Understanding Multiple Sclerosis: Symptoms, Diagnosis, and Treatment Options

Multiple Sclerosis (MS) is a common autoimmune disease that affects the brain and spinal cord. The journey to diagnosis can be challenging because each case is unique. While MS is unpredictable and currently has no cure, it is not as daunting as it once was. There are now several effective treatments that can help you manage the disease and live a long, full life.

Understanding MS and treatment options can help reduce stress and anxiety, making it easier to live with the condition.

OU Health provides compassionate, multidisciplinary care including speech therapy, physical therapy, occupational therapy, urology, neuropsychology, neuro-ophthalmology, and pharmacy services, said OU Health neurologist Dr. Nidhiben A. Anadani, M.D., associate professor in the Department of Neurology at the University of Oklahoma College of Medicine.

Dr. Anadani said the team is well-versed at walking patients through financial services and insurance options, to ensure they get the care they need.

“We have resources including MRI and infusion services and can help with resources to ensure patients can afford MS medications,” she said.

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is a disease where the immune system attacks the brain, spinal cord, and optic nerves. This attack targets the myelin, the protective coating of nerve cells, which helps electrical signals travel quickly. When myelin is lost, it forms scar tissue known as sclerosis, also referred to as plaques or lesions. This damage prevents nerves from conducting electrical impulses properly to and from the brain. This can lead to symptoms like numbness, weakness, vision problems, and imbalance.

Symptoms lasting more than 24 hours are called relapses or exacerbations, which can last from a day to several months. While myelin can often repair itself, severe inflammation can damage the nerves permanently, potentially leading to lasting disability.

How Common is MS?

Over 900,000 Americans are living with MS. Most people are diagnosed between the ages of 20 and 40, but children and older adults can also be affected. MS affects more women than men and about 76% of people with MS are women. Researchers believe that factors such as hormones, genetic differences, and immune system variations may contribute to this higher prevalence in women

Genetics can play a role in MS, but most people don't have a family history. About 85% of patients have relapsing-remitting MS, with attacks and recovery. Fifteen percent have primary progressive MS, which worsens slowly without attacks, causing weakness and walking problems.

Without treatment, many with relapsing-remitting MS will develop secondary progressive MS, which gets worse over time. This can take 7 to 30 years. About 10% never develop progressive disease without treatment, but it's hard to predict who. The good news is that treatment can help manage MS and reduce the risk of disability.

Symptoms of MS

Multiple sclerosis (MS) symptoms vary by person and can change over time. Common symptoms include:

• Numbness or tingling
• Electric-shock sensations with neck movements (Lhermitte sign)
• Lack of coordination
• Trouble walking or inability to walk
• Weakness
• Stiffness and spasticity
• Vision loss in one eye, often with pain
• Double or blurry vision
• Dizziness or vertigo
• Sexual, bowel, and bladder issues
• Fatigue
• Slurred speech
• Memory and thinking problems
• Mood changes

Small increases in body temperature can temporarily worsen MS symptoms. These are known as pseudorelapses.

How is MS Diagnosed?

Diagnosing MS involves a combination of physical and neurological exams, along with various tests. Your healthcare provider will review your symptoms and medical history. Tests may include blood work, MRIs of the brain and spinal cord, and spinal fluid analysis.

Receiving an official MS diagnosis can take time and may require multiple visits to your provider. This is because MS symptoms can resemble those of other conditions. Although the wait can be nerve-wracking, an accurate diagnosis is essential for effective treatment.

Managing MS

Once you have a positive MS diagnosis there are two approaches to managing it.

Symptomatic Treatments

These help to relieve the symptoms of the condition without addressing the underlying cause. These treatments include:

1. Drug treatments: Medications for pain or muscle spasticity.
2. Therapies: Physiotherapy for muscle stiffness, or cognitive behavioral therapy for pain, anxiety, or depression.
3. Management techniques: Learning to pace yourself to reduce fatigue.
4. Rehabilitation: Services like physiotherapy, speech therapy, cognitive rehabilitation, or occupational therapy to improve daily living.
5. Complementary and alternative medicines: Treatments like acupuncture, Pilates, and mindfulness to enhance physical and mental well-being.

Disease Modifying Therapies

Disease-Modifying Drugs (DMDs) work by reducing inflammation in the brain and spinal cord, which helps lower the number and severity of relapses.

Sometimes, inflammation doesn't cause visible symptoms, but it can still be detected on brain scans. DMDs can lead to fewer or smaller new areas of damage (lesions) in the brain and spinal cord. The goal is to have no visible or invisible disease activity, known as No Evidence of Disease Activity (NEDA).

The main benefits of DMDs for MS are:

• Fewer relapses
• Less severe relapses
• Reduced risk of long-term disability

In the United States, some commonly prescribed DMDs for MS include:

• Interferon beta-1a (Avonex, Rebif)
• Interferon beta-1b (Betaseron, Extavia)
• Glatiramer acetate (Copaxone)
• Fingolimod (Gilenya)
• Dimethyl fumarate (Tecfidera)
• Diroximel fumarate (Vumerity)
• Teriflunomide (Aubagio)
• Natalizumab (Tysabri)
• Alemtuzumab (Lemtrada)
• Ocrelizumab (Ocrevus)
• Ofatumumab (Kesimpta)
• Ublituximab (Briumvi)
• Siponimod (Mayzent)
• Cladribine (Mavenclad)

These medications not only help reduce the frequency and severity of relapses, but they may also slow the progression of the disease.

For severe MS attacks, corticosteroids like methylprednisolone can quickly reduce inflammation by calming the immune system. These drugs help speed up recovery and protect the myelin sheath around nerve cells. Your healthcare provider might give this medication through an IV. Other short-term treatments for severe attacks include IV immunoglobulin therapy or plasma exchange.

Developing Healthy Habits

Living well with multiple sclerosis goes beyond just managing the disease and its symptoms. Research indicates that certain healthy habits can positively influence MS progression and increase your lifespan and quality of life. These habits include:

• Maintaining a balanced diet
• Maintaining a healthy weight
• Getting regular physical activity (30 mins a day of moderate exercise)
• Giving up smoking
• Managing other health conditions
• Moderating alcohol consumption
• Being cared for by an experienced MS team

If you experience new symptoms, a sudden worsening of existing symptoms, or serious difficulty walking, contact your MS care team immediately, especially if you're having a relapse.

Sometimes, symptoms can gradually worsen over months or years, leading to significant changes. It's important to have your MS reviewed annually, but if this isn't happening or your appointment is far off, reach out to your MS care team.

Your Expert MS Team at OU Health

While there is no cure for MS, the specialists at OU Health offer a variety of treatments to help you manage symptoms and slow the progression of the disease. Learn more about OU Health's neurology services or call to make an appointment with an MS Specialist at (405) 271-3635.