Multiple Sclerosis: Types, Causes, Symptoms and Treatment
Fatigue, lack of focus, stiffness, eye pain…these are troublesome conditions that many people experience at some point in their lives. They tend to be dismissed as the result of too much stress, not enough exercise, or looking at a computer screen for too long. But symptoms like these should never be ignored, particularly if they persist or get worse, or if new symptoms start to pop up. According to the National Institute for Neurological Disorders and Stroke (NINDS), multiple sclerosis (MS) is a disease that affects over 2.3 million people worldwide and 250,000–350,000 people in the United States, and it often presents with symptoms just like these, symptoms that may be easy to overlook at first.
MS affects the central nervous system and catching the disease early is critical to prevent further damage and to slow disease progression. While awareness of MS is growing and research is providing new treatments, MS remains a bit of a mysterious and misunderstood disease. The cause of MS is not exactly clear, and we are still unsure why it affects more women than men. According to the National Multiple Sclerosis Society, women are 2 to 3 times more likely to develop MS than men.
What Is Multiple Sclerosis?
The National Multiple Sclerosis Society defines multiple sclerosis as an immune-mediated disease. Immune-mediated means that the body’s immune system attacks the central nervous system (CNS), including the brain, spinal cord, and optic nerve. The majority of multiple sclerosis experts consider MS an autoimmune disease, though not everyone agrees with this categorization, which continues to be the subject of some debate within the medical field.
In an autoimmune disease, the body’s immune system misfires and mistakes healthy cells, tissue, muscles, and organs for foreign invaders. The immune system thinks that normal substances like hormones or healthy cells are antigens, or foreign substances, and attacks them. Since no one has yet been able to identify a specific antigen that the immune system attacks in MS, some physicians think it is too soon to label MS an autoimmune disease.
What is clear in regards to MS is that the disease does attack the central nervous system, causing damage to the nerve cells and structure. The body’s immune system produces multiple kinds of white blood cells, including T cells. In multiple sclerosis, the T cells find their way into the central nervous system where they cause inflammation and damage to healthy tissue and cells. The result is the formation of hardened areas, or scleroses, in the brain and spinal cord. MS gets its name from the multiple hardenings, or sclerosis, that form with the progression of the disease. These scleroses are referred to as MS lesions. MS is often diagnosed by finding lesions on an MRI.
The most common parts of the central nervous system that fall under attack in MS include:
- Myelin, a protective layer around nerve fibers
- Nerve fibers
- Cells called oligodendrocytes that produce myelin
The damage to these parts can take place in any area of the central nervous system, including the brain, spinal cord, and optic nerve, and result in a variety of neurological symptoms.
What Causes Multiple Sclerosis?
The exact cause of multiple sclerosis is unknown. Scientists do not think that multiple sclerosis is the result of just one instigator but rather of a variety of factors. Genetics and environmental factors are both believed to play a significant role in the development of MS.
Scientists believe the environment has something to do with why certain people develop MS and others do not. For instance, MS occurs more frequently in areas far away from the equator as opposed to warm areas near the equator. It is not yet understood why this is so, but research does suggest that vitamin D deficiency may have something to do with it. Low vitamin D is a risk factor for MS, so that could be a link between cases of MS occurring more frequently in people who live in colder climates.
Additional factors such as smoking and obesity have also been shown to increase the risk of developing MS. A 2016 study published in Cellular and Molecular Life Sciences highlighted the impact of a “western diet” comprised largely of saturated fat and sodium on the immune system and its possible link to autoimmune conditions, including multiple sclerosis.
Doctors and scientists have determined that there is a genetic risk factor when it comes to multiple sclerosis. MS is not hereditary since it does not get passed down from one generation to another, like from a mother to a child. However, the National Multiple Sclerosis Society does advise that there is a genetic risk that can be inherited. This genetic risk means that those who have a first-degree relative, such as a parent, sibling, or child, who has been diagnosed with MS are at a greater risk of developing MS themselves.
Caucasians of Northern European descent are at higher risk for multiple sclerosis than are African, Asian, and Native Americans.
Research shows that there may be a link between multiple sclerosis and the Epstein-Barr virus (EBV). Epstein-Barr virus is a member of the herpes family of viruses, and it is very common. Many people contract it in childhood, often without ever knowing it. It is spread through bodily fluids, including saliva, and can easily be transferred from an adult to a child with a simple kiss hello or goodbye. It can also be spread through blood transfusions, organ transplants, and semen.
Epstein-Barr virus commonly causes mononucleosis, a highly contagious disease that creates chronic fatigue, fever, and sore throat, in young adults and adults.
Studies conducted by the Harvard School of Public Health have provided statistics surrounding the possible link between the Epstein-Barr virus and multiple sclerosis:
- Study subjects who eventually developed MS were found to have a significantly higher number of EBV antibodies than those who did not develop MS.
- After infection with EBV, the risk of developing MS increased significantly.
- Those who had a specific immune-related gene, as well as a high amount of EBV antibodies in their blood, were 9 times more likely to develop MS than those who had low antibody levels and no immune-related gene.
- Smokers with the highest levels of EBV antibodies were 70% more likely to develop MS than those who were not smokers and had low antibody levels.
Types of Multiple Sclerosis
Doctors and scientists have been able to identify four different disease courses that multiple sclerosis might take. The different paths of the disease have resulted in four types of MS.
