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Everything You Need to Know About MS. 

 May 21, 2024

By  Linda Rook

Driving with painful back.

Introduction.

Multiple sclerosis develops in about 2.8 million people worldwide, and is common in North America and Europe.

Multiple sclerosis is a chronic autoimmune disease that attacks your central nervous system (CNS), the disease can attack your brain or spinal cord.  The healthy immune system gets attacked by mistake, especially the myelin sheath which protects the covering of the nerve fibers.

In this blog I shall explore what is multiple sclerosis the types, symptoms, diagnosis, and treatment.  How you can live with this terrible disease and much more.

What is multiple sclerosis?

Multiple sclerosis or MS attacks your central nervous system that can affect your brain and spinal cord.  It mistakenly attacks the protective sheath which is called the myelin, that covers the nerve fibers.  Therefore, it can lead to communication problems from your brain to the rest of your body.  Over time your nerves can become permanently damaged, and can cause deterioration.

The main problem with MS is that it causes damage to the covering of your surrounding nerve fibres, called the myelin sheath.  Myelin sheath helps the electrical impulses to travel along the nerve cells. But, when the myelin is damaged the impulses could become blocked or slowed down. 

The damage can lead to scar tissue or sclerosis and lesions or plaques in the central nervous system.  Your medical professional will be able to see if this is happening with an MRI lesion, this means a brain lesion is an abnormality seen on a brain-imaging test.

Other symptoms could include:

  • Fatigue.
  • Difficulty in walking.
  • You may feel numbness or tingling.
  • Your muscles may become weak.
  • And problems with coordination and balance.
  • You may have issues with your vision.
Fatigue

Multiple sclerosis is a complex and varied disease that progresses in different ways, the progression of the disease is classified as several types.  Understanding the types can help with diagnosis, treatment and management.

The following are just the main types of multiple sclerosis that include:

Nerves in the central nervous system in the brain.

1.    Clinically Isolated Syndrome (CIS).

The definition of clinically isolated syndrome is one episode of neurological symptoms that lasts 24 hours, and causes inflammation of the central nervous system.

CIS symptoms could include visual disorders, sensory changes, and there may be other neurological symptoms.

Diagnosis: can be MRI, which can detect brain lesions, people may have a high risk of developing MS.

Prognosis: you may be at high risk of getting MS if the MRI lesions increase.

If the MRI lesions are absent then you are at a low risk of developing MS.

2.    Relapsing-remitting MS (RRMS).

The definition of RRMS is categorized by a definite attack of new or worsened neurological symptoms, that is followed by periods of complete or partial remission.

Progression can be over time and can transition to a more progressive form of the disease.

The prognosis could be variable, this is a frequent and severe relapse that can vary from person to person.

Treatment of this can be disease-modifying therapy DMTs, which can help reduce the frequency and the severity of the relapses.

3.    Secondary progressive MS (SPMS).

The definition of this next one begins as RRMS, but it then changes to a steady disease development and worsening of neurological function over time, that could be with or without the irregular relapses.

The progression of SPMS continues to worsen and can lead to disability over time.

Relapses may still occur but are less common than in RRMS.

The prognosis is that it gradually declines, and the rate of the progression is varied, but in general unfortunately the disability tends to increase.

Treatment of this is focused on managing the symptoms and slowing the progression down.

4.    Primary Progressive MS (PPMS):

The definition of PPMS is mainly a steady progression of the symptoms and disability from the start, and is without early relapses or remission.  It is less common, about 10-15% of people with multiple sclerosis.

The progression of this disease continues to worsen from the beginning.  The symptoms can include mobility problems with walking, and can steadily decline and become worse over time.

Treatment is limited but some DMTs (disease-modifying treatment), can help to slow the progress down.

5.    Progressive-Relapsing MS (PRMS).

The last one is a steady progression of the disease from the onset but can have some relapses or acute attacks, and the least common type of MS.

Progression can continue to worsen with the occasional relapses.

The symptoms can involve a wide range of neurological issues.

Prognoses are steadily declining with attacks, with an increase in disability with relapses.

The treatment is focused on the management of the symptoms to slow the progression down.

What are the risk factors.

