Multiple Sclerosis – Overview
A potentially disabling disease of the brain and spinal cord (central nervous system) is known as multiple sclerosis (MS).
The immune system attacks the protective sheath (myelin) in MS in which nerve fibers are covered and causes communication problems between the brain and the rest of the body. Eventually, permanent damage or deterioration of the nerves can be caused by the disease.
Signs and symptoms of MS differ widely and are depended on the amount of nerve damage and which nerves are affected. Some people with MS which is severe may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms.
Cure for multiple sclerosis is not available. However, the recovery can be speed up by treatments from attacks, modify the course of the disease and manage symptoms.
Signs and symptoms of multiple sclerosis may vary greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. Movement can be affected by the symptoms, such as:
- Numbness or weakness in one or more limbs that generally occurs on one side of the body at a time, or the legs and trunk
- During certain neck movements, electric-shock sensations that occur, especially bending the neck forward (Lhermitte sign)
- Tremor, lack of coordination or unsteady gait
Vision problems are also common which may include:
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
- Prolonged double vision
- Blurry vision
Additionally Multiple sclerosis symptoms may also include:
- Slurred speech
- Tingling or pain in parts of your body
- Problems with sexual, bowel and bladder function
A doctor should be consulted if experiencing any of the above symptoms for unknown reasons.
A relapsing-remitting disease course happens with most people. Periods of new symptoms or relapses that develop over days or weeks are experienced and usually improve partially or completely. Quiet periods of disease remission that can last months or even years are followed after the relapses.
Signs and symptoms of MS can be temporarily worsened due to small increases in body temperature, but these aren’t considered disease relapses.
About 60 to 70 percent of people with relapsing-remitting MS eventually have a steady progression of symptoms developed, with or without periods of remission, called as secondary-progressive MS.
Problems with mobility and gait are signs of worsening of symptoms. The rate of disease progression differs greatly among people having secondary-progressive MS.
A gradual onset and steady progression of signs and symptoms without any relapses is experienced by some people having MS. This is called as primary-progressive MS.
The cause of multiple sclerosis is not known as it is considered an autoimmune disease in which own tissues are attacked by the body’s immune system. In the case of MS, the fatty substance is destroyed by the malfunction of the immune system that coats and protects nerve fibers in the brain and spinal cord (myelin).
The insulation coating on electrical wires can be compared to myelin. When the protective myelin is damaged and nerve fiber is exposed, the messages may be blocked or slowed that travel along that nerve. The nerve may also become damaged by itself.
MS developing in some people and not others is unclear. A mixture of genetics and environmental factors appears to be responsible.
Risk of developing multiple sclerosis may be increased by the following factors:
- At any age MS can occur, but generally affects people somewhere between the ages of 16 and 55.
- Women are two to three times more likely as men are to get relapsing-remitting MS.
- If having family history of MS, risk of developing the disease is higher.
- A variety of viruses have been connected to MS, including Epstein-Barr, the virus which causes infectious mononucleosis.
- Risk of developing MS in white people specifically those of Northern European whereas people of Asian, African or Native American descent have the lowest risk.
- Countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe MS is more common to occur
- Having low levels of vitamin D and sunlight exposure is low is related with a greater risk of MS.
- Risk of developing MS is slightly higher if having thyroid disease, type 1 diabetes or inflammatory bowel disease.
- Smokers who have experienced an initial event of symptoms that may indicate MS are more likely compared to nonsmokers to develop a second event that confirms relapsing-remitting MS.
People with multiple sclerosis may also have:
- Muscle stiffness or spasms
- Paralysis, typically in the legs
- Problems with bladder, bowel or sexual function
- Mental changes, such as forgetfulness or mood swings
Cure for multiple sclerosis is not available. Speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms is the focus of the treatment. No treatment is necessary for some people having very mild symptoms.
Treatments for MS attacks
- Corticosteroids such as oral prednisone and intravenous methylprednisolone, are prescribed to decrease nerve inflammation. Insomnia, increased blood pressure, mood swings and fluid retention are side effects that may be included.
- Plasma exchange (plasmapheresis) is the liquid portion of part of the blood (plasma) which is removed and separated from the blood cells. The blood cells are then combined with a protein solution (albumin) and put back into the body. New, severe and haven’t responded to steroids then plasma exchange might be used.
Treatments to modify progression
For primary-progressive MS, the only FDA-approved disease-modifying therapy (DMT) is the ocrelizumab (Ocrevus). Those who are going through this treatment are slightly less likely to progress than those who are not treated.
Several disease-modifying therapies are available for relapsing remitting MS.
Most of the immune response related with MS occurs in the early stages of the disease. Aggressive treatment with these medications as soon as possible can decrease the relapse rate and slow the formation of new lesions.
Significant health risks are carried by many of the disease-modifying therapies used to treat MS. Many factors are taken into careful consideration for selecting the right therapy, including duration and severity of disease, effectiveness of previous MS treatments, other health issues, cost, and child-bearing status.
