Multiple Sclerosis: Hard Facts and Good News

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When you have multiple sclerosis (MS), your immune system attacks your central nervous system. It destroys the myelin, the fatty tissue that surrounds and protects the nerve fibers of your brain and spinal cord.

MS can have debilitating effects, such as paralysis, blindness, impaired thinking and loss of bladder and bowel control. That’s because scar tissue forms around the nerve fibers, preventing them from sending electrical impulses to and from your brain.

But there’s good news: The outlook for most people with MS has vastly improved over the past two decades.

“MS patients today have a very good prognosis,” says Tracy Eicher, MD, MSCS, neurologist with the Clinical Neuroscience Institute. “With early treatment and regular follow-up, we can keep most MS patients working and active and living a fairly ‘normal’ life.”

Types of MS

Dr. Eicher explains that there are four different types of MS, sometimes progressing from one to the next:

Clinically Isolated Syndrome, which is a first episode of neurologic symptoms that lasts at least 24 hours. It is caused by damage to myelin in the brain and/or spinal cord. If a second episode occurs and a brain MRI of the Spine and Brain reveals abnormal areas, it is likely you have relapsing-remitting MS.

Relapsing-Remitting MS affects about 85 percent of people with MS. They have clearly defined attacks of neurologic symptoms, which then lessen or go away for a time. The phase when symptoms go away is called remission.

Secondary Progressive MS, which, as patients age, may involve a steady decline in function rather than identifiable relapses.

Primary Progressive MS, in which people never present with clear events or relapses but show a progressive worsening of function and symptoms from the beginning.

MS Symptoms

Symptoms of MS vary from person to person, depending on the location of damaged myelin. They include:

  • Blurred vision or blindness from optic nerve damage
  • Muscle weakness in the arms and legs
  • Problems with coordination, balance and walking
  • Stiffness and spasms in muscles, called spasticity
  • Fatigue
  • Shaking
  • Dizziness
  • Numbness, prickling or pins-and-needles sensations
  • Bowel and bladder problems
  • Speech and hearing issues
  • Impaired concentration, memory and judgment
  • Depression

“The list of possible symptoms is long,” Dr. Eicher says, “because the brain is the control center for the body, and the spinal cord is the major highway through which messages pass from the brain to the body and from the body to the brain.” 

The outlook for most people with MS has vastly improved over the past two decades.

Exploring Causes

In broad terms, says Dr. Eicher, the immune system causes MS. Yet, no one knows exactly why the immune system begins attacking the body.

“We have not found a specific antibody within the immune system that is the culprit,” she notes. “We know that environmental exposures play a role in triggering the immune system to seek out and attack the central nervous system, but there does not seem to be one specific thing that is the trigger. There are probably multiple variables that play a role in MS.”

Other theories are that viruses or genetic factors may contribute, although MS is not directly inherited from parent to child. Women are three times more likely than men to get the disease, particularly Caucasian women. MS generally appears between ages 20 and 40, but it has been known to occur even in children. Dr. Eicher says that more cases are occurring in patients over age 40, as well.

Diagnosing MS

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Diagnosing MS is often a matter of ruling out other conditions or diseases with similar symptoms. The starting points for identifying MS include interviewing the patient, doing a neurologic exam and getting an MRI. An MRI can reveal plaques or scarring in the brain or spine caused by MS.

Other tests include:

  • Evoked potential test, which records the brain’s electrical response to auditory, visual and sensory stimuli. This test indicates if messages are moving more slowly in certain parts of the brain.
  • A spinal tap, also called a lumbar puncture, can evaluate whether your spinal fluid shows abnormalities commonly seen with MS.
  • Blood tests, to rule out other possible causes

Treating MS

“We have seen multiple new MS treatments come out over the past decade,” Dr. Eicher says. “The most recent drug was approved by the FDA in March 2017. The new medicine can be used for relapsing forms of MS and for primary progressive MS. Many other drugs are in development.”

She adds that there are now more than a dozen treatments, called disease-modifying therapies, that can be taken by injection, mouth (pills) or IV infusion. The therapies vary greatly in strength, side effects and risks. They each take a different approach to the immune system, so if one medication doesn’t work, doctors can move to another approach.

Often, steroids are given as the first treatment for a relapse. Doctors also treat the symptoms caused by the disease, such as spasticity or bladder issues.

Tips for Living with MS

Dr. Eicher offers these guidelines to help you live as well as possible with MS:

  • Take a positive attitude: Don't view yourself as the victim of MS. Put yourself in control by finding a neurologist you trust and can communicate with. Work with your doctor to find an MS medication that you tolerate well and that works for you. 
  • Take vitamin D: Vitamin D levels are important for keeping the immune system healthy. Ask your neurologist what level is right for you. 
  • Eat a low-sodium, low-fat diet: Too much sodium and fat are not good for MS. Fast foods or pre-packaged foods promote a more inflammatory immune system, which drives MS to be more active. Avoid processed foods and eat fresh produce and whole foods.
  • Don't smoke: Nicotine worsens many MS symptoms, because it’s inflammatory for the body and the immune system. Quit smoking and avoid chewing tobacco, patches, gums or vapor with nicotine.
  • Exercise: People with MS often avoid exercise. They’re afraid they will get hot and trigger a relapse. Or they think exercise will worsen their fatigue. Even if you have to make adjustments and increase activity slowly, a higher level of fitness will improve overall function. Exercise also helps improve many symptoms, including fatigue, depression, weakness and cognitive/focus issues, without medications that create potential side effects.
Small Steps: Healthy Vision
Keep your vision strong by visiting an ophthalmologist for a medical eye exam at age 40.