What is Multiple Sclerosis?
The name “multiple sclerosis” refers to the many scars which appear on the white matter of the brain and spinal cord in people who have the disease. Currently, there are approximately 2.5 million people around the world who are affected by multiple sclerosis, with symptoms usually appearing between the ages of 20 and 50.
Women are twice as likely to develop the disease as men. It is also far more common among populations living farther from the equator (this has to do with being of northern European decent rather than environmental or geographical factors although these later conditions may play some role).
Multiple sclerosis (often simply referred to as MS for short) is a disease of the brain and spinal cord. It damages specific parts of the nervous system, resulting in the diminished ability of the nerve cells to communicate with each other. This disrupted communication results in a wide variety of symptoms that can be physical, mental or even psychiatric in nature. However, symptoms are not always present because in many cases, they have a tendency to appear, subside, and then reappear in an episodic manner with the appearance of symptoms being known as “attacks.“
As of yet there is still little known about the exact causes of multiple sclerosis. Theories range from genetic factors to environmental factors such as infections. Although the cause is unknown, MS seems to be linked either to autoimmune diseases; other abnormal functioning of the immune system; or a failure of the cells which produce myelin (an insulating material found inside cells which is essential for the nervous system to function properly).
The three major symptoms of MS are scarring of the central nervous system, inflammation, and damage to the myelin layer inside cells. Diagnoses are based primarily on presenting symptoms, medical imaging, and laboratory tests.
After a diagnosis is made, doctors determine which of the four subtypes the patient falls under with the distinction being made based on the progression or course of the disease. By identifying the specific subtype, doctors can assess a more accurate prognosis as well as determine the ideal course of treatment for the patient. The four subtypes are as follows:
- Relapsing remitting
- Secondary progressive
- Primary progressive
- Progressive relapsing
An effective cure has yet to be found for the disease in any form it takes. However, treatments and methods for managing the disease have been developed and a lot of research is currently in progress to discover a cure as well as better treatment methods. Several adverse affects are associated with the medications used to manage the disease leading many patients to turn to alternative remedies or adopt a combined regimen of clinical treatment and alternative medicine.
What Causes Multiple Sclerosis?
Studies are still ongoing to determine the exact causes of multiple sclerosis; however, scientists believe it is most likely the result of a combination of different factors. Those different factors include issues with the immune system, environmental circumstances, certain infectious agents, and even genetic factors.
With that in mind, there is more and more information about the disease and its causes being uncovered by the dedicated scientists researching the issue. Each of the various potential factors is being pursued to learn more about the role they each play in the course of the disease.
1- The immune system
Although not strictly a cause of the disease, abnormal immune system responses may be responsible for the destruction of the myelin coating which surrounds nerves fibers and supports communication between nerve cells throughout the nervous system. In patients with multiple sclerosis, the number of T cells found in the spinal fluid is significantly higher. Another characteristic of MS patients is a higher number of T cells managing to pass through the blood brain barrier (BBB) and into the brain. The excess number of T cells found in these key areas are also significantly more active (especially against the important myelin coating) and exhibit decreased regulatory function especially during an attack or flare-up of the disease symptoms.
2- The environment
While the link between the environment and multiple sclerosis is not so clear as the link with the immune system, it has become clear over the years that it plays some role in the onset of the disease. Populations living farther from the equator have a higher risk of developing the disease. Even more telling is the research showing that people who move before the age of 15 adopt the risk level of the new area while those who remain in the same place at least until after this age retain the risk levels of their home environment.
Meaning, for example, that a child who moves south, closer to the equator will have his or her risk for developing multiple sclerosis later in life decreased. Evidence suggests that this may have to do with the increased amount of sunlight and, consequently, the more adequate levels of vitamin D (a vitamin which is thought to play an important role in assuring the proper functioning of the immune system.
