For the 400,000 Americans with multiple sclerosis (MS), the potentially incapacitating disease poses unpredictable challenges, but does not signal a shorter lifespan.
With no known cure, MS is named for the accumulation of scar tissue (sclerosis) around the nerves (multiple) of the brain and spinal cord, inhibiting signals from the central nervous system to the rest of the body. As a result, sufferers can experience a variety of neurological impairments ranging from paralysis to slurred speech to vision loss and more.
Most MS patients, however – who typically are diagnosed between the ages of 20 and 40 – don’t become severely disabled, according to the National Multiple Sclerosis Society.
Symptoms & Signs
Multiple sclerosis develops as the body’s immune system mistakenly attacks the fatty protective nerve covering known as myelin. No single diagnostic test can pinpoint MS, according to the Mayo Clinic, and ultimately its diagnosis depends on ruling out conditions that exhibit similar symptoms.
These symptoms, which can differ in each patient, include:
- Numbness or weakness in the arms and legs
- Blurred or double vision, or pain during eye movement
- Partial or total vision loss
- Pain or tingling in different areas of the body
- Lack of coordination or unsteady walking
- Extreme fatigue
Genetic Factors & Causes
Anyone can develop MS, though two-thirds of its sufferers are women. While there is no known cause, according to the Cleveland Clinic, several risk factors may predispose someone to the disease, including:
- Genetics: The disease is not directly inherited, but those with a family history have a heightened risk. Someone whose parent or sibling has had MS has 10 to 15 percent higher chance of developing it.
- Infections: MS has been linked to various viruses, with the Epstein-Barr virus (which causes mononucleosis) of particular interest to researchers, according to the Mayo Clinic.
- Other conditions: Those with Type 1 diabetes, Inflammatory Bowel Disease (IBD) or thyroid disease – which also autoimmune conditions – have a slightly higher risk of developing MS than the general population.
- Race: Caucasians whose families originated in northern Europe are at highest risk, while those of African, Asian or Native American heritage are at lowest, according to the Mayo Clinic.
- Geography: Areas with temperate climates have a far higher incidence of MS, such as Europe, northern United States, southern Canada, southeastern Australia and New Zealand.
Management & Prognosis
Each patient’s MS progresses unpredictably and has an unpredictable prognosis. However, based on symptom progression, patients usually face one of four disease courses. According to the Cleveland Clinic, these include:
- Relapsing-Remitting: Marked by acute attacks called relapses or exacerbations, this type is followed by partial or complete recovery periods (remissions) when the disease does not worsen. About 85 percent of patients are diagnosed initially with relapsing-remitting MS.
- Primary-Progressive: With no clear relapses or remissions, this type is marked by steadily worsening disability. About 10 percent of patients have primary-progessive MS, according to the National MS Society.
- Secondary-Progressive: This type follows an initial period of relapsing-remitting MS, evolving into a variable rate of steady progression.
- Progressive-Relapsing: Marked by steadily worsening neurologic function, this rare type also includes acute attacks that may or may not be followed by some recovery, according to the Cleveland Clinic.
Overall prognosis can be affected by complications that some MS patients experience, such as bladder, bowel or sexual problems; cognitive changes such as forgetfulness or confusion; depression; and epilepsy, according to the Mayo Clinic.
Treatments & Medications
Several FDA-approved drugs can slow the course of MS, reduce the number of relapses, and help manage major symptoms. These include:
- Corticosteroids: These reduce inflammation associated with relapse and are the most common MS drugs, according to the Mayo Clinic. Oral prednisone and intravenous methylprednisolone are two corticosteroids used.
- Interferons: These medications slow MS symptom progression, though they can result in liver damage. Examples include Betaseron, Avonex and Rebif (none of which comes in generic form).
- Glatiramer: Also known as the brand name Copaxone, this IV drug can hinder the immune system’s attack on myelin. Side effects can include shortness of breath and flushing, according to the Mayo Clinic.
- Natalizumab: Also known as Tysabri, this is used if other drugs don’t work or aren’t well tolerated. It impedes potentially damaging immune cells from migrating from the blood to the central nervous system.
- Mitoxantrone: Also known as Novantrone, this immunosuppressant is typically used only in advanced MS because of risks to the heart.
Other MS therapies address its resulting disabilities. Physical and occupational therapists can demonstrate flexibility- and strength-increasing exercises as well as the use of adaptive devices that help patients perform daily tasks, according to the Mayo Clinic.
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