Multiple sclerosis (MS)

Multiple sclerosis can cause a wide range of symptoms and affect any part of the body. Each person with the condition is affected differently, and the symptoms can be unpredictable. Some individuals experience mild symptoms, while others may have severe difficulties in performing daily tasks. These problems may come and go or persist and worsen over time.

The most common signs and symptoms of Multiple Sclerosis are:

• Fatigue: Fatigue or tiredness is one of the most common symptoms of MS. It can significantly interfere with daily activities and tends to worsen towards the end of each day.
• Vision Problems: Vision problems are usually observed in 1 out of 4 individuals and are often the first noticeable symptom. The person may experience eye pain, temporary loss of vision in the affected eye, and decreased vibrancy of colors.
• Muscle Spasms, Stiffness, and Weakness: MS can cause the muscles to become stiff and resistant to movement.
• Mobility Problems: MS can make walking and moving around difficult, particularly if a person is experiencing muscle weakness and stiffness. Symptoms may include difficulty in balancing and coordination, shaking of legs, dizziness, and vertigo.
• Musculoskeletal Pain: People with MS may find it difficult to walk or move around, leading to pressure on the joints and resulting in back pain, neck pain, and other joint pain.
• Bladder Problems: Loss of bladder control is an early sign of MS. The person may have difficulty emptying the bladder and experience a sudden urge to urinate.
• Sexual Problems: MS can affect sexual activity in both men and women. In men, it may lead to erectile dysfunction and loss of the ability to ejaculate. In women, it can include difficulty in reaching orgasm, decreased vaginal lubrication, and reduced sensation.
• Bowel Problems: MS can cause bowel dysfunction, leading to constipation (difficulty in passing stool) and bowel incontinence (inability to control bowel movements, resulting in stool leaks from the rectum without warning).
• Difficulties in Thinking, Learning, and Planning: Some individuals with MS may experience challenges in thinking, learning, and planning, which can include:
  • Slowness in processing information
  • Problems in understanding visual information
  • Difficulties in learning new things
  • Getting stuck on words
• Mental Issues: People with MS may experience periods of depression and anxiety. It is unclear whether this is caused by the disease itself or the stress of living with a long-term condition.

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The exact cause of the development of MS is not known. It is considered an autoimmune and inflammatory condition caused by a combination of genetic and environmental factors.

In MS, the myelin sheath covering the nerves in the brain and spinal cord becomes inflamed. These patches of inflammation can disrupt the messages traveling along the nerves. If the attacks are frequent and repeated, it can eventually lead to permanent damage to the underlying nerves.

Some factors that have been suggested as possible risk factors for multiple sclerosis include:

• Age: It most commonly occurs in people during their 20s to 40s, although it can develop at any age.
• Sex: According to the National Multiple Sclerosis Society, MS is at least two to three times more common in women than in men. It has been suggested that hormones may play a significant role in determining susceptibility to MS.
• Family history: Various family studies indicate that 15–20% of MS patients have one or more affected relatives.
• Genes: Multiple sclerosis is not an inherited disease; it is not passed from generation to generation. However, there is a genetic risk that is inherited. Variations in various genes increase susceptibility to MS, with variation in the HLA-DRB1 gene being the strongest genetic risk factor for developing multiple sclerosis.
• Race: Research shows that MS occurs in most ethnic groups, including African Americans, Asians, and Hispanics, but is most common among white individuals of northern European descent.
• Location: MS is more common in people at higher latitudes (further from the equator) at a young age.
• Vitamin D deficiency: Research indicates that young children and adults who spend more time outdoors have a reduced risk of developing multiple sclerosis. Low levels of vitamin D in the blood have been identified as a risk factor for the development of MS. Vitamin D is thought to support immune function and may help protect against immune-mediated diseases.
• Smoking: People who smoke are about twice as likely to develop multiple sclerosis compared to those who do not smoke. Smoking is associated with more severe disease and more rapid disease progression.
• Obesity: Obesity in early life increases a person's risk of developing MS and MS-related disabilities.
• EBV infection: Individuals who have had a previous infection with Epstein-Barr virus (EBV) contribute to the risk of developing MS. The virus may trigger the immune system, leading to the development of MS.

