Multiple sclerosis (MS) is a puzzling disease. While scientists know little about the causes of MS, they know much more about its potentially debilitating effects.
In people with MS, the immune system attacks the central nervous system (the brain and spinal cord). The symptoms of the disease are not continual. They come in episodes. Over time, these episodes can do much damage to the nerves, leaving some patients without the ability to walk or even speak.
There is no cure for MS. However, patients diagnosed with the disease should not feel helpless. There are many therapies that can treat attacks, treat symptoms, and change the course of the disease.
What is multiple sclerosis?
MS is an autoimmune disease, meaning it is driven by the immune system's attack on the body. In patients with MS, the immune system eats away at the layer protecting the nerves. This makes it difficult for the brain to communicate with the rest of the body. Eventually, the immune system's attack can damage the nerves themselves. Once the nerves are damaged, there is no way to fix them.
An estimated 2.1 million people are affected by MS around the world. In the United States alone, about 400,000 people are living with the disease. Every week, 200 more Americans are diagnosed with MS.
Women are much more likely to be diagnosed with MS than men. MS is also more common in places farther from the equator.
The signs and symptoms of MS vary widely, as the location and severity of each attack can be different. Some episodes may last for days, while others can continue for months.
In most patients, these episodes come and go. MS patients can experience periods of reduced or no symptoms. These periods are called remissions. However, symptoms commonly return in periods called relapses.
MS can damage the nerves in any part of the brain or spinal cord. As a result, symptoms of the disease can occur in many parts of the body. Symptoms may involve the muscles, bowel, bladder, eyes, brain, nerves, sexual problems, and speech. These symptoms may include:
- numbness or tingling in the arms, legs, face, or any other part of the body
- trouble walking
- speech problems
- coordination problems
- painful muscle spasms
- eye pain
- total or near-total loss of vision
- reduced attention span
- memory loss
- fatigue, which is often worse in the late afternoon
Types of MS
There are four types of MS. Each type is characterized by how the disease progresses.
Relapsing-remitting MS is the most common form of the disease. Over 80 percent of MS patients start with relapsing-remitting cycles. Patients with this form of MS experience attacks of symptom flare-ups (relapses) followed by periods of recovery (remission). The symptoms can be anywhere from mild to severe. Both relapses and remissions can last for only a few days or for months.
Secondary-progessive MS often happens in patients with relapsing-remitting MS. Patients with this form of MS have may recover to a point. However, their disability does not go away between relapses. Over time, these patients become more and more disabled until increasing disability replaces the cycle of attacks.
Primary-progressive MS does not involve periods of relapse and remission. This form of MS is characterized by the steady worsening of damage to the brain and spinal cord. In general, the intensity of symptoms does not improve. Around 15 percent of MS patients have primary-progressive MS.
Progressive-relapsing MS is a rarer form of the disease. Patients with this form of MS face steadily worsening symptoms and attacks during periods of remission.
Who is at risk for multiple sclerosis?
MS can happen at any age, to any gender, to any race, and in any part of the world. Nevertheless, the risk is greater among some populations, including:
- people between 20 and 40 years of age
- women, who are about two times more likely than men to develop MS
- people with a family history of MS
- people who have had certain infections
- white people
- people who live in countries with temperate climates
- people with other autoimmune diseases such as type 1 diabetes, thyroid disease, or inflammatory bowel disease
What causes multiple sclerosis?
The cause of MS is still a mystery. However, researchers are looking at several factors that could play a role. They believe the disease may be caused by a combination of these factors, which may be immunologic (the science of the immune system), environmental, infectious, or genetic.
Most scientists agree that MS involves an autoimmune process in which the body's own immune system attacks the myelin sheath (the fatty layer that covers nerve fibers). Yet, the exact antigen (the substance that causes the immune system to attack) is still not known. There have been a number of studies looking into the autoimmune process in MS. Researchers have found which immune cells are attacking nerves. They have also learned a little bit about why those cells might attack.
