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Multiple sclerosis (MS) is a potentially devastating brain and spinal cord illness (central nervous system).
The immune system assaults the protective sheath (myelin) that protects nerve fibers in MS, causing communication issues between the brain and the rest of the body. The condition might eventually cause permanent nerve injury or degeneration.
MS symptoms vary greatly depending on the extent of nerve damage and which nerves are impacted. Some persons with severe MS may lose the ability to walk independently or at all, whilst others may go through long periods of remission without experiencing any new symptoms.
Multiple sclerosis has no known cure. Treatments, on the other hand, can help patients recover faster from attacks, change the course of the disease, and manage symptoms.
WHAT ARE THE SYMPTOMS OF MULTIPLE SCLEROSIS?
The signs and symptoms of multiple sclerosis can vary widely from person to person and over the course of the disease, depending on the location of the damaged nerve fibers. Symptoms that frequently impair movement include:
- Numbness or weakness in one or more limbs, usually on one side of your body at a time, or in your legs and trunk
- Electric-shock feelings that occur with specific neck movements, particularly forward bending of the neck (Lhermitte sign)
- Tremor, a loss of coordination, or an unstable walk
Vision issues are also widespread, and these are some of the most common:
- Partial or total vision loss, usually in one eye at a time, often accompanied by pain during eye movement
- Long-term double vision
- hazy vision
Symptoms of multiple sclerosis may also include:
- Slurred speech
- Fatigue
- Dizziness
- Tingling or soreness in different regions of your body
- Sexual, bowel, and bladder function issues
WHAT ARE THE CAUSES OF MULTIPLE SCLEROSIS?
Multiple sclerosis has no recognized etiology. It is classified as an autoimmune illness, which occurs when the body's immune system assaults its own tissues. This immune system failure, in the case of MS, damages the fatty substance that coats and protects nerve fibers in the brain and spinal cord (myelin).
Myelin is like the insulating layer on electrical cables. When the protecting myelin is broken and the nerve fiber is exposed, communications can be slowed or blocked.
It is unclear why some people develop MS and others do not. It appears that a combination of hereditary and environmental variables is to blame.
WHAT ARE THE RISK FACTORS OF MULTIPLE SCLEROSIS?
The following variables may enhance your chances of having multiple sclerosis:
- Age: MS can strike at any age, however it commonly strikes between the ages of 20 and 40. However, both young and old persons may be affected.
- Sex: Women are two to three times more likely than males to develop relapsing-remitting MS.
- Family history: You are more likely to have MS if one of your parents or siblings has had the disease.
- Certain infections: MS has been associated to a number of viruses, including Epstein-Barr, the virus that causes infectious mononucleosis.
- Race: White persons, particularly those of Northern European ancestry, are most likely to get MS. People of Asian, African, or Native American ancestry are least at risk.
- Climate: MS is significantly more common in temperate climate countries such as Canada, the northern United States, New Zealand, southeastern Australia, and Europe.
- Vitamin D: Low vitamin D levels and low exposure to sunlight are linked to an increased risk of MS.
- Certain autoimmune diseases: If you have other autoimmune conditions such as thyroid disease, pernicious anemia, psoriasis, type 1 diabetes, or inflammatory bowel disease, you are at a slightly greater risk of getting MS.
- Smoking: Smokers are more likely than nonsmokers to acquire a second event that confirms relapsing-remitting MS after experiencing an initial event of symptoms that may signify MS.
HOW IS MULTIPLE SCLEROSIS DIAGNOSED?
There are no particular tests for multiple sclerosis. Instead, a diagnosis of multiple sclerosis is frequently based on ruling out other illnesses that may cause similar signs and symptoms, a process called as differential diagnosis.
Your doctor will almost certainly begin with a comprehensive medical history and examination.
Your doctor may then advise you to:
- Blood tests: to aid in the elucidation of other diseases with symptoms similar to MS Tests to detect specific biomarkers associated with MS are currently being developed and may aid in the diagnosis of the condition.
- Spinal tap (lumbar puncture): During this procedure, a little amount of cerebrospinal fluid is extracted from your spinal canal for laboratory analysis. This sample may reveal anomalies in antibodies linked to MS. A spinal tap can also help rule out infections and other illnesses that mimic the symptoms of MS.
- MRI: which can identify MS-related lesions on your brain and spinal cord An intravenous injection of a contrast substance may be given to you to highlight lesions that show your disease is active.
- Evoked potential tests: which captures the electrical impulses generated by your neurological system in reaction to stimuli Visual or electrical stimuli may be used in an evoked potential test. During these tests, you either view a moving visual pattern or have short electrical impulses delivered to nerves in your legs or arms. Electrodes assess the speed with which information passes through your nerve pathways.
Most persons with relapsing-remitting MS have a reasonably simple diagnosis based on a pattern of symptoms consistent with the condition and validated by brain imaging studies such as MRI.
Diagnosis of MS can be more difficult in those who have atypical symptoms or the disease is progressing. In certain circumstances, additional testing such as spinal fluid analyses, evoked potentials, and imaging may be required.
WHAT ARE THE TREATMENTS FOR MULTIPLE SCLEROSIS?
Multiple sclerosis has no known cure. Treatment primarily focuses on accelerating recovery from attacks, reducing disease progression, and managing MS symptoms. Some people's symptoms are so minor that no therapy is required.
Treatment options for MS attacks
- Corticosteroids: To minimize nerve irritation, medications such as oral prednisone and intravenous methylprednisolone are recommended. Insomnia, elevated blood pressure, increased blood glucose levels, mood fluctuations, and fluid retention are all possible side effects.