It can be hard to diagnose multiple sclerosis, as some symptoms can be vague or similar to other conditions. The diagnosis of MS is complicated because no single test can positively confirm it.

History and Physical Examination

A general practitioner will assess the individual during the appointment. This evaluation involves a complete health history and neurological exam, which includes:

• Movement and coordination
• Vision
• Balance
• Sensory exam
• Cranial nerves exam
• Mental functioning
• Emotional functions

The doctor will also inquire about the frequency of attacks in the last few months. An attack is defined as the sudden onset of any MS symptoms. Following this assessment, the doctor may order further imaging tests and evaluations to rule out other possible disorders. A series of lab tests will also be conducted to aid in diagnosis.

Blood Tests

Blood tests are performed to rule out other causes of various neurological symptoms. For example, tests may be conducted to exclude conditions like neuromyelitis optica, a rare condition where the immune system damages the spinal cord and the nerves of the eyes, which can cause similar symptoms to MS and is often misdiagnosed as such.

Book your tests from the comfort and safety of your home.

Imaging Tests

Magnetic Resonance Imaging (MRI) Test

An MRI scan is a painless imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in the body. It helps check for damage or scarring of the myelin sheath, the layer surrounding the nerves in the brain and spinal cord.

Lumbar Puncture

A lumbar puncture is a procedure to remove a sample of spinal fluid by inserting a needle into the lower back. Spinal fluid surrounds the brain and spinal cord, and changes in the fluid can indicate problems in the nervous system. This procedure provides additional information if abnormalities are detected in the scans.

Evoked Potential Tests

Sensory evoked potentials are painless tests that measure the electrical activity in the brain in response to stimulation of sight, sound, or touch.

The most common test assesses the functioning of the eyes. A light pattern is shown to the eyes while brain waves are monitored using small sticky patches of electrodes placed on the head.

This test is used in combination with other diagnostic tests to assist in diagnosing neurological disorders.

Currently, there are no known ways to prevent getting MS. However, a few lifestyle changes might help reduce the risk of developing this condition:

• Maintain a healthy weight: Being overweight or obese in early life increases a person's risk of developing MS. Maintaining a healthy weight through regular exercise, a nutritious well-balanced diet, and proper sleep is crucial in reducing the risk of MS.
• Sustain optimum levels of Vitamin D: Exposure to the sun and adequate intake of vitamin D in the diet are important modifiable environmental risk factors for the development of multiple sclerosis. Here are a few points you need to know about vitamin D and its importance.
• Avoid smoking: Smoking and exposure to secondhand smoke increase the risk of developing MS and its progression. Quitting smoking can not only reduce the risk of MS but also greatly benefit your overall health.

Looking to quit smoking but finding it difficult? Read about some practical ways that can help you overcome this unhealthy habit.

Currently, there is no cure for multiple sclerosis. Management of MS includes medication for managing MS attacks, slowing the progression of the disease, and managing its symptoms:

Treatment for MS Attacks

• Corticosteroids such as oral prednisolone and IV methylprednisolone are prescribed to reduce nerve inflammation and manage MS attacks.
• Plasma exchange may be advised in cases of new and/or severe symptoms with no response to corticosteroids. In this procedure, the plasma (liquid portion of the blood) is separated from the blood cells. The blood cells are then mixed with plasma from a donor or with a plasma substitute like protein (albumin) solution and injected back into the body.

Treatment to Slow Progression of MS

Several disease-modifying therapies (DMTs) are available to slow disease progression and reduce the number of attacks in multiple sclerosis. Treatment options include oral, injectable, and infusion medications. Some examples of each class are mentioned below.

