Multiple Sclerosis: From Early Signs to Managing Symptoms

By Jonathan Garza, MD

Most people have heard of multiple sclerosis, but many don’t know much about it. Multiple sclerosis, or MS, is a chronic autoimmune disease that affects the central nervous system, comprised of the brain and spinal cord. The immune system attacks and damages the protective sheath around nerves, called myelin, making the nerves unable to correctly relay messages between the brain and the rest of the body. This can be compared to the coating on electric wires being damaged and exposing the wires. The body, in a sense, short circuits and is unable to perform properly, especially in terms of mobility.

Who Gets Multiple Sclerosis?

It’s estimated that about 1 million people in the U.S. and 2.3 million people worldwide have been diagnosed with multiple sclerosis. As with most autoimmune diseases, it’s largely unknown what causes MS, but there are some factors that may contribute to the risk of developing it.

• Genetics – If you have a parent or sibling with MS, you have a 2% – 4% chance of developing it. If your identical twin has MS, your chance increases to 25% – 30%.
• Gender – Women are two to three times more likely than men to have relapsing-remitting MS, the most common type of multiple sclerosis.
• Age – While MS can develop at any age, onset typically occurs between 20 and 40 years of age.
• Geography – Climate in certain areas could be associated with the prevalence of MS. For example, the condition is more common in regions further from the equator, such as Europe, Canada, the northern U.S., New Zealand, and southeast Australia.
• Ethnic background – MS occurs in all ethnic groups but is most common among Caucasian people of Northern European ancestry.

Symptoms of Multiple Sclerosis

Everyone with MS experiences it differently because the symptoms and their severity depend on what part of the nervous system is being attacked, and symptoms can change over time. It can also be difficult to identify symptoms because they can be intermittent and may even disappear for months or years before occurring again. Symptoms can become more severe in hot environments or when a fever is present. This is due to high temperatures making it even more difficult for affected nerve cells to receive signals from the brain.

The most common symptoms of MS include:

• Issues with cognition, such as memory loss, lack of concentration and focus, and difficulty recalling words
• Vision problems, such as blurred vision, loss of normal color vision, blindness in one eye, seeing dark spots, double vision, and uncontrolled eye movements
• Becoming easily worn out and experiencing “lassitude” fatigue after doing simple things (lassitude fatigue is a severe fatigue thought to be unique to MS)
• Bowel and bladder dysfunction, such as incontinence, a frequent urge to urinate, constipation, and diarrhea, which result from the blockage of nerve signals in the parts of the nervous system that control the bowel and bladder muscles
• Sexual issues, such as difficulty becoming or staying aroused, reduced sensation, or painfully heightened sensation
• Sharp, stabbing pains in the face and body, tingling “pins and needles” sensations, numbness, and chronic back and musculoskeletal pain
• Weak, ineffective, or stiff muscles, in addition to muscle spasms, tremors, and sudden involuntary movements (known as spasticity)

Most people with MS experience the relapsing-remitting type of the condition, which means they have periods of new symptoms or relapses followed by periods of remission or no symptoms.

How Multiple Sclerosis Is Diagnosed

Most people are diagnosed with MS after other causes of their symptoms are ruled out, since there are many conditions that show similar symptoms. For this reason, physicians typically administer a series of neurological tests to exclude other conditions before diagnosing multiple sclerosis, which may be a longer process for some than others. However, the goal when MS is suspected is always to diagnose it as soon as possible since permanent neurological damage can occur even the early stages.

Before seeing your physician, it’s a good idea to keep a journal of your symptoms, including when they happen, how often they happen, and how severe they are. You should also be prepared to discuss your full medical history, as well as your family’s.

There is not one single test to diagnose MS. Any or all of the following tests may be used to determine the cause of symptoms, whether or not it’s MS:

• Magnetic resonance imaging (MRI) – Examines the central nervous system for damage
• Spinal tap (lumbar puncture) – Checks the spinal fluid for abnormalities, specifically for signs of inflammation and increased production of certain antibodies
• Evoked potentials – Measures the electrical activity in parts of the brain in response to light, sound, and touch stimuli to check if the sensory pathways are properly functioning
• Neurological exam – Tests the performance of the cranial nerves, as well as sensation, reflexes, coordination, walking, and balance
• Blood tests – Helps to rule out other conditions with similar symptoms to MS, such as lupus, Sjogren’s, vitamin deficiencies, hereditary diseases, and other issues

Newly Diagnosed with Multiple Sclerosis

Undergoing the numerous tests to diagnose MS is difficult enough, but getting a definitive diagnosis can be overwhelming. Most people feel relieved to finally have a name for what they’ve been experiencing, but they also have no idea where to begin with treatment and managing symptoms.

Available MS Treatments

While there’s no cure for multiple sclerosis, there are many treatment options, which focus on slowing the progression of brain lesions, making the management of symptoms easier, and reducing the severity, frequency, and duration of relapses.

All long-term MS treatments are considered disease modifying therapies (DMTs). There are more than 20 approved medications to slow MS activity and progression. Corticosteroids, muscle relaxants, and interferon beta blockers are the most commonly prescribed forms of medication. Depending on the type of medication, it may be administered in pill form, through infusion, or through injections.

Other treatment options include:

• Physical therapy – Eases symptoms and helps improve balance mobility problems
• Occupational therapy – Helps MS patients adapt to their changing bodies, manage symptoms, and stay active in daily life
• Speech therapy – Helps to strengthen and train the muscles that control speech and swallowing

Ways to Manage MS Symptoms

A big part of living with MS is making lifestyle choices to help manage your symptoms. Taking the following steps can help slow down the progression of multiple sclerosis and improve your general health.

• Be active. You should exercise as you’re able but being as physically active as possible can help increase mobility, reduce fatigue, and ward off depression. Resistance training can help maintain muscle mass, while activities like yoga or tai chi can improve balance and coordination.
• Get enough rest. Nearly half of people with MS have trouble sleeping. This may be due to the depression and stress of having a chronic disease or could be attributed to muscle spasms. Whatever the case, talking to your doctor about ways to get better sleep or undergoing a sleep study can help you get the rest you need and reduce daytime fatigue.
• Eat healthy. While there’s no specific way of eating for MS, an anti-inflammatory diet may help since MS is an inflammatory condition. Consuming plenty of fresh fruits and vegetables, whole grains, and healthy fats can help reduce the severity of your symptoms and improve your general health. Getting enough omega-6 and omega-3 fatty acids, as well as vitamin D, has also been shown to reduce pain and improve energy levels.
• Stay cool. Since MS symptoms tend to worsen when the body temperature rises, avoiding hot climates and environments can help avoid relapses and alleviate symptoms. Preparing to stay cool in such situations is also a good idea, which may mean wearing a cooling vest or bringing a portable fan with you.
• Reduce stress. MS symptoms can worsen with stress. Practicing self-care through deep breathing, meditation, yoga, massage, and other stress management methods can significantly help manage symptoms and reduce flare-ups.