- Clinically isolated syndrome (CIS): Clinically isolated syndrome encompasses the first bout of symptoms that manifest within the central nervous system. This episode suggests the presence of MS but is not enough for a physician to make a diagnosis.
- Relapsing-remitting MS (RRMS): This is the most common type of MS, and it consists of periods of MS symptoms, or relapses (also called exacerbations or flare-ups), followed by symptom-free periods of remission. During remission, there is no indication that the disease is progressing.
- Secondary progressive MS (SPMS): This type of MS occurs when someone with relapsing-remitting MS starts to progress with worsening neurological symptoms.
- Primary progressive MS (PPMS): Primary progressive MS is diagnosed when the disease starts progressing as early as the onset of symptoms. There are usually little to no periods of relapse and remission, but rather a steady progression of the disease.
Symptoms of Multiple Sclerosis
Multiple sclerosis symptoms will vary from person to person. The disease attacks the central nervous system, damaging various areas, which can cause a mix of symptoms.
Common MS symptoms include:
|Fatigue that affects quality of life||Numbness and/or tingling in the extremities|
|Muscle weakness||Dizziness and vertigo|
|Sexual dysfunction||Chronic pain|
|Depression||Uncontrollable laughing or crying|
|Difficulty walking||Muscle spasms (spasticity)|
|Muscle stiffness||Vision problems|
|Double vision||Loss of vision|
|Bladder and bowel issues||Cognitive impairment|
|Speech difficulties||Tremors or shaking|
Diagnosing Multiple Sclerosis
The National Multiple Sclerosis Society highlights three criteria for diagnosing MS:
- There must be a minimum of two damaged areas in the patient’s central nervous system.
- The physician must be able to find evidence that the damage occurred at two different times.
- All other possible diseases and conditions must be ruled out through tests, physical exams, and symptoms.
A diagnosis of multiple sclerosis can be tricky. The symptoms of MS are common among many diseases, including several autoimmune diseases. They can also be the result of an event such as a stroke or a growth such as a tumor. To diagnose MS, the neurologist will run several tests to rule out conditions such as stroke, tumor, and other diseases.
A complete neurological exam should be conducted to test various functions that reside within the central nervous system, including language and speech, walking and movement, balance, and vision. No blood test can determine whether or not a patient has MS. However, ordering blood tests can help rule out conditions such as Lyme disease, which is known to mimic the symptoms of MS.
The following two tests are commonly used to diagnose multiple sclerosis:
- Magnetic resonance imaging (MRI): MRI can help doctors see the deterioration of the myelin (demyelination) in the brain and spinal cord and see lesions that have formed as a result of MS.
- Cerebrospinal fluid (CSF): A spinal tap (or lumbar puncture) may be performed to check the patient’s spinal fluid for antibodies or proteins that are the result of myelin breaking down.
Treatment for Multiple Sclerosis
Since there is no cure for MS, treatment is often referred to as “managing MS.” MS is a lifelong condition that requires ongoing treatment, or management, to prevent further damage from occurring and to learn to live with the symptoms.
The U.S. Food and Drug Administration has approved several medications for the treatment of multiple sclerosis. These include oral, injectable, and infused medications. These disease-modifying therapies (DMTs) are used to prevent further progression of the disease as well as to manage symptoms to give patients a higher quality of life.
In March 2017, the FDA approved a new drug, Ocrevus, for the treatment of primary progressive MS as well as relapsing forms of MS. In clinical studies, Ocrevus was shown to reduce MS relapses by half and is the first approved therapy for patients with primary progressive MS, giving hope to the MS community.
In addition to medications intended to target MS, other medications have been approved to manage specific symptoms such as:
- Bladder and bowel problems
- Dizziness and vertigo
- Emotional problems
- Sexual problems
- Muscle spasms
- Difficulty walking
Amino Acid Supplements
A recent study has shown a link between the amino acid taurine and an increase in the effectiveness of multiple sclerosis treatments.
Amino acids are essential for building a healthy, properly functioning body. They help the body form protein and make chemicals that are needed for optimal organ function, including brain function.
As reported by Multiple Sclerosis News Today, a 2017 study published in Nature Chemical Biology concluded that taurine helped MS patients during treatment by enabling cells to create new myelin sheaths where damage had previously occurred from the disease.
While this study shows that taurine may be beneficial to MS patients, it is best to also take a balanced mixture of essential amino acids to make sure that the blood concentration of amino acids is optimal. In addition, MS patients should always discuss starting any new supplements or complementary therapies with their physician.
Complementary and Alternative Therapies
Some MS patients find symptom relief through complementary and alternative therapies in addition to their MS treatment plan. Scientific evidence that these therapies may be beneficial is still lacking, though clinical trials are ongoing), and what works for one patient may not work for another. But many MS patients do find relief and improved quality of life through complementary and alternative therapies including:
- Physical and occupational therapy to help maintain and restore movement and optimal function
- Exercise to improve strength, mobility, fatigue, and mood
- Acupuncture to relieve chronic pain in different parts of the body
- Stress management to improve quality of life
In summary, even though MS is not as common as some other diseases, anyone experiencing any MS symptoms should never dismiss them. While most MS patients tend to have the same life expectancy as people without MS, the key to MS management is to work with your health care team to inhibit the worsening of symptoms and to stop the disease from progressing. It is critical to discuss any new or ongoing symptoms, neurologic or otherwise, with a physician right away.