Oral Medications

• Dimethyl fumarate
• Monomethyl fumarate
• Diroximel fumarate
• Fingolimod
• Ponesimod
• Teriflunomide

Injectables

• Interferon beta
• Glatiramer acetate

Infusion Treatments

• Mitoxantrone
• Natalizumab
• Ocrelizumab

Treatment of Specific MS Symptoms

MS can cause a range of symptoms that can be treated individually. Symptoms differ from person to person. Treatments for some of the main symptoms are discussed below.

Fatigue

Many people with MS experience fatigue, and medications like amantadine, modafinil, and methylphenidate are prescribed for managing fatigue caused by MS. Fatigue is also managed by light exercise, energy-saving patterns, and maintaining healthy sleeping habits.

Visual Problems

MS-related visual problems often improve on their own. However, if symptoms are particularly severe, steroids may be prescribed to help speed up recovery.

Neuropathic Pain

Neuropathic pain is caused by damage to the nerves and is usually sharp and stabbing. This type of pain can be treated using antidepressants, which are used as painkillers, such as gabapentin and amitriptyline.

Muscle Stiffness

Muscle relaxants such as baclofen, tizanidine, and cyclobenzaprine may be prescribed to manage painful or uncontrollable muscle spasms.

Other medications may be prescribed for depression, sexual dysfunction, insomnia, bladder or bowel control issues, increasing walking speed, and other symptoms associated with MS.

Eat a healthy diet

Consume a healthy diet rich in fruits and vegetables, healthy fats, and whole grains. Limit the intake of sugar, high salt, packaged, and processed foods.

Add these to your diet:

• Omega fatty acids: Omega fatty acids play an important role in MS patients. The consumption of omega fatty acids from food sources such as walnuts, flax seeds, and fatty fish (including salmon and sardines), or in supplements is linked with decreased morbidity and mortality.
• Turmeric: Some studies have shown that turmeric has potential benefits in treating MS. Turmeric contains high levels of the natural compound curcumin, which has outstanding anti-inflammatory and neuroprotective effects.

Manage stress

According to some studies, stress can precipitate MS relapses and worsen disability through various mechanisms, including excessive inflammatory response and worsening degeneration.

Do regular exercise

Regular, moderate physical exercise is beneficial for the body, mind, and mood, especially for patients with MS. Exercise can improve fitness, endurance, and strength in the arms and legs, provide better control over bowel and bladder functioning, and boost mood.

The best exercises for individuals with MS are:

• Stretching: This helps maintain your range of motion and eases symptoms related to muscle tightness or stiffness. Yoga can also be performed for stretching the body for 10-15 minutes.
• Resistance training: This helps maintain muscle strength and can be performed twice a week.
• Aerobic exercise: Also known as endurance activities or cardio exercises of low to high intensity that increase your heart rate, such as walking, jogging, or swimming. It is recommended to perform these exercises three times a week or a total of 120 minutes.

Avoid smoking and limit alcohol intake

Smoking and exposure to secondary smoke increase the risk of developing MS and its progression. Quitting smoking can help reduce the rate of disability progression. Alcohol intake affects the bladder by increasing urinary urgency and frequency. Even one drink of alcohol depresses the central nervous system and can interfere with certain medications commonly used to manage MS symptoms.

Maintain optimum Vitamin D levels

Vitamin D is essential for bone, muscle, nerve, and immune system health. Research has shown that maintaining adequate levels of vitamin D may have a protective effect and lower the risk of developing multiple sclerosis.

Fill any gaps in your Vitamin D levels with dietary supplements.

Did you know? Ginkgo biloba is a promising medicinal herb that may reduce inflammation and fatigue in individuals living with MS. However, caution should be exercised with ginkgo in patients with bleeding disorders or those taking nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants such as heparin or warfarin.

