An Overview of Multiple Sclerosis

You may know that multiple sclerosis (MS) causes symptoms like fatigue, abnormal sensations, or an inability to walk. But you may wonder how it occurs and why people with MS have such unique symptoms. Or maybe you want answers to more difficult questions, like whether there is a cure for MS or if MS is fatal (it's almost always not).

Whether you or a loved one was recently diagnosed with MS or you simply want to gain a basic understanding of this unpredictable condition, it is important to know that you can live well with MS and that gaining knowledge of the condition is a critical first step.

What Is Multiple Sclerosis?

Multiple sclerosis is a chronic disease of the central nervous system—which is comprised of the brain and spinal cord. In a healthy person, nerve cells in the brain and spinal cord rapidly send signals to each other and to the rest of the body. These signals are called nerve impulses and are critical to our functioning and way of life. They allow us to process information, feel sensations, and move freely.

But in a person with MS, these nerve signaling pathways are impaired. In other words, those nerve impulses transmitted in the brain and spinal cord—and to the rest of the body—are either slowed or not transmitted at all. This is because, in MS, a person's immune system launches an attack against myelin—the protective coating around nerve fibers (axons) where nerve impulses travel. When myelin is damaged or destroyed by immune system cells, nerve impulses cannot travel efficiently or rapidly anymore.

Depending on the location of myelin damage in the central nervous system, a variety of symptoms can manifest.

This is why the symptoms of MS are unique for each person who has it. That being said, there are symptoms of MS that are more common than others. This is because MS tends to affect certain locations within the central nervous system. For example, the brainstem (the stalk connecting the brain and spinal cord) and the cerebellum (located at the back of the brain near the brainstem) are two commonly affected areas. Damage to the brainstem and cerebellum can result in vertigo, speech problems, tremor, ataxia, and vision problems.

Another very common symptom among those with MS is fatigue. While there are a number of potential causes for fatigue, MS itself is a major culprit. As you can imagine, the constant attack on myelin and the nerve fibers—and the body's attempt to push through and send messages—is quite an exhausting fea. This manifests as debilitating fatigue in many people with MS.

Other common symptoms of MS include:

Abnormal sensations (e.g., numbness and tingling, itching, tightness, burning)

In terms of the precise cause of MS, scientists are still scratching their heads—although, a number of theories have been proposed including infectious disease exposure (like the Epstein-Barr virus), genetic makeup, and vitamin D levels. It's likely that a complicated interaction between a person's genes and their environment is what ultimately triggers MS—maybe one more than the other in some people.

As of right now, there is no specific gene that we can test to determine whether you will develop MS, but there are some risk factors that may or may not increase your chances. Some of these include age, gender, where you live, diet (maybe), and habits like smoking.

What to Know About MS

It can be difficult to diagnose MS based solely on symptoms. The symptoms of MS can be downright perplexing, even bizarre. One month your vision might be slightly blurry, and then six months later your leg may feel numb when you exercise too much. In addition, many symptoms of MS are nonspecific, meaning they can be seen in other health conditions.

For instance, fatigue and muscle aches are common in fibromyalgia and systemic lupus erythematosus. Numbness, tingling, and muscle weakness can be from a vitamin B12 deficiency or from a herniated disc.

It's actually fairly common for people with MS (prior to their diagnosis) to report that they attributed their symptoms to a benign illness, like the flu, or even to their imagination. Doctors, too, sometimes miss an MS diagnosis because the symptoms are so subtle and transient. In fact, some people recall years of seeking out medical care without a diagnosis, and it can actually be a sign of relief when that diagnosis finally happens.

This is why it's important to see your primary care physician if you are having new, worrisome symptoms. Don't try to diagnose yourself or ignore your gut feeling—it's reasonable to seek a second opinion if you are not getting the answers you need.

If your doctor suspects a neurological disease like MS, he or she will refer you to a neurologist. A neurologist will ask you questions about your symptoms and perform a physical examination.

He or she may also order an MRI of your brain and/or spinal cord to help rule in or out a diagnosis of MS.

Types of MS

You may be surprised to know that there are four types of MS and they vary in their symptoms, their disease course, and how they are treated.

Relapsing-Remitting MS: Most people with MS are first diagnosed with relapsing-remitting MS—about 85 percent. In this type, a person experiences relapses or flares of neurological symptoms (blurry vision, a numb arm) that then resolve fully or partially (the remitting period) over weeks to months.
Secondary-Progressive MS: Many people with relapsing-remitting MS eventually develop a more progressive disease course where their symptoms become chronic and irreversible. This transition is not always easy to determine, though. Sometimes there is overlap, meaning a person will develop a gradual decline in their neurological function (become more disabled), but still have relapses or episodes of reversible neurological symptoms.
Primary-Progressive MS: In primary-progressive MS, a person develops gradual, progressive neurological symptoms from the start (there are no relapses). This is a less common type of MS and tends to affect the spinal cord more than the brain.
Progressive-Relapsing MS: Progressive-relapsing MS is the least common type of MS and occurs when a person experiences both a gradual decline in their neurological function (like primary and secondary progressive MS) along with relapses (like relapsing-remitting MS).

There Is No Cure

While there is no cure for MS, it's important to understand that the vast majority of people do not become severely disabled, and for only a very few is MS fatal (this is rare). In addition, the good news is that there are numerous therapies available to help you combat your MS. Most of these therapies are for relapsing types of MS—although research is evolving on treating progressive MS.

There are also a number of therapies to help you manage your MS symptoms. These include medications and therapies like physical or occupational therapy, assistive mobility devices, and complementary therapies, like yoga and reflexology. You may need to explore a number of treatment regimens before finding the one that works for you.

If You've Been Recently Diagnosed With MS

While this may be a frightening time for you, it's important to understand that you are not alone. That being said, while MS certainly does not define you, it is now part of your life and requires thoughtful attention and care. As you absorb and process your new diagnosis, be good to yourself. Reach out to your loved ones or the MS community.

Learn All You Can

While it may be difficult, try to read as much as you can about MS, including the symptoms of MS, treatments for MS, and living well with MS. Knowledge is power and will hopefully give you some control over the unpredictable nature of this condition.

Also, be prepared when you visit your neurologist. It's a good idea to devise a list of questions prior to your visit (doctor visits can be overwhelming) and consider asking a friend or loved one to attend with you if you are comfortable.

Commit to Treatment

It's important for your peace of mind and MS care to establish an open, trusting relationship with your health team. Inquire about proper ways to communicate and what constitutes an emergency. Maintain adherence to your medication and communicate all concerns, like adverse effects, with your doctor.

While your MS is now a major priority in your life, it's important to continue seeing your primary care doctor for health screening tests (e.g., colonoscopy to screen for colon cancer, a blood test to screen for diabetes or high cholesterol), vaccinations, and counseling on healthy lifestyle habits like weight management.

Consider Changes

Frustrated by your diagnosis? The good news is that by engaging in healthy lifestyle habits like stress management, regular exercise, smoking cessation, and sleep hygiene you will feel better and help your MS too.

A Word From Verywell

You may feel anxious about your MS, concerned about when your next relapse will strike, or how disabled you will become in years to come. This anxiety is normal, but it shouldn't debilitate you. You can live a full and happy life with MS and control certain parts of the disease like your treatment and lifestyle.

Sources:

Birnbaum, M.D. George. (2013). Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment, 2^nd Edition. New York, New York. Oxford University Press.

National MS Society. What is MS? Retrieved July 17th 2016.