3-Infection
There are many viruses and bacteria which are known to cause the degradation of the myelin coating on nerve fibers. It is thought that becoming infected with any of these could act as a trigger for the development of multiple sclerosis. However, little is known about exactly how this works or if it is a sufficient explanation for the cause of the disease. There is a lot of research in this area being conducted in an attempt to definitively prove or disprove the hypothesis that certain infectious diseases could trigger multiple sclerosis.
4- Genetics
Although it is clear now that multiple sclerosis is not hereditary, there is a very strong correlation between having a close relative (such as a parent or sibling) with the disease and one’s own risk for developing it. Research is finding that among populations with higher incidents of MS, there is a correspondingly higher prevalence of specific genes. This would suggest that some people are born with a genetic predisposition toward the disease, making them more susceptible to external triggers like the environment or infection which then trigger the abnormal immune system response, leading to the various symptoms of multiple sclerosis.
What Are the Risk Factors for Developing Multiple Sclerosis?
It is important to mention here that there are many popular myths about the causes of multiple sclerosis which have been proven untrue. The most well circulated of these myths include developing multiple sclerosis from living with a pet; having allergies; being exposed to heavy metals (such as mercury, lead, or manganese); consuming the artificial sweetener aspartame; and experiencing physical trauma.
Although you may hear people talking about these proposed causes of the disease, studies have shown that there is little correlation between any of the above factors and the onset or exacerbation of symptoms of multiple sclerosis.
There are, in any case, certain factors which will put a person at a higher risk for developing the disease. Although some of these risk factors are unavoidable circumstances, there are some which you can work to avoid and, in doing so, lower your risk for the disease.
1- Sex
While there are, of course, some exceptions, it has become clear that women are much more likely to develop multiple sclerosis than men. Previous estimates had claimed that women were twice as likely as men to have the disease. However, recent evidence suggests that is even higher than that, with the ratio of female to male multiple sclerosis patients nearly reaching 4:1. That said, when a male patient does show signs of the disease, those symptoms are usually significantly worse than they are in female patients.
2- Location
As mentioned earlier, where a person lives (and whether or not they moved there before the age of 15) affects their likelihood for having MS. Those living further north, away from the equator as well as those Americans which descend from ancestors in these regions are more likely to develop multiple sclerosis than those living at or near the equator.
3- Time of birth
Strangely enough, what time of year a person was born corresponds to the level of risk he or she has for the disease. People born in the spring or summer have the highest risk (9.4% higher) and those born in the winter months have the lowest risk (approximately 11% lower). This may be because the mother’s vitamin D levels during pregnancy affect the developing fetus.
4- Genetic ancestry
Even your ancestors can contribute to your risk for MS. People with northern European ancestry have a much higher risk of developing multiple sclerosis than people with African, Asian or Native American ancestry. Some notable exceptions to this are populations such as the Inuit and others living far from the equator but exhibiting almost no instances of multiple sclerosis.
5- Smoking
Yet another reason to quit smoking is the proven link between smokers and multiple sclerosis. The bad habit can dramatically increase your risk and, when symptoms present, smoking can exacerbate them further, causing the disease to progress more quickly.
6- Autoimmune diseases
Because multiple sclerosis seems to be strongly linked with the immune system, people with pre-existing autoimmune diseases are at a much greater risk for the disease than those without. There are different kinds of autoimmune diseases with the most well-known being AIDS. Therefore, practicing safe sex could lower one’s risk for getting multiple sclerosis since it lowers the risk for getting this dangerous autoimmune disease.
What Are the Signs and Symptoms of Multiple Sclerosis?
There are a lot of different symptoms of multiple sclerosis, some more severe than others. However, some of these symptoms could also be signs of other diseases or illnesses so it is important to get an expert diagnosis from a qualified doctor if you exhibit symptoms that worry you.
1- Vision problems: multiple sclerosis can cause inflammation of the optic nerves often leading to blurred vision, double vision, or loss of ability to see contrast or vivid colors. This degeneration of vision can sometimes be accompanied by pain when the person looks upward or to the side.
