Advanced Multiple Sclerosis

Definition

Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS.

MS affects from 250,000 to 350,000 people in the United States and 2.5 million worldwide.

Multiple sclerosis affects women more than men. It often begins between the ages of 20 and 40. Usually, the disease is mild, but some people lose the ability to write, speak, or walk.

Causes

MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop.

The nerve damage is caused by inflammation. Inflammation occurs when the body’s own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.

It is unknown what exactly causes this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may play a role.

You are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.

Symptoms

Symptoms vary, because the location and severity of each attack can be different. Attacks can last for days, weeks, or months. Attacks are followed by periods of reduced or no symptoms (remissions). Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.

It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.

Nerves in any part of the brain or spinal cord may be damaged. Because of this, MS symptoms can appear in many parts of the body.

Muscle symptoms:

Loss of balance
Muscle spasms
Numbness or abnormal sensation in any area
Problems moving arms or legs
Problems walking
Problems with coordination and making small movements
Tremor in one or more arms or legs
Weakness in one or more arms or legs

Bowel and bladder symptoms:

Constipation and stool leakage
Difficulty beginning to urinate
Frequent need to urinate
Strong urge to urinate
Urine leakage (incontinence)

Eye symptoms:

Double vision
Eye discomfort
Uncontrollable rapid eye movements
Vision loss (usually affects one eye at a time)

Numbness, tingling, or pain:

Facial pain
Painful muscle spasms
Tingling, crawling, or burning feeling in the arms and legs

Other brain and nerve symptoms:

Decreased attention span, poor judgment, and memory loss
Difficulty reasoning and solving problems
Depression or feelings of sadness
Dizziness and balance problems
Hearing loss

Sexual symptoms:

Problems with erections
Problems with vaginal lubrication

Speech and swallowing symptoms:

Slurred or difficult-to-understand speech
Trouble chewing and swallowing

Fatigue is a common and bothersome symptom as MS progresses. It is often worse in the late afternoon.

Exams and Tests

There is no single test for MS. Doctors use a medical history, physical exam, neurological exam, MRI, and other tests to diagnose it.

Tests to diagnose multiple sclerosis include:

Blood tests to rule out other conditions similar to MS
Lumbar puncture (spinal tap) for cerebrospinal fluid tests, including CSF oligoclonal banding
MRI scan of the brain and MRI scan of the spine are important to help diagnose and follow MS
Nerve function study (evoked potential test, such as brainstem auditory evoked response)

Symptoms of MS may be mimic those of many other nervous system problems. MS is diagnosed by ruling out other conditions.

People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.

The doctor may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times.

An exam of the nervous system may show reduced nerve function in one area of the body. Or it may be spread over many parts of the body. This may include:

Abnormal nerve reflexes
Decreased ability to move a part of the body
Decreased or abnormal sensation
Other loss of nervous system functions

An eye examination may show:

Abnormal pupil responses
Changes in the visual fields or eye movements
Decreased visual acuity
Problems with the inside parts of the eye
Rapid eye movements triggered when the eye moves

Treatments

There is no known cure for multiple sclerosis at this time. But, there are treatments that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.

Medicines are often taken long-term. These include:

Medicines to slow the disease
Steroids may be used to decrease the severity of attacks
Medicines to control symptoms such as muscle spasms, urinary problems, fatigue or mood problems

The following may also be helpful for people with MS:

Physical therapy, speech therapy, occupational therapy, and support groups
Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
A planned exercise program early in the course of the disorder
A healthy lifestyle, with good nutrition and enough rest and relaxation
Avoiding fatigue, stress, temperature extremes, and illness
Changes in what you eat or drink if there are swallowing problems
Making changes around the home to prevent falls
Social workers or other counseling services to help you cope with the disorder and get assistance
Vitamin D or other supplements (talk to your doctor first)

Depression
Difficulty swallowing
Difficulty thinking
Less and less ability to care for self
Need for indwelling catheter
Osteoporosis or thinning of the bones
Pressure sores
Side effects of medications used to treat the disorder
Urinary tract infections

When To Contact A Medical Professional

Call your health care provider if:

You develop any symptoms of MS
Symptoms get worse, even with treatment
The condition worsens to the point when home care is no longer possible

Preventions

Without a clearly defined cause of multiple sclerosis, ways to prevent this disease have not yet been identified. Exercising regularly, getting sufficient sleep, or eating healthy meals will be of long-term benefit for many people, but have not been shown to be of help to prevent the development of multiple sclerosis.