Multiple sclerosis – Symptoms, Causes, Diagnosis, and Treatments

Introduction

Multiple sclerosis (MS) is a chronic, disabling autoimmune disease that affects the brain and spinal cord. It occurs when the immune system affects the covering over the nerve fibres known as the myelin sheath.

Classification of Multiple Sclerosis

Depending on the clinical features, Multiple sclerosis is classified as the following:

1. Relapsing-Remitting Multiple Sclerosis  
2. Secondary Progressive Multiple Sclerosis  
3. Primary Progressive Multiple Sclerosis  
4. Clinically Isolated Syndrome

The most usual type of MS is Relapsing-Remitting Multiple Sclerosis.

Symptoms of Multiple Sclerosis

• Fatigue
• Vision problems – temporary loss of vision, colour blindness, eye pain, double vision.
• Numbness and tingling sensation in different parts of the body
• Muscle spasms, stiffness and weakness
• Mobility problems – difficulty in balance, coordination, tremors.
• Pain
• Problems with thinking, learning and planning
• Depression and anxiety
• Bladder & bowel problems
• Speech and swallowing difficulties

Causes of Multiple Sclerosis

Experts are still not sure as to what causes Multiple Sclerosis.  Factors that may trigger MS include:

• Exposure to certain viruses or bacteria: Exposure to certain infections (such as Epstein-Barr virus) can trigger Multiple Sclerosis later in life.
• Environment: The place where you live may play a role in increasing the risk of developing this disease. Places away from the equator have higher rates of Multiple Sclerosis. The reason may be due to deficiency of Vitamin D.  
• Genetic predisposition: A family history of MS increases your risk of the disease. But the gene involved is still not known clearly.

Diagnosis of Multiple Sclerosis

Investigations to diagnose Multiple Sclerosis include

• Certain blood tests, including inflammatory markers
• MRI
• Lumbar puncture  
• Evoked potential tests

There is no specific test for Multiple Sclerosis, and diagnosis involves physical examination, history analysis and correlation with lab reports, including imaging.

Treatment for Multiple Sclerosis

• Disease-modifying therapies (DMTs): Several medications are available to help reduce relapses (also called flare-ups or attacks) and slow the progression of the disease.  
• Relapse management: During a severe attack, the treating doctor may recommend corticosteroids to help recover from relapses. This has an anti-inflammatory effect.
• Physical rehabilitation: If the patient’s physical functionality is affected, they may benefit from rehabilitation and physiotherapy.  
• Mental health counselling: Memory impairment and mood-related problems can be managed by neuropsychiatrists and psychologists. Coping with the burden of the disease also needs to be addressed.

Preventing flare-ups in Multiple Sclerosis

• Eating a healthy diet
•  Engaging in regular exercise
• Managing stress
• Quitting smoking  
• Limiting alcohol intake

Conclusion

Multiple sclerosis is a neurological disease occurring due to the autoimmune destruction of the protective covering over the nerve fibres in the brain and the spinal cord. This is sometimes a chronic progressive disease and may also manifest with an episodic flare-up. The condition can be managed with medicines.

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