The topic this month is Multiple Sclerosis/MS. It is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation, or balance. It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild. It is another auto-immune disease where the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between the brain and the rest of the body. Eventually, the disease can cause permanent damage or deterioration of the nerve fibers. However, there are treatments to help speed the recovery from attacks, modify the course of the disease and manage symptoms. There’s no cure for multiple sclerosis. Worldwide over 2.8 million people are living with MS.
Studies have shown that it is more common in women, and an increase of this condition as you travel farther north or south from the equator. Countries that lie on the equator tend to have extremely low levels of MS, while places closer to the poles such as New Zealand, Canada and Scotland have particularly high rates.
MS is an unpredictable disease that affects people differently. Some people with MS may have only mild symptoms. Others may lose their ability to see clearly, write, speak, or walk when communication between the brain and other parts of the body becomes disrupted. Some people may experience long periods of remission without any new symptoms depending on the type of MS they have. When MS causes repeated attacks, it’s called relapsing-remitting MS. When the symptoms progress over time without clear attacks, it’s called primary progressive MS.
Early/common symptoms of multiple sclerosis can be:Changes to your vision – optic neuritis/double vision, vision loss, red-green color distortion, muscle weakness usually affecting one side of your face or body, or below your waist, numbness or abnormal sensations, numbness, prickling, or pins and needles, usually affecting one side of your face or body, or below your waist, fatigue, clumsiness, dizziness, difficulty with bladder control, loss of balance/coordination, difficulty with cognitive function (thinking, memory, concentration, learning and judgment, mood changes, muscle stiffness, muscle spasms, tremors). These symptoms vary from person to person and may fluctuate in severity from one day to the next. A person may have a few of these symptoms but it’s unlikely you’ll experience all of them at once.
Many of the symptoms of MS may look like other health problems, so a ‘rule out’ of other conditions will be done to identify this condition. Not one specific test is used to diagnose MS. Diagnosis is based on symptoms and signs, imaging tests, and lab tests. Your healthcare provider can make a diagnosis by following a careful process to rule out other causes and diseases. Two things must be true to make a diagnosis of relapsing-remitting MS: (A) you must have had two attacks at least one month apart. An attack is when any MS symptoms show up suddenly, or when any MS symptoms get worse for at least 24 hours. (B) You must have more than one area of damage to the central nervous system myelin. Myelin is the sheath that surrounds and protects nerve fibers. This damage must have occurred at more than one point in time and not have been caused by any other disease.
Your care provider may refer you to a neurologist and also enlist tests such as: (A) MRI. It can find plaques or scarring caused by MS. Generally, a single attack along with certain patterns of changes in brain tissue seen on an MRI scan of the brain done with contrast can mean that you have MS. (B) Evoked potentials. These tests record the brain’s electrical response to visual, auditory, and sensory stimuli, showing if you have a slowing of messages in the different parts of the brain. (C) Cerebrospinal fluid analysis called a spinal tap/lumbar puncture. It looks at the fluid taken from the spinal column to make check for cellular and chemical abnormalities seen with MS. (D) Blood tests to rule out other causes for various neurological symptoms. (E) Eye exam – another “‘rule out” ‘process for other possible conditions
Treatment will depend on your symptoms, age, and general health. It will also depend on how bad the condition is. Currently treatments are divided into: (A) Disease-modifying treatments. These directly target inflammation in the central nervous system. They help slow its deterioration. (B) Treatment of acute relapses.The use of steroids and plasma exchange (PLEX) can speed up your recovery when you have an MS attack. There is no known cure for MS, but things can be done to help change the course of the disease, treat flare-ups, manage symptoms, and improve function and mobility. Multiple sclerosis treatment focuses on minimizing further damage, managing symptoms and preventing complications.
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