Multiple sclerosis, or MS, is one of several types of immune-mediated diseases that develop when the immune system attacks the body’s central nervous system.
The most common types of MS are relapsing remitting, primary progressive and secondary progressive.
While there is not yet a cure for MS, the latest treatments are about 95% effective in controlling symptoms and stopping the progression of the disease in those patients with the relapsing remitting form of the disease. To date, there has been less success with the progressive forms of the disease.
The exact cause of MS is unknown, but experts believe it may be related to Epstein-Barr virus infection acquired during adolescence. The virus triggers an immune response in a genetically susceptible individual that persists even after the virus has long been cleared from the body. Most patients with relapsing MS experience their first symptoms at about age 30.
Relapsing MS is most commonly diagnosed in young Caucasian women. Currently, the ratio of women to men who have MS is about 3 to 1. In the 1980s, the ratio was about 1.4 to 1. The reason for this increasing difference in gender vulnerability is unknown.
Other risk factors for MS include having low levels of vitamin D in the blood.
There is a long list of possible MS symptoms, and they vary from person to person. The most common symptoms of MS include fatigue, urinary and bowel issues and sexual dysfunction. Some patients may have problems with pain, walking, balance, blurred vision, slurred speech and swallowing.
Symptoms depend on where in the central nervous system the MS attack causes damage.
“Those damaged areas produce the symptoms,” explains Charles Smith, MD, a neurologist at Scripps Clinic Torrey Pines and Scripps Clinic Rancho Bernardo. “For one person, the first symptom might be blurred vision with pain in one eye. Another may present with numbness from the waist down.”
MS symptoms tend to come and go in the relapsing form of the disease. Typically, an attack somehow “turns off.”
When the immune system invades the central nervous system — including the brain, spinal cord and optic nerves — the damage may or may not cause a symptom.
If the attack causes symptoms, the person affected usually recovers. In the early phases of MS, recovery is the norm but over time, attacks can lead to gradually increasing disability.
“Perhaps the damage wasn’t strong enough to produce a scar, but just caused inflammation that healed,” says Dr. Smith.
“Or perhaps the nervous system found a work-around the damaged area, a process called plasticity,” he adds. “We know that the healthy parts of the brain, spinal cord and optic nerves can compensate for damage near an affected spot and make it asymptomatic.”
MS is generally diagnosed by checking symptoms and an MRI of the brain, spinal cord or optic nerves.
When a patient complains of symptoms that suggest MS, the first step is to rule out other possible causes. The neurologist typically orders MRIs of the brain and spinal cord to look for the characteristic spots (plaques).
MS treatment focuses on two goals. First and foremost is disease course modification, or treatment of the disease process to prevent progression and disability down the road. Multiple medications can help address the immune attacks that can lead to progression of MS.
Once the disease course is stabilized, the focus turns to relieving symptoms and improving the patient’s quality of life. Treatments will depend on each patient’s specific symptoms and may include medication, physical therapy, occupational therapy and speech therapy.
“The more recent treatments are now producing responses that are about 95% effective. We call this NEDA, for no evidence for disease activity,” explains Dr. Smith.
“I think it’s important to realize that there are so many therapies out there that help MS. We can be positive about this because we will try whatever treatment we need to do to get you having a normal full life."