Multiple Sclerosis

  • Multiple sclerosis (MS) is a disease that causes demyelination (disruption of the myelin that insulates and protects nerve cells) of the spinal nerve and brain cells.
  • Although the exact cause is unknown, it’s considered an autoimmune disease.
  • Risk factors for the disease include being between 15-60 years of age; women have about two to three times the risk for multiple sclerosis than men.
  • Rarely, MS in children and teens (pediatric MS) get MS.

Symptoms, causes, and treatments for MS in children and teens are similar to those for adults, except children and teens may also have seizures an or mental status changes.

  • Multiple sclerosis symptoms and signs depend on where the nerves are demyelinated and may include:
    • Visual changes including double vision or loss of vision
    • Numbness
    • Tingling or weakness (weakness may range from mild to severe)
    • Paralysis
    • Vertigo or dizziness
    • Erectile dysfunction (ED, impotence)
    • Pregnancy problems
    • Incontinence (or conversely, urinary retention)
    • Muscle spasticity
    • Incoordination of muscles
    • Tremor
    • Painful involuntary muscle contractions
    • Slurred speech
    • Fatigue
  • There are four types of MS:
    1. Relapsing-remitting multiple sclerosis (RRMS),
    1. Secondary-progressive multiple sclerosis (SPMS), the most common type
    1. Primary-progressive multiple sclerosis (SPMS)
    1. Progressive-relapsing multiple sclerosis (PRMS)
  • There is no one test to diagnose MS. However, healthcare professionals diagnose the disease by a patient’s history, physical exam, and tests such as MRI, lumbar puncture, and evoked potential testing (speed of nerve impulses); other tests may be done to rule out other diseases that may cause similar symptoms.
  • Treatment options include:
    • IV steroids
    • interferon injections (Rebif)
    • glatiramer acetate (Copaxone)
    • dimethyl fumarate (Tecfidera
    • Many others, depending on the patient’s symptoms.
  • Most people with MS have an average life expectancy. Those that don’t get treatment may develop mobility dysfunction. In contrast, those with severe progressive forms may develop complications like pneumonia.
  • Currently, there’s nothing you can do to prevent getting MS.
  • Research is ongoing in developing new medications, immune system modifications, and other ways to identify potential causes of MS.

Multiple Sclerosis

Multiple sclerosis is a disease that involves an immune-mediated process that results in an abnormal response in the body’s immune system that damages the central nervous system (CNS) tissues in which the immune system attacks myelin. This substance surrounds and insulates nerve fibers causing demyelination that leads to nerve damage. Because the exact antigen or target of the immune-mediated attack is unknown, many experts prefer to label multiple sclerosis as “immune-mediated instead of an autoimmune disease.”

Multiple sclerosis is a disease that causes demyelination of the brain and spinal cord nerve cells. When this occurs, axons (the parts of the nerve cells that conduct impulses to other cells) don’t work as well. Myelin acts as insulation on electrical wires. As more areas or nerves are affected by this loss of myelin, patients develop symptoms because axons’ ability to conduct impulses is diminished or lost. The specific symptom that someone experiences are related to the area that has been affected. As demyelination occurs, areas of inflammation and subsequent injury can be identified; these damaged areas are called lesions or plaques and are readily apparent on magnetic resonance imaging (MRI) studies.

Children and teenagers can have MS (pediatric MS). It is estimated that about 8,000 to 10,000 children and teens up to 18 years old have been diagnosed with pediatric MS. Moreover, an additional 10,000 to 15,000 children and teens have had at least one symptom of the disease.

Almost all children diagnosed with pediatric MS have the relapsing-remitting MS type; however, additional symptoms often not experienced in adults with MS may include seizures and mental status changes like lethargy.

Children and teens with multiple sclerosis are treated with the same therapies as adults. Still, they are considered “off label” for treating children (not an FDA approved to use for the drug, but it is/may be useful for some people with the condition). Small studies suggest the IV drug natalizumab (Tysabri) is safe to use in children with MS. They have not responded to other treatments. Discuss all of your child’s MS treatments or home therapies with his or her health-care team.

Symptoms and Signs of Multiple Sclerosis

Multiple sclerosis symptoms are dependent on the area of the destruction of the myelin sheath protecting the nerves (demyelination).

Early signs and symptoms are vision problems like double vision or vision loss.

Other symptoms and signs may include:

  • Visual changes, including loss of vision if the optic nerve has been affected
  • Double vision
  • A sensation or feeling of numbness, tingling, or weakness. The weakness may be mild or severe enough to cause paralysis of one side of the body.
  • Vertigo (a sense of spinning) or dizziness
  • Lack of coordination of the arms or legs, problems with balance, problems walking, and falling
  • Slurred speech
  • A sense of an electrical charge traveling down the spine with neck flexion (Lhermitte sign)
  • In some cases, a person may develop incontinence or even an inability to empty their bladder.
  • As the condition progresses, some people are left with muscle spasticity or an involuntary painful contraction of specific muscles.