Here is a detailed overview of the risk factors of MS:

1.    Genetic Susceptibility.

Genetic Factors: MS is influenced by genetic tendency. Several genes can be associated with the increased risk. The most significant genetic link is the HLA-DRB1 gene on DNA.  A family history of MS can increase the risk, but it is not only a hereditary disease.

genetics

2. Environmental Triggers.

Various environmental factors have been seen to have implications on the onset of MS, this can include:

•     Infections: such as viral infections, especially with Epstein-Barr virus (EBV), could be potential triggers for MS.

•     Vitamin D Deficiency: If you have low levels of vitamin D you may be at higher risk of MS.

•     Smoking: Smoking is a significant risk factor for developing MS and can worsen the disease's progression.

3. Immune System Dysfunction.

Autoimmune Response: MS is an autoimmune disorder where the immune system mistakenly attacks the body’s own tissues.

Symptoms.

Multiple Sclerosis (MS) has many symptoms, which vary, depending on the person and location and extent of the damage to the central nervous system (CNS). These symptoms can also affect various parts of the body and change in intensity or change over time.

Here is an overview of the common symptoms including:

1.    Fatigue: you may have feelings of severe and persistent tiredness even though you have not done any activities.

2.    Muscle Weakness: A decrease in strength of one or more limbs, may occur that may lead to difficulty in movement.

•     Motor Symptoms: Muscle weakness, spasticity, tremors, and coordination problems.

3.    Sensory Symptoms that may include:

•     Numbness and Tingling and pain.

•     A sudden, electric-shock-like sensation that runs down the spine and limbs when the neck is bent forward.

4.    Problems with visual:

•     Optic Neuritis: (inflammation of the optic nerve),

•     Diplopia (Double Vision): and blurred vision.

•     Nystagmus: or rapid eye movements.

5.    Cognitive Impairment.

•     Memory Problems:

•     Trouble focusing or maintaining concentration.

•     Memory problems such as problems with planning,

•     Difficulty concentrating and decision-making.

dry eyes
Toilet with rails.

6.    Emotional and Psychological Changes:

•     Depression.

•     Anxiety.

•     Mood Swings.

7.    Bladder and Bowel Dysfunction:

•     Urinary Urgency and Frequency.

•    Incontinence.

•     Constipation.

•     Loss of bowel control, less common but possible.

8.    Sexual Dysfunction:

•     Decreased Libido.

•     Erectile Dysfunction.

•     Vaginal Dryness.

9.    Speech and Swallowing Difficulties:

•     Dysarthria: Slurred or slow speech due to muscle weakness.

•     Dysphagia: Difficulty swallowing, which can lead to choking or aspiration.

Diagnosis.

When your doctor or healthcare professional diagnoses your symptoms, it can be complex as it involves multiple steps, that need to be ruled out with other conditions to confirm the presence of the MS.  The diagnosis is on a mixture of clinical tests, imaging such as MRI scans and laboratory tests.

The clinical tests can include medical history, and they will want to do several tests.

 This can include:

A neurological examination can asses various functions like your strength, and sensation function, this could be touch, pain, vibration, and temperature.  If your reflexes are present and strong, your vision, facial strength, and sensation.  Also, your balance and coordination.

You may have a magnetic resonance imaging MRI of your brain and spinal cord.  MRI can take images to reveal any lesions or plaques in the central nervous system.

A lumbar puncture or spinal tap, of your cerebrospinal fluid CSF is also analysed, this is done if there other tests show uncertainty.

Visual Evoked Potentials VEP measures the electrical activity in the brain in response to visual stimuli.  Another is Somatosensory Evoked Potentials SEP, which measures the electrical activity in response to sensory stimuli, usually involving the limbs.

Taking Blood

Another test could be blood tests, this can rule out other conditions such as:

•     Infections: Lyme disease, syphilis, HIV.

•     Autoimmune Diseases: Lupus, Sjogren's syndrome, sarcoidosis.

•     Metabolic Disorders: Vitamin B12 deficiency.

The McDonald Criteria is used for diagnosing MS. The test will combine clinical, imaging, and laboratory findings to make a diagnosis.

