MS

Be Informed About This Difficult to Diagnose Disease

What Is MS?

MS is a chronic, unpredictable, and often difficult to diagnose disease which affects the central nervous system (the brain, optic nerves, and spinal cord). It is believed to be an autoimmune disorder (a disease in which the body’s immune system attacks the person’s own tissue).

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Myelin

A complex substance that isolates and protects the nerve path. It is essential to conduct electricity so that brain signals can effectively reach their target.

Axon

Threadlike part of the neuron that acts as the path where electrical impulses travel.

Damaged Myelin

In MS, the myelin is attacked by immune cells and destroyed. When the myelin is damaged, nerves in the brain and spinal cord lose their ability to transmit signals.

Synapses

Gap between two nerves where information is passed along.

Dendrites

Part of the neuron that connects with neighboring cells and relays incoming messages to the cell body.

Cell Body

Also known as soma.

Nerve cells in the brain that constantly send and receive signals

What Happens in Multiple Sclerosis?

The short answer is the destruction of myelin. Myelin is a complex substance that surrounds and insulates nerve fibers and is essential for nerves to perform their function and conduct electricity. When the myelin is damaged, nerves in the brain and spinal cord lose their ability to transmit signals. Think about a cable that should bring a clear signal to your TV but has interference due to damage or corrosion.

With MS, the immune system that normally defends against viruses and bacteria acts atypically and actually attacks the central nervous system, damaging the myelin and creating interference in normal nerve functionality and communication to various parts of the body.

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The Brain

The Brain

  • Tingling or numbness in face, arms, legs, and fingers
  • Cognitive changes such as memory loss or shortened attention span
  • Unexplained weakness or fatigue
  • Dizziness
  • Depression
  • Tremors
  • Difficulty swallowing
  • Difficulty with tasks requiring coordination
  • Loss of muscle coordination
  • Difficulty walking
  • Balance problems

Visual

Visual Disturbances

  • Vision loss
  • Double vision (Diplopia)
  • Blurred vision, eye pain, or blindness
  • Involuntary eye movement

Speech

Speech

  • Muscles in face and mouth may grow weak affecting speech
  • Difficulty with word expression
  • Slurred speech

Muscular

Muscular

  • Pain and muscle stiffness
  • Muscle spasms
  • Disturbances

Excretory

Excretory

  • Dysfunctional bladder
  • Sexual dysfunction
  • Dysfunctional bowel

Symptoms

Symptoms

Multiple sclerosis is a disease with neurological, diverse, and random symptoms that may vary in intensity and location.

Risk Factors

Despite being discovered in 1868, there is still much mystery surrounding the causes of the disease. We do know there are several factors that may increase your risk for developing multiple sclerosis, including:

Age: Commonly affects people who are between 20-40 years of age

Gender: Women are twice as likely as men to develop MS.

Family History: If one of your parents or a sibling has MS, you have a 1-3% chance of developing the disease

Ethnicity: Caucasian people, particularly those whose families originated in Northern Europe are at the highest risk of developing MS.

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Relapse

  • A relapse is also known as an exacerbation or flare-up.
  • Occurs as a result of damage in your brain or spinal cord disrupting nerve signals.
  • A true relapse lasts more than 24 hours, happens at least 30 days after any previous relapse, and occurs in the absence of infection.
  • Relapses will vary in length, severity, and symptoms.
  • Many people will recover from their relapse without any treatment.

Progressive

  • Progressive stages of MS will continuously worsen after it first develops.
  • Neurological disability will accumulate over time. How fast or to what degree disability develops varies for each person and cannot be predicted.
  • Progressive typically means there are no relapses or remissions with the exception of PRMS.
  • Usually takes longer to diagnose. Doctors need to determine the disease is progressing without flare-ups which can take several years of observing.

There are 4 TYPES OF MS

  • Least common stage, only 5% of MS patients have it.
  • May or may not experience recovery periods between attacks.
  • Steadily worsening symptoms.
  • Clearly defined attacks of worsening neurological function followed by complete recovery periods known as remission.
  • Usually, the 1st stages of MS and diagnosed earlier than progressive stages.
  • Symptoms develop at time of attacks but then improve or disappear without trace of disability.
  • PPMS steadily worsens after it first develops without any relapse or remission periods.
  • Diagnosed after progression is continuous for a full year.
  • A person with PPMS may first seek medical care because of leg weakness or difficulty walking.
  • 10 to 15% of people with MS are diagnosed with PPMS.
  • Affects men and women equally.
  • PPMS tends to be diagnosed later in life than other types of MS. Usually after 10 years.
  • Stage which occurs in some patients after RRMS.
  • May or may not experience periods of remission.
  • Diagnosed when the patient begins to experience less and less relapse.
  • 50% of MS patients will develop SPMS within 10 years, 90% within 25 years.
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Pediatric Multiple Sclerosis

Although MS occurs most commonly in adults, it is unfortunately also diagnosed in children and adolescents. Estimates suggest that 8,000-10,000 children (up to 18 years old) in the United States have MS and another 10,000-15,000 have experienced at least one symptom suggestive of MS. Studies suggest that two to five percent of all people with MS have a history of symptom onset before age 18.