2- Numbness or tingling: Because the main target of the disease is the nervous system located in the brain and spinal cord, a person’s nerves will start to send and receive conflicting signals if he or she has multiple sclerosis. This can result in numbness or tingling sensations in the face, arms, legs or fingers.
3- Pain: Pain is another relatively common symptom of MS. One study showed that more than half of all patients with the disease reported experiencing chronic pain but acute pain is also very common. This pain is usually experienced as a chronic burning, aching, or prickling sensation. Acute pain in MS patients is usually described as a stabbing or electric shock-like sensation in the face or running from the back of the head down along the spine.
4- Bladder dysfunction: At least 80% of people with multiple sclerosis experience some form of bladder problems. This is because the nerve signals responsible for regulating the bladder are disrupted or abnormal in patients with the disease resulting in a higher frequency of urination (particularly at night), difficulty initiating urination, and incontinence.
5- Muscle spasms: This can either refer to involuntary spasms or to a feeling of stiffness in the muscles. The symptom ranges from a vague sensation of tightness in the muscles to intensely painful, uncontrollable spasms of the limbs (most often the legs). The occurrence and severity of spasms can be affected by sudden changes of position, extreme hot or cold temperatures, humidity levels, certain infections, or even wearing clothes that fit too tightly.
There are many, many more symptoms which are associated with multiple sclerosis and every patient’s experience with the disease is different. These are five of the most common signs and symptoms that you may have the disease but it is important to do additional research and obtain an expert diagnosis.
What Are the Different Types of Multiple Sclerosis?
Multiple sclerosis has been divided into four main types, each characterized by a unique speed and form of progression of the disease. Doctors use these four different classifications in order to determine the most effective treatment plan, tailored to the exact needs of the patient. The four types of multiple sclerosis are relapsing remitting, secondary progressive, primary progressive, and progressive relapsing.
1- Relapsing remitting multiple sclerosis (RRMS)
This type of multiple sclerosis is characterized mainly by its affects on neurologic function, namely that the functioning continuously worsens with each attack of the symptoms. Each attack or flare up is followed by a period of full or nearly full recovery or remission. This is the most common diagnosis with around 85% of patients being initially diagnosed with RRMS. The primary distinguishing factor separating this type form the other, progressive types of multiple sclerosis is that lesions and scarring are more prevalent on the brain rather than along the spinal cord.
Further distinguishing RRMS from the progressive types of multiple sclerosis is the tendency for the symptoms to present episodically, in the periodic attacks described above, whereas progressive types of MS are usually characterized by more chronic symptoms and gradual intensification of the symptoms experienced. It is also the type that appears earliest, around the age of 20 or 30 and in rare cases, even in childhood. The progressive types usually don’t appear until later in life, around age 40 or 50.
2- Secondary progressive multiple sclerosis (SPMS)
This type has the name of “secondary progressive” because it is primarily characterized by the fact that it tends to follow from relapsing remitting multiple sclerosis. Of the large amount of people who are initially diagnosed with RRMS, a majority will eventually transition to this type within 10-25 years or so. This means that while symptoms were at first episodic and relatively unpredictable in nature, the disease will now begin to progress more consistently and steadily. Although, this does not necessarily mean it will progress more quick
ly. Of the people diagnosed with RRMS, about 50% will have transitioned to SPMS within a span of 10 years and 90% will have transitioned to this type within a span of 25 years, meaning that, eventually, just about every case of relapsing remitting multiple sclerosis will transition to secondary progressive multiple sclerosis. This type is more responsive to treatment methods than the other two progressive types. The other two are also distinguished from SPMS by virtue of the fact that relapses are more likely with this type.