Multiple Sclerosis symptoms can overlap with other neurological conditions, which can make the different diagnoses essential. Conditions to consider include:

•     Neuromyelitis Optica Spectrum Disorder (NMOSD).

•     Acute Disseminated Encephalomyelitis (ADEM).

•     B12 Deficiency.

•     Vasculitis.

•     Sarcoidosis.

blood flow

Treatment.

The treatment of Multiple Sclerosis can become complicated as it aims to manage the symptoms, by reducing the frequency and cruelty of declines and slowing the progression of the disease.

Treatment strategies include the following:

•     Disease-modifying therapies (DMTs).

•     Symptomatic treatments, and lifestyle interventions.

•     Injectable Therapies.

Acute Relapse Management means being treated with corticosteroids, which can reduce inflammation and speed recovery. They do not affect the long-term course of the disease.

•     Methylprednisolone (Solu-Medrol): these are high-dosages of intravenous administration for 3-5 days.

A weekly box of medication.

Symptomatic Treatment focuses on managing the specific symptoms of MS to improve quality of life.

Treatment for fatigue could be an Antiviral drug, or modafinil (Provigil) which is a stimulant that can help with excessive daytime sleepiness.

To help with muscle weakness you could be prescribed Baclofen (Lioresal), which is a relaxant that reduces spasticity. Another muscle relaxant could be Tizanidine (Zanaflex). Or you can have an injection called Botulinum Toxin (Botox).

Drugs that can help your pain may include:

•     Gabapentin (Neurontin) and Pregabalin (Lyrica): these are for neuropathic pain.

•     Carbamazepine (Tegretol): Effective for the cranial nerve.

You may have bladder dysfunction: for this, you may have Oxybutynin (Ditropan), or for nighttime, you may have Desmopressin (DDAVP).

Exercise can help with improving cognitive functions, or you may be prescribed medication.  Medication that may help could be donepezil (Aricept), although it is not conclusively proven effective.

When you suffer from depression and emotional changes, you may need antidepressants, such as SSRIs like fluoxetine (Prozac) and SNRIs like venlafaxine (Effexor).

Other treatments could be:

•     Counselling and Psychotherapy.

•     Rehabilitation and Supportive Care.

•     Physical Therapy.

•     Occupational Therapy.

•     Speech Therapy.

Physio, Balancing Ball

Or you may have to change your lifestyle which may include:

Changing your diet and nutrition with a balanced diet that is rich in fruits, vegetables, and omega-3 fatty acids.

Exercises regular physical activity tailored to your abilities.

Vitamin D Supplementation can help with deficiencies linked to MS.

Stress Management could be techniques like yoga, meditation, and mindfulness.

There is continued ongoing research to explore new treatments and interventions. 

•     Such as, in some cases there could be Stem Cell Therapy, which includes Hematopoietic stem cell transplantation (HSCT).

•     Another research into new DMTs, meaning research into more targeted therapies with fewer side effects.

•     Or Remyelination Strategies this could be developing treatments that can repair damaged myelin.

The last section is:

How to Live With Multiple Sclerosis.

Living with Multiple Sclerosis (MS) can have a range of challenges, that can affect various aspects of life, this could include, physical health, emotional well-being, social interactions, and professional activities.

With an effective management strategy and support you can lead a fulfilling life.  The next list shows you how you can live with MS and how to manage the impact of daily life.

Pain at the bottom of spine

Physical health management. 

1.    Symptom Management:

•     Fatigue.

•     Spasticity and Muscle Weakness.

•     Pain.

2.    Mobility Aids:

Assistive Devices: such as canes, walkers, and wheelchairs.

Home Modifications: Installing grab bars, ramps, and stair lifts.

3.    Regular Medical Care:

Regular check-ups with a neurologist to monitor disease progression and adjust treatments as needed.

Consulting with urologists for bladder issues, ophthalmologists for vision problems, and physical therapists for mobility concerns.

Emotional and Psychological Well-being.

1.    Mental Health Support:

•     Therapy: Psychological counselling or cognitive-behavioural therapy (CBT).

•     Support Groups: Joining MS support groups provides a sense of community, shared experiences, and emotional support.