Environmental factors also seem to play a role in MS. It is known that rates of MS are higher in areas farther from the equator. Some studies have shown that people born in high-risk areas who move to low risk-areas before 15 years of age no longer have the MS risk of their birthplace. They acquire the risk of their new environment.
Some researchers believe that the higher risk of people farther from the equator is related to vitamin D - a vitamin the body produces in response to sunlight. People who live farther from the equator do not get as much sunlight per year, compared to those closer to the equator. As such, people closer to the equator have higher levels of vitamin D, which may be good for the immune system and protect against autoimmune disease like MS.
Some studies have suggested that certain infections may trigger the development of MS. Because viruses are known to damage the myelin sheath and cause inflammation, it could be possible that a virus or other infection is causing MS. Currently, researchers are looking at a variety of viruses and bacteria as potential culprits in MS. These viruses and bacteria include measles, canine distemper, herpes, Epstein-Barr, and Chlamydia pneumonia. While some of these infections may play a role in MS, none of them have been shown to cause the disease.
Scientists are also studying the role of genetics in MS. Studies shown that certain genes are more common in groups with higher rates of MS. Researchers have found common genetic factors in families where more than one person has MS. In addition, people with a first-degree relative (parent or sibling) with MS have an increased risk of developing the disease. While there is still a lot of mystery around the role of genetics in MS, new technologies and techniques for studying genes may reveal more in the coming years.
What are the treatment options for multiple sclerosis patients?
Despite the crippling effects of MS, patients diagnosed with the disease do not need to feel hopeless. While there is still no cure for the disease, there are treatments to modify the course of the disease, treat attacks, and manage symptoms.
Modifying the Course of the Disease
Modifying the disease course means to reduce disease activity and slow the progression of MS. There are many drugs that patients can take, including:
- Avonex (interferon beta-1a)
- Betaseron (interferon beta-1a)
- Copaxone (glatiramer acetate)
- Extavia (interferon beta-1a)
- Gilenya (fingolimod)
- Novantrone (mitoxantrone)
- Rebif (interferon beta-1a)
- Tysabri (natalizumab)
Attacks of MS, or exacerbations, are caused by inflammation in the brain and spinal cord that damages the myelin sheet and makes it difficult to transmit nerve signals. The most common treatment for severe exacerbations is usually a high-dose of corticosteroids, which are often simply called "steroids." Corticosteroids decrease inflammation and reduce the activity of the immune system.
The symptoms of MS can be very different from person to person. They can even change over time in the same individual. They can be mild or severe and affect many parts of the body.
Many symptoms are managed using medications. Besides medications, MS patients can deal with their symptoms through self-care techniques, rehabilitation (physical or occupation therapy, speech therapy, cognitive remediation therapy, and others), and the use of a number of devices for bathing, dressing, cooking, housekeeping, writing, reading, and driving.
MS patients can also take advantage of rehabilitation programs to improve their function. These programs are designed to help patients boost and preserve their ability to perform many tasks at home and at work. Rehabilitation experts can help patients with their overall fitness and energy management, as well as with speech, swallowing, memory, and other cognitive functions.
How do multiple sclerosis patients cope with emotional stress?
While MS patients have options for reducing their symptoms, there is no way to rid their body of the disease. A lifelong battle with MS - or any chronic disease, for that matter - can be emotionally stressful.
People with MS should be aware that your physical health can affect your mental health. But there are ways to manage the emotional toll. Dealing with the ups-and-downs of MS mainly involves maintaining normal activities and relationships. Support groups can also help by giving patients a forum to share their experiences and feelings with people in similar situations. Your doctor may be able to recommend an MS support group in your area.
MS may be a debilitating and painful disease, but treatments are improving with each new research discovery. As scientists continue to search for the causes of MS, they get closer and closer to a cure. Until then, patients should take advantage of the variety of treatments that can reduce pain, disability, and the overall progression of the disease.