Multiple sclerosis MS (1)

Multiple sclerosis MS is a disease that targets the central nervous system and potentially disables the brain and spinal cord.

A fatty sheath is known as “myelin”, covers the nerve fibers, and protect them. In MS, the immune system targets myelin and causes damage to nerves. This damage forms the scar tissue on nerves. As a result, the brain fails to send signals to all parts of the body.

Types of MS (2)

MS shows different illness patterns in different patients. According to these patterns, MS has been categorized into three types.

  1. Relapsing-remitting multiple sclerosis RRMS

It is the most common type of MS and accounts for about 85% of all cases. It begins in the early 20s. Patient experiences alternate periods of recovery (remission) and flared-up symptoms (relapses). These symptoms last longer up to years. After the age of 20 years, this type switches to another type of MS known as “secondary progressive multiple sclerosis”. The number of affected nerves, the severity of attacks, and recovery vary from person to person. The patient suffering from RRMS may experience

  • Tingling
  • Sensitivity to heat
  • Spinal pain
  • Vision problem
  • Numbness
  • Dizziness
  1. Secondary progressive multiple sclerosis SPMS

Most people develop SPMS after RRMS. Unlike RRMS, symptoms of SPMS are steady. Patient of SPMS feels:

  • More weakness
  • More troubling coordination
  • Stiffness in leg muscles
  • Bladder problem
  • bowel issues
  • depression
  1. Primary progressive multiple sclerosis PPMS

In this type of MS symptoms gradually become worse. There are no phases of relapse and remission. It accounts for only 10% of all cases. It usually occurs in people age 40 years. Unlike other types, it causes disability just after its onset.

Causes

There is no definite cause of multiple sclerosis. But some factors may increase the vulnerability of a person.

  • Geography

In comparison to the people living in warm areas inhabitants of the colder area are more prone to MS. Researchers have suggested that sunlight and vitamin D might suppress the onset of MS.

  • Smoking

It is one of the factors that may increase the risk of MS

  • Genetics

Genetics plays an important role in the development of MS. If one of the twins has an MS, then the other twin has a 20-40% risk of developing it.

  • Vaccines

Researchers have ruled out vaccines as a causative agent of MS.

  • Epstein Barr virus exposure

Research has shown that people who have exposure to Epstein Barr are at higher risk of getting MS.

  • Compromised or abnormal immune

And as is said to be an autoimmune disorder. A trigger stimulates the abnormal immune system, as a result of which the immune system starts producing antibodies against the body itself, causing damage to myelin and nerves.

  • Sex hormones

Two female sex hormones “progesterone” and “estrogen”, and a male sex hormone “testosterone” suppresses the immune system. Higher levels of these hormones account for more MS cases.

Risk factors

Several factors enhance the risk of getting multiple sclerosis. Such as:

  • Age. It can begin at any age but people between 20 and 40 years age are at higher risk of getting multiple sclerosis.
  • Gender. Women are three to four times more prone to MS.
  • Vitamin D. People deficient of vitamin D and who have less exposure to sunlight are more vulnerable to MS.

Signs and Symptoms

The patient shows various signs and symptoms. The appearance of signs and symptoms depends upon the nature and type of disease. Some of the common symptoms are as follows:

  1. Weakness or numbness in more than one limb. It typically targets one side of the body, trunk, or legs.
  2. Sensations of electric shock while moving neck, specifically bending it in forwarding direction.
  3. The patient experiences tremors frequently
  4. Lack of coordination
  5. Loss of vision ( partial or complete)
  6. Pain in eyes while moving them
  7. Blurred vision
  8. Fatigue
  9. Dizziness
  10. Slurred speech
  11. Tingling
  12. Loss of sexual function
  13. Bowel and bladder dysfunction

Complications

People with multiple sclerosis may also suffer from:

  • Paralysis mostly in legs
  • Epilepsy
  • Depression
  • Muscle spasm or stiffness
  • Mental changes, such as mood swings or forgetfulness
  • Problems with bowel
  • Hormonal dysfunctioning

Diagnosis

The diagnosis of MS does not include any specific tests. It depends upon ruling out other problems having symptoms similar to MS. A thorough medical examination includes:

  1. Blood tests

It is used to make a differential diagnosis. It recognizes the signs and symptoms of a disease that is similar to MS.

  1. Spinal tap

Also called a lumbar puncture. In this, Lab analysis is done on the sample of cerebrospinal fluid taken from the spinal canal. It helps the doctor to find the abnormal nature of MS-related antibodies.

  1. Magnetic resonance imaging MRI

It shows the image of MS lesions. A person is given a contrasting solution intravenously, which highlights the lesions inside.

  1. Evoked potential test

This test is performed to check how quickly nerves send the impulse and brain responds to the stimuli. Electrical stimuli are given to the nerves of arms and legs, then electrodes record the pattern of response.

Treatment

Treatment aims for the complete remission of symptoms.

  • Corticosteroids

They reduce the inflammation of nerves. They cause some side effects such as high blood pressure, mood swings, insomnia, and fluid retention.

  • Plasmapheresis

In this technique, plasma is removed from the blood and then blood cells are then mixed with albumin. This mixture of blood and albumin is then put back in the body. This approach is done when a patient does not respond to steroidal therapy.

  • Interferon-beta medications

They are injected into the muscles or under the skin and reduce the severity and frequency of relapses.

  • Glatiramer acetate

It is injected under the skin and inhibits the immune system attack on the myelin sheath.

  • Physical therapy

A physical therapist suggests strengthening and stretching exercises to reduce the symptoms of multiple sclerosis.

  • Muscle relaxants

Stiffness and headache in MS can be reduced by using muscle relaxants such as tizanidine, baclofen, and cyclobenzaprine.

References

  1. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
  2. https://www.mssociety.org.uk/about-ms/types-of-ms