2.    Stress Management:

•     Relaxation Techniques: Practices such as yoga, meditation, deep breathing exercises, and mindfulness can reduce stress and improve emotional resilience.

•     Hobbies and Interests: Engaging in enjoyable activities and hobbies to maintain a positive outlook and mental stimulation.

Relaxing Yoga

Social and Family Life.

1.    Communication:

•     Talk with family and friends about MS and its impacts to help build understanding and support.

•     Providing information about MS to loved ones to help them understand the disease better.

Office Chair.

Professional Life.

1.    Workplace Adaptations:

•     Flexible Work Arrangements.

•     Ergonomic Adjustments: Adjusting your workspaces and using special chairs, keyboards, or voice recognition software.

2.    Legal Protections: Americans with Disabilities Act (ADA): Understanding rights and protections under the ADA to ensure reasonable accommodations at work.

•     Employer Communication: Informing employers about MS and discussing potential accommodations to maintain productivity and job satisfaction.

Financial Considerations.

1.    Insurance and Benefits:

•     Health Insurance: Ensuring you have adequate health insurance coverage for medical treatments, medications, and specialist visits.

•     Disability Benefits: Exploring options for disability benefits if unable to work due to MS-related disability.

2.    Financial Planning:

•     Budgeting: Managing finances to accommodate medical expenses and potential changes in income.

•     Legal Advice: Consulting with financial planners and legal advisors to create long-term financial and healthcare plans.

Lifestyle and Wellness.

1.    Nutrition:

•     Healthy Diet: Eating a balanced diet rich in fruits, vegetables, lean proteins, and omega-3 fatty acids to support overall health.

•     Supplements: Considering supplements like vitamin D, as recommended by healthcare providers, to address deficiencies and support immune health.

2.    Exercise:

•     Regular Physical Activity: Engaging in regular, moderate exercise such as walking, swimming, or yoga to maintain strength, flexibility, and cardiovascular health.

•     Adapted Exercise Programs: Working with physical therapists to develop exercise routines tailored to individual abilities and limitations.

Community and Social Engagement.

1.    Staying Connected:

•     Social Activities.

•     Volunteer Work.

2.    Advocacy and Education: Raising Awareness:

•     Support Networks.

Technological and Therapeutic Advances.

1.    Assistive Technology:

•     Devices and Apps.

•     Telehealth.

2.    Emerging Treatments:

•     Clinical Trials.

•     Stem Cell Therapy and Beyond.

Drawing of a nerve cell

Conclusion.

When you live with multiple sclerosis, you should have an active and well-rounded method of keeping the symptoms from getting any worse.

There are many things that you could do including medical treatments, emotional support, social engagement, and lifestyle modifications.

By having available resources, support systems, and many therapies, you could steer the challenges of the disease and maintain a fulfilling life. The journey with MS is unique for each person, and a personalized approach to care, and a strong support network is key to thriving despite the disease.

I hope this article has helped you.  Please subscribe to my website, and I will keep you updated on new blogs.  Also, if you need to know anything about arthritis, please go to my contact page and leave a message, and I will get back to you.

In the meantime, if this post is informative, I would be very grateful if you would help your friends or family if they have a similar condition to tell them.  So please share it on Twitter (X) or Facebook or send them an email.

Also, check out my eBook for more information on this article.

I am not a medical professional, and this blog is for information only.  If you have any worries, you should consult your doctor.

I hope this blog has helped.

More Information:

https://foodwitharthitis.com

https://www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-sclerosis-ms

https://www.nationalmssociety.org/understanding-ms/what-is-ms

https://www.webmd.com/multiple-sclerosis/default.htm

Linda Rook

Linda is now retired and has suffered from Osteoarthritis for about 40+ years.  She struggled with her weight until she found the correct one that also helped with her arthritic pain.  Linda was in terrible pain until the physician thought her right hip needed replacement. 


Now Linda has an artificial right hip, which has left her with the left leg shorter than the right.  Therefore, her spine is now wonky, and has arthritis of the lower back, also it seems to be going all over the body, her pain is now in the knees, elbow, wrist, fingers and both hips.


Linda now spends her days writing information to help others with the same conditions, so they do not suffer like Linda.


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