3- Primary progressive multiple sclerosis (PPMS)
Like relapsing remitting multiple sclerosis, this type of the disease is also characterized by a continuous worsening of neurological functioning. However, unlike RRMS, primary progressive multiple sclerosis is notably lacking in the alternating experience of relapses (also known as attacks or flare ups) and remissions (also known as recovery). Instead, the disease progresses steadily and continuously although the speed of the progression may change over time.
In patients with PPMS, there is significantly less inflammation and usually a lower number of lesions or scars on the brain. Instead, lesions and scarring occur primarily on the spinal cord meaning patients exhibiting this type of multiple sclerosis will usually have greater difficulties with walking and other everyday activities.
4- Progressive relapsing multiple sclerosis (PRMS)
This type of multiple sclerosis is the rarest of the four. Only about 5% of those with the disease are diagnosed with progressive relapsing multiple sclerosis. People with PRMS experiencing a steady worsening of neurological function from the beginning similar to those with primary progressive multiple sclerosis. However, unlike PPMS, this type is also characterized by occasional relapses or flare ups similar to those experienced by patients with relapsing remitting multiple sclerosis. Because this type is progressive from the beginning, it is often first diagnosed as PPMS and only when the first relapse occurs will the doctor modify the diagnosis to be progressive relapsing.
How Is Multiple Sclerosis Diagnosed?
Doctors use a variety of techniques to diagnose the various types of multiple sclerosis in their patients. Because the symptoms vary so widely and many of them could be attributed to other diseases or illnesses as well, doctors must use a combination of different diagnostic tools to confirm that the symptoms the patient is experiencing are indeed a result of multiple sclerosis. The primary diagnostic tools used are the patient’s medical history, neurological exams, and laboratory testing.
1- Medical history: Making sure that your physician has an accurate, detailed history of your medical conditions and problems as well as those of your relatives will help him or her to narrow in on the most likely possibilities for what is causing the symptoms you are experiencing.
2- Neurological exams: MRIs (Magnetic Resonance Imaging), EPs (Evoked Potentials) and other examinations of the brain can help the doctor identify any lesions or scarring on the brain which could indicate the existence of multiple sclerosis.
3- Laboratory testing: blood and spinal fluid tests can help doctors recognize signs and symptoms that aren’t visible from looking at the patient. For example, they can test the concentration of T cells in your brain or spinal cord as well as find out if there is any damage to the myelin layer of your nerve fibers.
The criteria that doctors are looking for when using these diagnostic tools are mainly evidence of damage in a minimum of two separate parts of the central nervous system (which includes the brain, spinal cord, and optic nerves); evidence that these two sites of damage occurred at least one month apart; and that no other possible diagnosis could be used to explain the signs found in the patient. Only when all three of these criteria are met will a doctor ascribe the diagnosis of multiple sclerosis.
This is because only one site of damage or multiple sites of damage which occurred at the same time could be attributed to acute trauma or other conditions affecting the nervous system. When the two sites of damage occurred at least one month apart, this is strong evidence that the damage is progressing along a course similar to that of multiple sclerosis.
What Is the Treatment of Multiple Sclerosis?
As of yet, no cure for multiple sclerosis exists. However, there are treatments available to help those suffering from the disease manage their symptoms, making living with the disease easier to handle.
Currently, there are ten disease modifying medications for multiple sclerosis which have been approved by the FDA (Food and Drug Administration). These medications work to modify the disease course by decreasing the disease activity and slowing the progression. The ten medications include: Aubagio, Avonex, Betaseron, Copaxone, Extavia, Gilenya, Novantrone, Rebif, Tecfidera, and Tysabri.
Additionally, there are medications available for those with RRMS or PRMS to help manage relapses. These are temporary treatment regimens used only when an attack or flare up occurs. The medical options include a high dose of Solu-Medrol administered intravenously; a high dose of Deltasone administered orally; or an adrenocorticotropic hormone gel known as H.P. Acthar Gel which is injected on a daily or near-daily basis.
It is important when taking any medications prescribed by a physician to follow the treatment plan exactly as he or she has laid it out. Straying from the established plan could lead to diminished effectiveness of the medication or worsening of the side effects experienced.
