Multiple Sclerosis is most often diagnosed in adults between the ages of 20 and 40, and progression varies depending on the severity of inflammation and the location in the nervous system. There are four main types of MS:
- Relapsing-Remitting: Relapsing-Remitting Multiple Sclerosis is the most common form of the disorder, affecting about 85% of Multiple Sclerosis patients. People with this type of MS experience clearly defined flare-ups (also called relapses, attacks, or exacerbations). Each episode is followed by a remission period with some amount of recovery when the inflammation is resolved. Recovery after a relapse is not always complete.
- Primary-Progressive: Considered relatively rare, primary-progressive Multiple Sclerosis affects only 10% of MS patients. People with this type of MS experience a slow but nearly continuous worsening of their disease from the onset, with no distinct relapses or remissions. However, there are variations in rates of progression over time, occasional plateaus, and temporary minor improvements.
- Secondary-Progressive: Secondary-Progressive Multiple Sclerosis acts more like a relapsing form in its early to mid-stage with relapses and remissions. Then a more gradual, progressive loss of physical and cognitive functions begins, and relapses become less common. According to the National Multiple Sclerosis Society, 50% of people with relapsing-remitting MS developed secondary-progressive within 10 years of their initial diagnosis before introduction of the “disease-modifying” drugs.
- Progressive-Relapsing: Of the four clinical courses of Multiple Sclerosis, the progressive-relapsing type is the most rare, affecting only 5% of MS patients. People with this type of MS experience a steadily worsening disease from the onset but also have clear acute relapses (attacks or exacerbations), with or without recovery. In contrast to relapsing-remitting Multiple Sclerosis, the periods between relapses are characterized by continuing disease progression.
Multiple Sclerosis: Symptoms
The symptoms of Multiple Sclerosis vary greatly from person to person, depending on what part of the nervous system is affected. Symptoms that may occur include:
- Eye pain or vision loss: Optic Neuritis is an inflammation of the optic nerve that controls vision. Over a period of 1 or 2 days, blurred vision develops, and there may be pain behind the eye, which increases when the eye is turned.
- Loss of muscle strength in arms and legs: Loss of muscular strength can range from reduced dexterity to actual paralysis. This loss of strength occurs in both relapsing forms and in the progressive forms. It occurs more frequently in the legs than in the arms. Depending on severity, a cane, crutches, or wheelchair may be needed.
- Numbness or tingling: This can include a “numb” feeling, burning, “pins and needles” sensations, or prickly feeling in various parts of the body. It can occur in just an arm, in patches all over the body, or in the lower half of the body from a particular point such as the navel. These symptoms can be painful.
- Pain: MS can cause one of the nerves of the face to become painful, a symptom known as trigeminal neuralgia. Loss of muscular power can cause overstrain and pain.
- Loss of Bladder or Bowel Control: Patients may have difficulty retaining urine or initiating urination. An even more common symptom is bladder-urge incontinence. Some people, because they move around less, can be troubled with constipation.
- Sexual Problems: Men may find it difficult to get or maintain an erection. Women may experience a loss of sensitivity, pain, or reduction of natural lubrication.
- Loss of Balance and Coordination: Due to disturbances in the cerebellum (the part of the brain that controls and corrects all movement), patients may experience difficulty grasping small objects, often accompanied by a hand tremor. With loss of balance, patients may experience difficulty walking.
- Fatigue: Debilitating fatigue can often last a few months, during which energy is used up every day after just a little effort.
- Decline in Cognitive Function: Memory, speed of thinking, and concentration can be affected.
- Mood Changes: Depression is sometimes linked directly to MS.
Multiple Sclerosis: Diagnosis
At NeuroHealth, we work with you from the beginning to understand your symptoms, establish or verify a diagnosis, and determine the best course of treatment. Diagnosis begins with a discussion of your full medical history and with neurological and physical exams.
One of the most frustrating things about Multiple Sclerosis is that it is very difficult to diagnose. No single test is available to identify or rule out MS. Several tests and procedures are needed. The most commonly performed lab tests are the MRI scan, the lumbar puncture, and the measurement of “evoked potentials.” Other diagnostic tests may include blood work, Nerve Conduction Studies (NCS), Electromyography (EMG) and Electroencephalography (EEG).
Multiple Sclerosis: Treatment
With Multiple Sclerosis, early treatment is key to preventing further disability. Research and trials continue to search for new therapies. To get the most from your treatment, ask your doctor:
- What are the side effects and effectiveness of each therapy?
- How will the therapy fit your lifestyle?
- How often are injections and other medications needed?
Currently, medical science knows the most about treating relapsing MS, which can be broken down into three approaches:
- Treatment for the underlying course of the disease: MS can be treated with injections of proteins (Interferon beta 1a or beta 1b or Glatiramer Acetate) that slow down inflammatory activity. The proteins regulate immune response and reduce the frequency of relapses. Studies show that interferon beta 1a slows the progression of disability. Side effects can include uncomfortable injection site reactions or general flu-like reactions (shivering, muscle pain).
- Treating exacerbations: Corticosteroids combat inflammation and shorten the duration and intensity of MS exacerbations. They have no effect on the number of relapses or on the progression of MS. Corticosteroids are usually administered by infusion or drip, and they tend to be more effective on symptoms involving loss of muscle strength and vision than on sense of touch or balance.
- Treatment of specific symptoms, especially for the more progressive forms of MS:
For people with secondary progressive MS (relapses with periods of recovery), treatment with immunomodulatory agents may be appropriate. There are fewer options for treating progressive MS with no periods of recovery. The effects of interferon beta, methylprednisolone (a corticosteroid), and chemotherapeutic medications are currently being studied.
Multiple Sclerosis: Resources
There are many resources that can help you learn more about MS, treatments, alternative therapies, and the latest clinical updates:
The National Multiple Sclerosis Society
733 Third Avenue, 3rd Floor
New York, NY 10017
National MS Society RI Chapter
205 Hallene Road, Suite 209
Warwick, RI 02886
International MS Support Foundation
9420 E. Golf Links Rd. #291
Tucson, AZ 85720-1340