The following therapies can be used to augment conventional treatment modalities. Do consult your doctor before starting any of these alternative therapies:

• Stress Management
  Stress can exacerbate MS symptoms as it is linked to brain health and immune response. Effective stress management is crucial for practicing good sleep hygiene, maximizing the restorative process during sleep. Techniques such as deep breathing, progressive muscle relaxation, listening to music, and aromatherapy with essential oils like chamomile and lavender can help manage stress. Is stress affecting your overall well-being? Try some relaxation techniques to manage stress.
• Yoga
  For individuals experiencing muscle spasticity, fatigue, pain, or difficulty walking due to MS, yoga may offer relief. It encourages relaxation, builds core strength, strengthens pelvic floor muscles, decreases spasticity, and improves balance and coordination.
• Psychotherapy
  Also known as talk therapy, this encompasses various treatments aimed at helping individuals identify and change troubling emotions, thoughts, and behaviors. A psychologist assists in modifying or alleviating symptoms while promoting personal growth. The goals of psychotherapy include:
  • Alleviating emotional pain or confusion
  • Assisting in developing a complete understanding of psychological issues
  • Establishing coping strategies or skills
• Acupuncture
  Acupuncture typically involves the use of thin needles to stimulate specific areas of the body. This ancient practice may provide relief from pain, muscle spasms, numbness, tingling, bladder problems, and depression associated with MS.

Right care and support may help people suffering from MS lead long, active, and healthy lives. Self-care is an integral part of daily life, which includes taking responsibility for your own health and well-being, with support from those involved in care. Self-care includes engaging in activities like maintaining good physical and mental health, preventing illness or accidents, and effectively dealing with long-term complications.

Individuals living with MS can manage the disease by considering the following aspects:

• Get good sleep: MS can cause sleep problems, including insomnia, frequent nighttime urination, narcolepsy, and leg spasms. Practicing good sleep hygiene can help combat MS fatigue. Here are a few ways to achieve restful sleep:
• Try to go to bed and wake up at the same time every day.
• Avoid caffeine in the late evening.
• Try meditation, yoga, and deep breathing during the day.
• Struggling to fall asleep? Read about some amazing tips that will help you improve your quality of sleep. Explore tips
• Keep your body active: Exercise helps improve muscle strength and fitness, enhances posture, and reduces pain and fatigue in people with MS. Individuals participating in aerobic exercise programs benefit from improved cardiovascular fitness, increased strength, and better bladder and bowel functioning.
• Take a nutritious diet: Diet is an essential part of managing MS. Individuals with MS should follow a diet rich in fruits, vegetables, whole grains, and lean proteins.
• A plant-based diet can lower fatigue and mood swings while helping manage weight and cholesterol levels.
• Intake of foods rich in omega-3 fatty acids, including fish oil supplements, walnuts, and flax seeds, has been found to reduce relapse and inflammation rates and improve the quality of life for individuals living with MS.
• Consuming enough fiber and drinking adequate water can help ease constipation, reducing gut inflammation and aiding in fighting MS.
• Talk to a Counselor: Counseling helps people manage emotions and understand thoughts and behaviors, playing an important role in the management of MS patients.
• Coping with stress.
• Managing depression and anxiety.
• Improving communication with loved ones.
• Take care of your emotional and mental well-being: Engaging in mentally stimulating activities contributes to personal growth, helping the mind stay active, alert, and engaged even in the face of aging or changes caused by MS.
• Staying connected to feelings, priorities, and values can help calm emotional turmoil by eliminating unnecessary stressors.
• Relationships and bonding can provide support and opportunities for shared goals and problem-solving. Positive relationships reduce feelings of isolation and promote a sense of emotional well-being in everyday life.
• Meditation can be amazing for your soul and body. Read how meditation can improve your life. Tap Here
• Join Support Groups: Support groups can help individuals connect with other patients and caregivers, establishing a valuable network for exchanging ideas, providing motivation, and encouragement. This fosters a sense of well-being and reminds individuals that they are not alone in this journey.