In addition to treatments for modifying the course of the disease and managing the symptoms, physicians recommend that patients take up a rehabilitation program designed to promote the functions and abilities that are often diminished by multiple sclerosis. The programs usually help to tackle problems with motor functions, accessibility, mobility, and cognitive functions. Taking up a rehabilitation program will help to prevent or overcome the everyday complications that arise from multiple sclerosis so that patience can remain as independent as possible despite the disease.
What Is the Prognosis and Life Expectancy with Multiple Sclerosis?
The good news is that although multiple sclerosis still has no effective cure, it is not a fatal illness. The life expectancy for those with the disease is about the same as those without it so people who have developed multiple sclerosis can feel encouraged that their life span will not be affected by the disease.
With that said, there is still the issue of quality of life. Because the disease causes a lot of uncomfortable, painful, or even embarrassing health problems—such as moderate to severe pain, bladder control problems, and uncontrollable muscle spasms—people with multiple sclerosis can experience a higher amount of suffering throughout their lifetime than those without the disease.
Furthermore, as the disease progresses, the decline in neurological function as well as other symptoms can worsen and become debilitating to the point that patients will require assistance in some or all of their daily activities.
Due to the wide variety of symptoms and the unpredictability of relapses or attacks, living with the disease can become very stressful since you cannot be sure when you will experience an attack or what symptoms will appear when you do.
In general, the prognosis for a patient with multiple sclerosis will depend upon a few different factors. For example, women with the disease will typically experience less symptoms (or less severe symptoms) than men with the disease. Other factors which can increase the amount and severity of symptoms include experiencing the first symptoms after the age of 40, experiencing the first symptoms in more than one area of the body, and having initial symptoms which affect your cognitive abilities, bladder control, or motor functions.
However, it is difficult to make a clear prognosis as the course of the disease varies widely in each patient. It is generally conceded that the progressive forms of the disease have more severe consequences than the relapsing type. About 25% of people diagnosed with a progressive type of multiple sclerosis will need some form of assistance in their everyday activities within eight years of the diagnosis.
On the other hand, another 25% of people who are diagnosed will still be able to live without any assistance up to 25 years after the diagnosis. It really depends upon how quickly the disease progresses in the patient’s specific case. And with treatment methods available to help slow the progression, there is still hope for people diagnosed with multiple sclerosis.
Luckily, however, there are many treatment options available which are designed to help decrease these symptoms and slow the progression of the disease meaning that even if you suffer from multiple sclerosis, you still have options for improving your quality of life. Since it does not affect your life span, the right combination of treatment and rehabilitation therapy can make living with multiple sclerosis very manageable and possible.
Can Multiple Sclerosis Be Prevented?
Unfortunately, there is no sure way to prevent the onset of multiple sclerosis. However, there are things you can do to lower your risk. Quitting smoking is a great first step to lowering your risk. Smokers have been shown to be significantly more likely to develop multiple sclerosis later in life.
There is also some evidence to suggest that making sure you get enough vitamin D can help to decrease the likelihood of getting multiple sclerosis later in life. While this is not yet confirmed, it isn’t a bad idea to make sure you have enough vitamin D since it will definitely help the functioning of your immune system and it is important for bone strength.
Other dietary habits have been linked to multiple sclerosis in some recent research. Drinking caffeinated beverages and green tea could potentially lower your risk. Tart berries may also contribute to lowering your risk. Furthermore, the resveratrol found in red wine has been shown to reduce your risk in some preliminary studies. While the evidence for these dietary changes lowering your risk is not conclusive, improving your diet and overall health are great ways to reduce your risk for a host of diseases and illnesses so it’s never a bad idea to stay on the safe side.
What Research Is Being Done on Multiple Sclerosis?
