What’s important to note is that MS is somewhat treatable - doctors can bring down the impact that the disease has on your life.
You don’t have to live under the impression that you have to live with MS for the rest of your life. With medication and hopefully some therapy, your symptoms might be greatly reduced.
What is multiple sclerosis (MS)?
Multiple sclerosis (MS) is a chronic disease of the central nervous system where the immune system attacks the protective covering of nerve fibres called myelin.
What are the symptoms of MS?
MS symptoms vary widely from person to person and may include fatigue, difficulty walking, numbness or tingling, muscle weakness, vision problems, coordination issues, and cognitive challenges.
What causes multiple sclerosis?
The exact cause of MS is unknown, but it is believed to involve a combination of genetic and environmental factors. In MS, the immune system mistakenly attacks the myelin in the central nervous system.
Is multiple sclerosis hereditary?
MS is not directly inherited, but genetics play a role. Having a close relative, like a parent or sibling, with MS increases the risk, but the vast majority of people with MS do not have a family history of the disease.
How is MS diagnosed?
MS is diagnosed through clinical evaluation, medical history, MRI scans, lumbar punctures (spinal taps), and sometimes blood tests to rule out other conditions.