Causes of Multiple Sclerosis

While multiple sclerosis is considered an autoimmune disorder, the exact cause hasn’t yet been found. There are many theories regarding the reason that people develop MS. These theories range from vitamin D deficiency to a viral infection. Even consuming too much salt is being looked at as possible causes. However, none of these theories has been proven, and the cause of MS remains unknown. It’s not contagious and can’t be passed from person to person.

Hereditation and Life Expectancy of Multiple Sclerosis

Genetic factors don’t seem to play a large role in the disease. Although people who have a first-degree relative with MS have a slightly higher risk of developing it themselves, this risk is felt to be modest.

People who live in northern latitudes (predominantly Northern European countries) were previously identified as having a higher incidence of the MS. However, over the last 30 years, more MS cases are now being diagnosed in more temperate regions such as Latin America. Moreover, living in an area until approximately age 15 seems to give someone the relative risk of developing MS for that area. People younger than 15 who move to assume the risk of the new location.

Lifestyle factors are not risk factors for developing MS, such as diet, exercise, and tobacco use, unlike conditions in which these risk factors are critical, such as stroke, heart disease, or diabetes.

Development of Multiple Sclerosis

  • Multiple sclerosis occurs predominantly in younger persons, with those aged 15 to 60 most likely to be diagnosed.
  • The average age of diagnosis is about 30 years; however, multiple sclerosis has been identified.
  • While multiple sclerosis can occur in children, this is very rare.
  • About 2.5 million people worldwide have been diagnosed with MS; about 400,000 live in the United States.
  • Women are about twice as likely as men to develop multiple sclerosis.

Types of Multiple Sclerosis

There are four types of multiple sclerosis.

  1. Relapsing-remitting multiple sclerosis (RRMS)

Relapsing-remitting multiple sclerosis (RRMS) is the most common form of MS.

People with this form of the disease develop symptoms that respond to treatment and then resolve. The development of symptoms is often referred to as an exacerbation of the disease. Episodes of remission may last for weeks to years.

  1. Secondary-progressive multiple sclerosis (SPMS)

Secondary-progressive multiple sclerosis (SPMS) is diagnosed when the problems caused by an exacerbation don’t fully resolve during a remission. This often occurs in patients who were initially diagnosed with RRMS. Over time, patients are identified with progressive debility.

  1. Primary-progressive multiple sclerosis (PPMS)

Primary-progressive multiple sclerosis (PPMS) progresses over time, without episodes of remission or improvement of symptoms.

  1. Progressive-relapsing multiple sclerosis (PRMS)

Progressive-relapsing multiple sclerosis (PRMS) is identified when patients experience escalating symptoms over time and intermittent episodes of remission.

Procedures and Tests for Multiple Sclerosis

Patient history important because many people with multiple sclerosis have experienced various symptoms, which were ignored or attributed to other events or illnesses. If a person recalls no prior symptoms, the remaining medical history is needed to exclude other conditions that might mimic multiple sclerosis.

Once history is obtained, a complete physical examination is required. Doctors look for signs of injury to the central nervous system (either the brain or spinal cord); findings on the examination can help a doctor determine which area of the central nervous system (CNS) is involved.

Imaging studies help to confirm a diagnosis of multiple sclerosis. The most common test done is a magnetic resonance image or MRI. CT scans, while helpful in finding some brain injuries, are unable to reveal the changes associated with multiple sclerosis with as much detail as an MRI. MRIs can be used to image the brain and the spinal cord.

A spinal tap, or lumbar puncture, is done to collect a small amount of cerebrospinal fluid. Testing can be done on this fluid to confirm protein, inflammatory markers, and other substances. With the routine use of MRI, performing a spinal tap is not considered mandatory, unless there are questionable findings on the MRI or other questions to answer.

Evoked potential testing (visual evoked potentials, brainstem auditory evoked potentials, and somatosensory evoked potentials) can show slowed response times in the optic nerve, the spinal cord, and the spinal cord, or the brainstem. While helpful, these tests are not specific for changes seen in multiple sclerosis.

When multiple sclerosis is suspected, blood work and testing to exclude other conditions, such as Lyme disease, vasculitis, lupus, human immunodeficiency virus (HIV), and processes that lead to multiple strokes, are often done as well.

Treatment for Multiple Sclerosis

Many factors go into consideration for the treatment of a patient who has multiple sclerosis. During an acute exacerbation, steroids given through an IV are commonly prescribed, and often help patients recover more rapidly. If a patient cannot receive steroids, plasma exchange can be used.

Steroids given through an IV are commonly used to treat acute exacerbation of the disease, and often help people recover more quickly. If an individual cannot receive steroids, plasma exchange can be used.

Once a diagnosis has been confirmed, disease-modifying therapy is often recommended. This therapy may decrease the number of exacerbations that a patient experiences or reduce an exacerbation’s severity. Also, many of these therapies have been shown to decrease the potential for developing a long-term disability.