Multiple sclerosis (MS) is a disease that attacks the central nervous system, namely the spinal cord and brain. It can also affect the optic nerves, the essential nerves of vision.
“Sclerosis” means scarring or hardening, as in atherosclerosis (hardening of the arteries). In MS, the scarring occurs from damage to nerve tissue. Nerves are insulated by a fatty layer of cells known as the myelin sheath, which acts like the insulation around an electrical wire. In MS, demyelination occurs as the disease triggers the body to attack the myelin sheath as if it was a foreign invader.
As nerves more damaged and the myelin sheath deteriorates, those neurons can no longer efficiently carry signals from the brain to the organs and limbs that they control. Changes in movement and balance are common, as well as speech and other motor activities.
As certain types of MS worsen, the symptoms experienced by the patient become more severe. There is currently no cure for MS, yet various treatments can mitigate symptoms and help the person with MS live their life to the best of their ability.
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Four Types of MS
There are actually four types of multiple sclerosis, each with their own course and symptomatology. According to the National Multiple Sclerosis Society, the four types of MS are:
Clinically Isolated Syndrome (CIS):
This type of MS is “a first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system. The episode, which by definition must last for at least 24 hours, is characteristic of multiple sclerosis but does not yet meet the criteria for a diagnosis of MS because people who experience a CIS may or may not go on to develop MS.”
Relapsing-remitting MS (RRMS):
This is the most common form of MS, with “clearly defined attacks of new or increasing neurologic symptoms.” Often referred to as relapses or flares, the patient may also experience periods of remission with few or no symptoms and no changes in MRI results. Approximately 85 percent of patients living with multiple sclerosis are first diagnosed with RRMS.
Secondary progressive MS (SPMS):
SPMS first appears to be like relapsing-remitting MS. However, some patients will become increasingly disabled and ultimately be diagnosed with this type. SPMS is also seen as active or inactive based on MRI results and the “accumulation of disability”.
Primary progressive MS (PPMS):
PPMS “is characterized by worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions.” Active and inactive states can also occur in this type of MS. Approximately 15 percent of MS patients receive a diagnosis of PPMS.
The Symptoms of MS
As nerves are damaged by MS, the patient will have difficulty using or controlling affected parts of the body. According to the Mayo Clinic, the main symptoms of MS include:
- Numbness or weakness in one or more limbs, more often than not on one side of the body
- Feelings of “electric shock” when the neck is moved in certain ways
- Tingling in the extremities
- Tremors, poor coordination
- Loss of bladder, bowel control, and sexual function
- Difficulty walking
- Visual disturbances, including double vision, vision loss, or pain with eye movement
- Fatigue
- Dizziness
- Difficulty speaking
Treatment Options
The options for treatment of MS have improved over time, yet there is still no cure.
Commonly used treatment regimens are administered via injection while others come in pill form.
Injectables include:
- Beta-interferons, which are drugs that decrease how frequent or severe MS flares may become
- Copaxone or Glatopa (glatiramer) stop the body’s immune system from attacking the myelin sheath
A wide variety of oral medications may be used, some of which can make the patient more prone to infection. Certain chemotherapy drugs used against cancer may be introduced if the patient does not respond to other treatments. Other medications are prescribed based on the type of MS the patient has been diagnosed with.
A medical provider may also prescribe medications for muscle stiffness, depression, bladder control, or fatigue. Some intravenous drugs may also be used for flares, and physical therapy may assist with decreasing mobility and coordination.
The Prognosis When Living with MS
Living with multiple sclerosis is not simple or easy, and many physical and psychological symptoms will manifest. From depression and pain to the loss of bladder control or the inability to walk, the patient must contend with many challenges over time.
Multiple sclerosis is not fatal, thus the prognosis for many patients with MS is that they may live as long as others who do not have the disease. However, some studies show that the individual with MS may live 5 to 10 years less than the general population.
Quality of life and the management of very difficult, inconvenient, and painful symptoms are the reality in life with MS, thus patients need support, love, encouragement, and excellent medical and psychological management in order to live the best life possible with this highly challenging disease.
