What is MS?
All you need to know about Multiple Sclerosis
Author: Dr. Thomas Hemmen
Multiple Sclerosis (MS) affects the brain and spinal cord (central nervous system). It is thought to be due to an autoimmune attack against the nervous system that can start at any age but is more common in young to middle aged women. MS frequently is progressive but can undergo periods of recovery (remission). In each individual it is difficult to predict if the period of recovery lasts a long time or not. Finding the best tests and learning on how to make the best treatment decision can be challenging. Modern therapies are available to reduce the amount of autoimmune attacks and lengthen the periods of remission, ideally causing permanent remission
What is MS?
MS is an autoimmune disorder of the central nervous system (brain and spinal cord). It can affect people at any time in their life but is most common in women between 20-50 years. The autoimmune condition affects the insulating sheaths around the brain and spinal cord cells. These sheets are made out of myelin and the underlying mechanism of MS is that the immune response strips the nerve cell of their myelin (demyelination). Without the myelin the cells cannot transmit information effectively and reduce the connectivity that is so essential in the central nervous system as if controls and relays thought and intent to the rest of the body.
The autoimmune disorder affecting the brain and spinal cord (Central Nervous System, or CNS) can afflict any part or portion of CNS and create different symptoms that can be very specific to each individual patient. The most common symptoms at the beginning are visual change in one eye, double vision, changes in movements or feeling and changes in walking or balance. It is important to learn about MS as many of these symptoms are not specific to MS. This means that many diseases and conditions can lead to these physical manifestations. This makes the diagnosis often difficult.
The disease is caused by an immune response to one's own Central Nervous System (CNS). This autoimmune response, in particular, attacks the myelin sheath around brain cells. Once stripped of their myelin the cell undergoes reduced function and connectivity leading to a myriad of symptoms that patients with MS can experience. The disease has various forms but the most common is the relapsing and remitting form. In this case patients experience attacks against the myelin followed by periods of improvement. It is often difficult to predict the duration and magnitude of improvement, but therapies to reduce autoimmune response the CNS can improve the chances for a longer period of remission. The second major form of MS is the primary progressive. In this rarer form, patients have a progressive decline in function with little or no intervening periods of recovery.
MS affects different areas of the CNS (Central Nervous System) in many patients. This leads to such different symptoms that include vision changes, changes in sensation, movement or balance changes. The correct diagnosis is difficult and often delayed. It is best to see a medical provider with expertise in brain and spinal cord function and assess the CNS with a scan of the brain and/or spinal cord (MRI). While no single test is always confirmatory, the combination of symptoms (often multiple issues at the same time), recurrence (relapsing) and MRI findings can lead to the correct identification of MS. The diagnosis is important, because treatments to reduce the disease progression cannot be started without the proper identification of patients with MS.
Types of MS
MS affects all in different ways, but is grouped into two major types:
Relapsing and remitting is the type that often starts with an attack (vision change etc) and then improves (remits) for a while until reoccurring. The periods between attacks can last years and the improvement (remission) can be near complete of only partial.
Primary progressive is a form that has very little of no periods of recovery (remission) and often affects the spinal cord.
Multiple Sclerosis is a complex condition that often requires treatment with focus on the underlying autoimmune process and also the symptoms that the person affected is experiencing. Currently no specific intervention leads to a permanent cure of MS, but many treatments exist to reduce the immune activity (inflammation) and brain and spinal cord (CNS)damage over time. It is important to be identified as suffering from MS early so that these treatment that can affect the overall disease progress (disease modifying) therapies are implemented to avoid CNS injury. Often treatment also focuses on the symptoms and need to be targeted towards each person's needs. These often are related to functions of the body and the mind. It is important to identify all aspects of life that are affected, such as balance, eyesight, mood, memory and other aspects of mind and body function. Multidisciplinary teams are best equipped in addressing these issues and help each person with MS reach their best potential while also fighting the underlying process with disease modifying therapies.