What are the other Names for this Condition? (Also known as/Synonyms)

• Acute Fulminating Multiple Sclerosis
• Demyelinating Disorder due to Multiple Sclerosis
• Disseminated Sclerosis

What is Multiple Sclerosis? (Definition/Background Information)

• Multiple Sclerosis (MS) is an autoimmune disorder that affects both the brain and spinal cord (central nervous system) and is observed in young to middle-aged adults. The disorder affects twice as many females as males
• In Multiple Sclerosis, the myelin sheath, a protective layer surrounding the nerve cells, is progressively destroyed. Hence, MS is also known as a demyelination disorder. Over time, usually several years to decades, the nerve gets damaged causing an associated set of symptoms
• There are many forms of Multiple Sclerosis, but not all forms may be observed in each individual. The various forms of MS include:
  • Clinically Isolated Syndrome (CIS): It is described as the first appearance of a single or multiple neurological signs and symptoms lasting a day or more that may potentially indicate the onset of MS
  • Relapsing-Remitting Multiple Sclerosis (RRMS): It is the most common type that affects about 80% of the individuals with MS that is marked by series of relapses and remissions
  • Secondary-Progressive Multiple Sclerosis (SPMS): It may be described as an advanced stage of multiple sclerosis that develops decades after RRMS
  • Primary-Progressive Multiple Sclerosis (PPMS): It is an advanced stage in which the neurologic function constantly deteriorates right from MS onset, generally in the absence of relapses and remissions
• It is extremely difficult to predict the course of development of Multiple Sclerosis over years and decades, and how it will present itself in different individuals. The condition can be mild, moderate, or severe and vary from one individual to another quite significantly
• The common signs and symptoms associated with Multiple Sclerosis include a loss of balance, problems with coordination, prickling sensation, pain, itching, numbness, weakness of arm and leg, vision, and urinary related abnormalities
• Multiple Sclerosis may be diagnosed by a thorough physical exam, radiological examination of the brain and spinal cord (MRI studies), specialized lab tests, and by excluding other conditions affecting the central nervous system
• There is no cure for Multiple Sclerosis. The treatment is aimed at managing the symptoms, slowing progression of the disease, and to ensure better recovery from the signs and symptoms. The administration of disease-modifying treatments by the healthcare provider can help delay progression of the condition
• Most individuals with Multiple Sclerosis may be able to continue with a normal quality of life and work, with minimal disabilities. While some individuals are able to avoid relapses for a longer period of time, others might lose their independence completely, necessitating daily support including wheelchair use

Who gets Multiple Sclerosis? (Age and Sex Distribution)

• Multiple Sclerosis (MS) most commonly begins between the ages 20 to 40 years; it is not generally observed in children
• Both males and females are affected; generally, the condition affects twice as many females as males
• Multiple Sclerosis is seen worldwide and people of all races and ethnicities may be affected. Individuals of Northern European descent are at an increased risk for MS compared to other races
• Studies have also shown that people living in certain regions with temperate climate, such as parts of Australia and New Zealand, some European nations, Southern Canada, and Northern United States seem to have a higher risk too

What are the Risk Factors for Multiple Sclerosis? (Predisposing Factors)

The risk factors associated with Multiple Sclerosis (MS) may include:

• Young adult women are known to have a higher risk
• Family history of Multiple Sclerosis
• People of Northern European descent
• Environmental triggers: People living in certain countries with temperate climate, such as Southern Canada, Northern United States, New Zealand, and Europe, report a greater number of MS cases; hence, certain environmental factors may be involved
• Presence of autoimmune diseases such as type 1 diabetes mellitus and thyroid disease
• Smoking
• Studies have also shown that a lack of vitamin D may lead to MS
• Epstein-Barr virus (EBV) infection
• Individuals with certain HLA gene types have an increased risk for MS

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Multiple Sclerosis? (Etiology)

The exact cause of Multiple Sclerosis (MS) is unknown, but it is considered an autoimmune disorder. In MS, the body’s own immune system attacks the myelin sheath, resulting in its damage. The condition spans several decades and its course is difficult to predict.

• The myelin sheath is a protective layer/membrane surrounding the nerve cells. Inflammation of the myelin sheath ultimately affects the nerve signals. The damage to nerves is characterized by plaque formation in the brain and spinal cord
• Studies have shown that a genetic defect or a virus could be the reason for the damage to the myelin sheath, causing a series of events that lead to the condition. It is believed that childhood infections and environmental factors could also play a role in individuals developing MS

What are the Signs and Symptoms of Multiple Sclerosis?