Currently, research on multiple sclerosis takes on a two part focus on finding the causes and finding a cure. Studies include clinical trials for treatments and possible cures as well as investigations into the effects of diet, environment, and genetics on the risk for getting multiple sclerosis.
One major area of focus for better understanding the causes is on multiple sclerosis clusters. This refers to populations exhibiting higher than average rates of the disease. Researchers focus on these clusters in order to examine the common factors which may be contributing to the onset of the disease.
Another focus of the ongoing research relating to the disease is finding treatments with fewer side effects than what is currently available. Because the treatments most often used today are often difficult or inconvenient to administer and can often come with severe side effects, this is an important field of research to help improve the quality of life of multiple sclerosis patients.
Scientist are also investigating the efficacy of combined medical treatments where two or more medications are used in conjunction in order to treat multiple causes at the same time. This could potentially be more effective than the use of one medication at a time since it would offer a more comprehensive assault on the disease. However, this is a new line of research and, as of yet, there is little news to report regarding whether or not it will be successful.
In addition to improving treatments, researchers are working on developing better diagnostic tools and means of identifying the disease. This is mainly being carried out as research into different biomarkers that could be identified by testing cerebrospinal fluid or blood for various indicators such as proteins or the presence of certain cells. Although in the early stages, such biomarkers could not only help to identify a person with multiple sclerosis but could also potentially provide information about how severe symptoms could be and how well he or she will respond to the different treatments available.
Thankfully, there are many research societies dedicated to multiple sclerosis and scientists all around the world collaborate and share their findings in order to speed up the progress toward a better understanding of the disease and, ultimately, a cure.
Home Remedies for Multiple Sclerosis
Some alternative methods exist for treating multiple sclerosis. However, it is important to note that doctors advise against using only alternative treatments. The best option is to develop a combined regimen of medical treatments and alternative methods to create a complementary treatment plan ideal for you. It is very important to talk with your doctor before you begin any new treatment.
Questions you need to ask yourself and your doctor include: what is involved in the treatment? How effective has it been? Are there any risks or side effects and if so, what are they? Will this treatment conflict or interfere with other treatment methods I am currently using? How is supposed to work? What are the active ingredients and why are they supposed to help treat multiple sclerosis? How expensive is it and is it really worth that money?
With that cautionary note in mind, some of the alternative methods out there include changes to your diet, workout routines, managing stress levels, and acupuncture.
1- Changing your diet: Although there is no diet which has been proven to cure the disease, there are many which are suggested to help manage the symptoms. While they may not be directly linked to improvement in the course of the disease, a healthy, balanced diet high in nutrients and fiber can definitely help you feel better overall.
2- Working out: exercise has been shown to help manage the symptoms of multiple sclerosis. This is because a well-designed workout regimen as part of a larger rehabilitation plan can help to reduce the debilitating effects of the disease as it progresses. Aerobic exercises can help to reduce your levels of fatigue or sluggishness while also improving your bladder control and boosting your overall mood. Stretching can reduce stiffness felt in the muscles and increase your mobility. Talk with your doctor or physical therapist about designing a workout regimen that is right for you.
3- Stress management: It is still unclear whether higher stress levels really play a significant role in the onset of multiple sclerosis or the frequency and intensity of relapses. There are many different types of stress and each one affects different people in countless different ways. However, lowering your stress levels can improve your overall quality of life which can give you the mental and emotional strength to live with multiple sclerosis. So finding relaxation techniques and ways of managing your stress levels that work for you can be a great addition to your comprehensive multiple sclerosis treatment plan.
4- Acupuncture: Acupuncture is working its way further and further into modern Western medicine as more and more studies are coming out to suggest it has potential benefits for a wide range of conditions. However, it is still not a fully proven treatment method. Many people still report a positive experience with this method and generally does not interfere with the effectiveness of other medical treatments for multiple sclerosis so it will not cause any harm to try it out and see if it helps you manage your symptoms. If it works, keep it up. If not, move on. But always consult your doctor first.