For relapsing-remitting MS options for treatment include injectable medications, including:
- Beta interferons are medications which are among the most commonly prescribed medications for the treatment of MS. They are injected under the skin or into muscle and can decrease the frequency and severity of relapses.
Flu-like symptoms and injection-site reactions are the side effects of beta interferons.
Blood tests may be required to monitor the liver enzymes because liver damage is a possible side effect of interferon use. Neutralizing antibodies may be developed in people taking interferons that can reduce drug effectiveness.
- Glatiramer acetate (Copaxone, Glatopa) medication may help block the immune system’s attack on myelin and must be injected beneath the skin. Skin irritation at the injection site may be the side effects included.
Oral treatments include:
- Fingolimod (Gilenya) is a medication which is once-daily oral medication which reduces relapse rate.
Heart rate may need to be monitored for six hours after the first dose because the heartbeat may be slowed. Rare serious infections, headaches, high blood pressure and blurred vision are other side effects which may be included.
- Dimethyl fumarate (Tecfidera) is a twice-daily oral medication which can decrease relapses. Flushing, diarrhea, nausea and lowered white blood cell count are side effects which may be included.
- Teriflunomide (Aubagio) is once-daily oral medication which can decrease relapse rate. Liver damage, hair loss and other side effects can be caused by teriflunomide. It is harmful to a fetus which is developing and should not be used by women who may become pregnant and they or their male partner are not using proper contraception.
- Siponimod (Mayzent) has shown in research that this once-daily oral medication can decrease relapse rate and help slow progression of MS. It’s also approved for secondary-progressive MS. Viral infections, liver problems and low white blood cell count are possible side effects. Changes in heart rate, headaches and vision problems are other possible side effects. Siponimod is harmful to a developing fetus, so women who may become pregnant should use contraception when taking this medication and for 10 days after ceasing the medication.
Infusion treatments include:
- Ocrelizumab (Ocrevus) is a humanized immunoglobulin antibody medication that is the only DMT approved by the FDA to treat both the relapse-remitting and primary-progressive forms of MS. Reduced relapse rate in relapsing disease and slowed worsening of disability in both forms of the disease has shown in clinical trials.
Via an intravenous infusion ocrevus is given by a medical professional. Irritation at the injection site, low blood pressure, a fever and nausea, among others are infusion related side effects. The risk of some types of cancer, particularly breast cancer may be increased by ocrevus.
- Natalizumab (Tysabri) is a medication which is designed to block the movement of potentially damaging immune cells from the bloodstream to the brain and spinal cord. It may be a first line treatment which is considered for some people with severe MS or as a second line treatment in others.
The risk of a potentially serious viral infection of the brain called progressive multifocal leukoencephalopathy (PML) is increased in people who are positive for antibodies to the causative agent of PML JC virus. Almost no risk of PML is present in people who don’t have antibodies.
- Alemtuzumab (Campath, Lemtrada) is a drug that helps to reduce relapses of MS by targeting a protein on the surface of immune cells and depleting white blood cells. Potential nerve damage can be limited by this effect caused by the white blood cells. But the risk of infections and autoimmune disorders is also increased, including a high risk of thyroid autoimmune diseases and rare immune mediated kidney disease.
Five consecutive days of drug infusions followed by another three days of infusions a year later is involved in the treatment with alemtuzumab. Reactions to infusion are common with alemtuzumab.
Registered providers only have this drug available, and people treated with the drug must be registered in a special drug safety monitoring program.
- Mitoxantrone is a immunosuppressant drug that can be harmful to the heart and is related with development of blood cancers. As an outcome, its use in treating MS is extremely limited. Mitoxantrone is only rarely used for the treatment of severe, advanced MS.
Treatments for MS signs and symptoms
Treatments for MS signs and symptoms
- Physical therapy. Stretching and strengthening exercises can be taught by the physical or occupational therapist and how to use devices to make it easier to perform daily tasks may also be shown.
Physical therapy combined with the use of a mobility aid when required can also help in managing leg weakness and other gait problems often related with MS.
- Muscle relaxants. Painful or uncontrollable muscle stiffness or spasms, particularly in the legs may be experienced. Baclofen (Lioresal) and tizanidine (Zanaflex) are muscle relaxants that may help.
- Medications to decrease fatigue such as Amantadine (Gocovri, Oxmolex), modafinil (Provigil) and methylphenidate (Ritalin) may be helpful. Some drugs which are used for the treatment of depression, including selective serotonin reuptake inhibitors, may be recommended.
- Medication to increase walking speed. For some people, Dalfampridine (Ampyra) may help to slightly increase walking speed. People having a history of seizures or kidney dysfunction should not consume this medication.
- Other medications. Medications for depression, pain, sexual dysfunction, insomnia, and bladder or bowel control problems that are associated with MS may also be prescribed.