The signs and symptoms of Multiple Sclerosis vary based on the disease stage and progression of the condition. Also, these may significantly differ from one individual to another. The commonly observed signs and symptoms include:

Movement-related signs and symptoms that include:

• Muscle stiffness or spasticity; muscle spasms
• Exaggerated reflexes or hyperreflexia
• Loss of balance
• Coordination difficulties
• Numbness or abnormal sensations
• Difficulties while walking, moving one’s arm or leg; weakness in the arm or leg
• Tremors

Bowel and bladder associated signs and symptoms that include:

• Constipation
• Difficulty beginning to urinate
• Increased urinary frequency; urgency due to defect in bladder muscle (detrusor muscle)

Visual-related signs and symptoms that include:

• Double vision
• Eye discomfort
• Loss of vision, one eye at a time
• Episodes of optic neuritis: Pain and temporary loss of vision, also known as Uhthoff’s phenomena, which could be triggered by hot bath, fever, exposure to sun, stress, and other factors

Other signs and symptoms that may include:

• Decreased attention span
• Depression
• Dizziness
• Hearing loss
• Sexual-related problems
• Fatigue 

How is Multiple Sclerosis Diagnosed?

The criteria for the diagnosis of Multiple Sclerosis (MS) consist of two or more episodes of the symptoms. These symptoms must be present for more than 24 hours and present as separate episodes with no symptoms in between, for a period of a month or more. 

A diagnosis of Multiple Sclerosis is generally made after ruling out other conditions of the central nervous system. A physician may employ one or more methods (given below) to diagnose MS, since there is no single definitive test for diagnosis of the condition.

• Complete evaluation of medical history and family history, along with a thorough physical exam
• Evaluation of the presenting signs and symptoms
• Neurological examination that involves the central nervous system (brain and spinal cord)
• Magnetic resonance imaging (MRI) scan of the affected region of the brain and spinal cord
• Spinal tap: Cerebrospinal fluid is examined for the presence of oligoclonal bands (these are antibodies present in the spinal fluid of individuals with multiple sclerosis)
• Visual evoked potential tests for evaluating optic nerve function
• Nerve function test
• Specialized blood tests to look for specific antibodies, as well as blood tests to rule out other disorders or conditions with signs and symptoms similar to multiple sclerosis
• A diagnosis generally involves ruling out other conditions of the central nervous system that may cause similar neurological symptoms

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Multiple Sclerosis?

The complications associated with Multiple Sclerosis may be varied and depend on the form of the condition. The complications may include:

• Emotional distress and depression
• Difficulty concentrating
• Osteoporosis
• Urinary tract infections
• Increased use of assistive devices, such as walkers or walking sticks, including motorized wheelchairs for mobility
• Sudden sensation of electric shocks down the spinal cord
• Difficulty eating, swallowing, and performing simple daily tasks due to poor coordination
• Side effects from the long-term use of medication

How is Multiple Sclerosis Treated?

Following a diagnosis of Multiple Sclerosis (MS), the healthcare provider in consultation with the patient decides on the treatment plan and the use of prescription medications. However, since medications that help control and manage MS tend to change the course of the condition, such therapies are termed disease-modifying therapies (immunotherapies).

• Medications prescribed include beta interferons, glatiramar acetate (immunomodulator drugs), intervenous immunoglobulins, and cyclophosphamide
• Acute attacks of the disorder are treated with corticosteroids and plasma exchange therapy (plasmapheresis)
• Use of drugs such as baclofen (to reduce muscle spasm) or benzodiazepine
• Cholinergic drugs can be used to decrease urinary-related signs and symptoms
• Anti-depressants may be used for mood or behavior associated conditions
• Physical therapy including occupational therapy and rehabilitation
• Healthy living including a well-balanced diet and exercising, including adequate sleep

Even though there is no specific treatment for Multiple Sclerosis, there are treatment measures available to help the affected individuals have a better quality of life.

How can Multiple Sclerosis be Prevented?

Currently, there are no effective preventative methods available for Multiple Sclerosis.

What is the Prognosis of Multiple Sclerosis? (Outcomes/Resolutions)

The development course and overall prognosis of Multiple Sclerosis is difficult to assess. It is a chronic and incurable condition. Nevertheless, the life expectancy can be normal to near-normal for most individuals.

• Most individuals with Multiple Sclerosis are able to continue with their life and work with minimal disabilities. Some individuals are observed to go for a long time without a relapse of neurological symptoms
• Regular medical evaluation is essential to assess how the disease is progressing and if any changes are necessary to be brought into the treatment plans
• There is an increased burden of disability for the advanced stages of Multiple Sclerosis

Additional and Relevant Useful Information for Multiple Sclerosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/neurological-institute/