Diagnosis

Diagnosing MS in children is more challenging than in adults due to shorter medical histories, the frequency of other childhood disorders with similar symptoms and characteristics, and certain diagnostic limitations in criteria and equipment. Pediatricians may not be familiar with MS because they are not expecting to see it in children. Children with MS benefit from comprehensive care through multidisciplinary teams that include pediatric and adult MS experts.

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Common Diagnostic Tests

MRI

Magnetic Resonance Imaging

  • Machine that uses magnetic field and radio waves to capture high-resolution images of internal systems of the body and brain.
  • Noninvasive way for doctors to examine organ, tissue, and skeletal system.
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Evoked Potential Testing

Evoked Potential Testing

  • Series of tests that focuses on nerve reaction time to various forms of stimulation.
  • Responses are recorded by monitoring brain waves using electrodes.
  • Preformed to see if multiple parts of the CNS are affected.
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Visual

  • Series of tests that focuses on the optical sensory nerves.
  • Can include Strobe lights or checkered patterns

Audio

  • Series of tests that focuses on the auditory system.
  • Often by playing clicking noises or varying tones through headphones.
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Sensory

  • Arms & Legs are stimulated using electrical impulses.
  • Somatosensory testing focuses on signals sent to the muscular system of the body.

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Lumbar Puncture

  • Analysis of fluid surrounding the brain and spinal cord.
  • Fluid is extracted by inserting a needle between two spinal vertebrae in your lower back region.
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FAQs

Multiple sclerosis is a chronic, unpredictable disease of the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. It is thought to be an immune-mediated disorder, in which the immune system incorrectly attacks healthy tissue in the CNS. MS can cause many symptoms, including blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, extreme fatigue, problems with memory and concentration, paralysis, blindness, and more.

Anyone may develop MS but there are some patterns. More than two to three times as many women as men develop MS and this gender difference has been increasing over the past 50 years. Studies suggest that genetic risk factors increase the risk of developing MS, but there is no evidence that MS is directly inherited. Environmental factors, such as low Vitamin D and cigarette smoking have also been shown to increase the risk of MS. MS occurs in most ethnic groups, including African Americans, Asians, and Hispanics/Latinos, but is most common in Caucasians of Northern European ancestry.

More than 2.3 million people are affected by MS worldwide. Because the Centers for Disease Control and Prevention (CDC) does not require U.S. physicians to report new cases, and because symptoms can be completely invisible, the prevalence of MS in the U.S. can only be estimated. Efforts are underway for the establishment of a national registry that will track the number of people living with MS.

Because MS causes damage in the CNS, nearly any function can be adversely affected. However, the most common symptoms are overwhelming fatigue, visual disturbances, altered sensation, and difficulties with mobility. Symptoms of MS are unpredictable and vary in type and severity from one person to another and in the same person over time. Symptoms may disappear or remit completely or they may persist and worsen over time.

MS symptoms occur when the immune-system produces inflammation within the CNS. The inflammatory attack damages myelin, (the protective insulation surrounding nerve fibers), oligodendrocytes (cells that make CNS myelin), and sometimes the underlying nerve fiber. The damage caused by inflammation can produce symptoms that resolve over weeks to months or symptoms that are permanent.

In general, MS is not considered a fatal disease, and most people with MS have a normal or near-normal life expectancy. In rare cases, complications of MS can shorten life—though many complications are preventable or manageable. Very rare instances of MS that progress rapidly from disease onset can be fatal.

No. Moreover, the majority of people with MS do not become severely disabled. Two-thirds of people who have MS remain able to walk, though many will need an aid, such as a cane or crutches, and some will use a scooter or wheelchair because of fatigue, weakness, balance problems, or to assist with conserving energy.

No. MS is not contagious or directly inherited. Studies do indicate that genetic factors and certain environmental factors may make certain individuals more susceptible to the disease.

Not yet. There are now FDA-approved medications that have been shown to “modify” the course of MS by reducing the number of relapses and delaying the progression of disability to some degree. In addition, many therapeutic and technological advances are helping people manage symptoms. Advances in treating and understanding MS are made every year, and progress in research to find a cure is very encouraging.

The doctors at MSCA recommend that a person consider treatment with one of the FDA-approved “disease-modifying” drugs as soon as possible following a definite diagnosis of MS with active or relapsing disease. These medications help to reduce inflammation in the CNS, reduce the frequency and severity of MS attacks and the numbers of lesions in the CNS, and may slow the progression of disability. In addition, these medications that address the disease process, there are many medications and other strategies to manage MS symptoms such as spasticity, pain, bladder problems, fatigue, sexual dysfunction, weakness, and cognitive problems. People should consult a knowledgeable MS care provider to develop a comprehensive plan to manage their MS.

Diagnosing MS can be a challenging process. In early MS, symptoms may be non-specific and suggestive of several disorders of the nervous system. Early symptoms that come and go may be ignored. While no single laboratory test is yet available to prove or rule out MS, Magnetic Resonance Imaging (MRI) is a great help in reaching a definitive diagnosis. Diagnostic criteria that incorporate MRI findings have been developed and revised by experts in the field and have helped providers make an accurate and timely diagnosis.