Multiple Sclerosis

Multiple sclerosis is a long-lasting disease affecting the myelin sheath around the nerves. Myelin sheath is the fatty layer around the nerves protecting the nervous and is helpful in faster conduction of impulses from the brain, spinal cord to the rest of the body. It commonly affects the brain, spinal cord, and optic nerves.

Multiple sclerosis causes:

The exact cause of multiple sclerosis is unknown. It is thought to be an autoimmune disease, in which our body’s immune system attacks the myelin sheath and causes demyelination of the nerve cells, which can result in symptoms. Environmental or genetic factors are thought to have a role in inducing the autoimmune response responsible for causing the demyelination of the nerve cells. The nerve cells are also known as axons will develop areas of sclerosis or plaques where demyelination occurs.

Risk factors:

Certain risk factors can increase your chance of developing multiple sclerosis. They are:

Age: It is most common in the age between 15 to 50
Sex: Multiple sclerosis affects women more commonly than men. Women are two times more susceptible to get MS than men.
Genetics: Some genetic variations increase the risk of developing MS.
Infections: Infections withEpstein – Barr virus, herpes virus, Mycoplasma pneumonia are thought to be associated with MS.
Vitamin D deficiency: Vitamin D deficiency increases the risk of developing multiple sclerosis.
Vitamin B12 deficiency: Vitamin B12 is vital for the development of the myelin sheath. Hence, vitamin B12 deficiency increases the risk of developing multiple sclerosis.

Types of multiple sclerosis:

There are four types of multiple sclerosis

Clinically isolated syndrome (CIS): If symptoms are lasting at least 24 hours, it comes under this category. It can involve a single neuron or multiple neurons.
Relapsing-remitting MS (RRMS): This is the most common type seen in more than 80% of the patients with MS. In this type, there will be an episodic flare-up of symptoms (relapse) and then there will be mild to no display of symptoms (remitting).
Primary progressive MS (PPMS): In this type, there will be a gradual progressive worsening of symptoms, with periods of minimal or no symptoms in between.
Secondary progressive MS (SPMS): in this type the patients will be seen progressing from the relapsing-remitting type to the progressive type of MS, causing progressive worsening of the condition.

Multiple sclerosis symptoms:

The symptoms and signs depend on the region of demyelination of nerves. No two people will have the same symptoms in multiple sclerosis. It differs from one individual to another. There is a wide spectrum of symptoms commonly witnessed in MS.

They are:

Fatigue: seen in around 80% of the people with MS
Feeling of numbness in the arms and legs
Tingling sensation or feeling of needles and pins
depression
anxiety
inability to concentrate
unstable mood
double vision
speech difficulties such as slurred speech
painful movements of the eye
blurry vision
difficulty in swallowing
The feeling of weakness in the muscles
Difficulty in walking
Difficulty in balancing
Tremors
Spasms of muscles
Respiratory problems
Seizures
Urinary tract infections
Sexual problems such as loss of interest in sex
Diarrhea or constipation
Inability to hold the feces in the bowel
Inability to hold the urine
Increased urge to urinate or increased frequency of urination or retention of urine

Diagnosis:

There is no one specific test to diagnose MS. Diagnosis is done by considering medical history, clinical examination findings, and some other tests.

The diagnostic tests performed for MS are:

MRI scan: It is performed by injecting a contrast dye and taking serial images of the nervous system which sows the areas affected.
Visual evoked potentials test: In this test, the brain and spinal cord are stimulated and the electrical activity is recorded, which will be less than normal in MS.
Spinal fluid analysis: spinal fluid is collected by performing a lumbar puncture. Spinal fluid analysis can help to exclude infectious diseases.
Blood tests: Some other diseases can also cause similar symptoms as MS such as HIV/AIDS, Lymes diseases, and vasculitis. Blood tests are performed to exclude these diseases.

Treatment:

The treatment aims to restore the normal functions and preventing further deterioration and progression of the disease. The treatment modalities include medications, diet, exercise, and other therapies.

Medications:

The medications for treating MS are ozanimod, laquinimod, estriol, monoclonal antibodies such as alemtuzumab, daclizumab, rituximab, ocrelizumab, and ofatumumab.

Diet and exercise:

Low fat, high fiber diet can help in maintaining good general health. Regular physical exercise, yoga, and swimming can help in maintaining good physical and mental health.

Other therapies: other forms of therapies that are helpful in managing MS are plasma exchange, stem cell therapy, occupational therapy, physical rehabilitation, and speech therapy.