- Plasma exchange (plasmapheresis): The liquid element of your blood (plasma) is extracted and separated from your blood cells. After that, the blood cells are combined with a protein solution (albumin) and reintroduced into your body. If your symptoms are new, severe, and have not responded to drugs, plasma exchange may be employed.
WHAT ARE THE TREATMENTS TO MODIFY PROGRESSION?
The only FDA-approved disease-modifying therapy for primary-progressive MS is ocrelizumab (Ocrevus) (DMT). Those who take this treatment have a somewhat lower chance of progressing than those who do not.
Several disease-modifying treatments are available for relapsing-remitting MS.
The majority of the immune response associated with MS happens in the early stages of the disease. Early aggressive therapy with these drugs can minimize the relapse rate, limit the production of new lesions, and potentially lessen the risk of brain atrophy and disability accumulation.
Many of the disease-modifying treatments used to treat MS are associated with serious health hazards. Many aspects must be considered when deciding on the best therapy for you, including the duration and severity of your disease, the effectiveness of past MS treatments, other health issues, cost, and child-bearing status.
Injectable and oral medicines are among the treatment options for relapsing-remitting MS.
Among the injectable therapies are:
- Interferon beta medications: These medications are among the most regularly used for the treatment of multiple sclerosis. They are injected beneath the skin or into the muscle and have been shown to lessen the frequency and severity of relapses.
Flu-like symptoms and injection-site reactions are possible side effects of interferons.
Because liver damage is a probable adverse effect of interferon use, you'll require blood tests to monitor your liver enzymes. Interferon users may generate neutralizing antibodies, which can impair therapeutic efficacy.
- Glatiramer acetate (Glatopa, Copaxone): This medicine, which must be injected beneath the skin, may help limit your immune system's attack on myelin. Skin inflammation at the injection site is one of the possible side effects.
Oral treatments include the following:
- Fingolimod (Gilenya): This once-daily oral medicine lowers the risk of relapse.
Because your heartbeat may be slowed, you'll need to have your heart rate and blood pressure checked for six hours following the first dose. Other major side effects include rare infections, headaches, elevated blood pressure, and blurred vision.
- Dimethyl fumarate (Tecfidera): This twice-daily oral medicine has been shown to minimize relapses. Flushing, diarrhea, nausea, and a decrease in white blood cell count are all possible side effects. This medication necessitates regular blood test monitoring.
- Diroximel fumarate (Vumerity): This twice-daily tablet works similarly to dimethyl fumarate but has less negative effects. It is approved for the treatment of relapsing forms of multiple sclerosis.
- Teriflunomide (Aubagio): This once-daily oral medicine has been shown to minimize relapse rates. Teriflunomide can harm the liver and cause hair loss, among other negative effects. When both men and women take this medication, it has been linked to birth abnormalities. As a result, use contraception while taking this drug as well as for up to two years afterward. Couples who want to get pregnant should talk to their doctor about measures to speed up the drug's departure from the body. This medication necessitates regular blood test monitoring.
- Siponimod (Mayzent): According to research, this once-daily oral drug can help decrease relapses and delay the course of MS. It is also approved for secondary-progressive multiple sclerosis. Viral infections, liver issues, and a low white blood cell count are all possible side effects. Changes in heart rate, headaches, and eye issues are all possible side effects. Because siponimod is detrimental to a developing baby, women who may become pregnant should utilize contraception while taking it and for 10 days after discontinuing it. Some people may require their heart rate and blood pressure to be monitored for six hours following the first dose. This medication necessitates regular blood test monitoring.
- Cladribine (Mavenclad): This medicine is typically used as a second-line treatment for those who have relapsing-remitting MS. It was also authorized for secondary-progressive multiple sclerosis. Over the course of two years, it is administered in two treatment cycles of two weeks each. Upper respiratory infections, headaches, malignancies, severe infections, and a decrease in white blood cell numbers are some of the side effects. People who have active chronic illnesses or cancer, as well as women who are pregnant or breast-feeding, should not take this medication. Contraception should be used by both men and women while taking this medicine and for the next six months. While using cladribine, you may need to be monitored with blood tests.
Infusion treatments include the following:
Ocrelizumab (Ocrevus): The only DMT licensed by the FDA to treat both relapse-remitting and primary-progressive MS is this humanized monoclonal antibody drug. Clinical trials revealed that it lowered the rate of recurrence in relapsing MS and slowed the progression of impairment in both forms of the disease.
A medical professional administers ocrelizumab by intravenous infusion. Infusion-related side effects may include, among other things, injection site discomfort, low blood pressure, fever, and nausea. Some patients, notably those with hepatitis B, may be unable to take ocrelizumab. Ocrelizumab may potentially increase the risk of infections and certain types of cancer, especially breast cancer.
Alemtuzumab (Campath and Lemtrada): By targeting a protein on the surface of immune cells and reducing white blood cells, this medication helps minimize MS relapses. This effect has the ability to reduce possible nerve injury produced by white blood cells. However, it raises the risk of infections and autoimmune disorders, including an increased risk of thyroid autoimmune diseases and a rare immune-mediated kidney disease.
Alemtuzumab treatment consists of five consecutive days of medication infusions, followed by another three days of infusions a year later. Alemtuzumab infusion reactions are common.
WHAT ARE THE TREATMENTS FOR MULTIPLE SCLEROSIS SIGNS AND SYMPTOMS?
- Physiotherapy: A physical or occupational therapist can teach you stretching and strengthening exercises as well as how to use equipment to make daily tasks simpler.
Physical therapy, in conjunction with the use of a mobility device as needed, can also assist control leg weakness and other gait issues that are frequently associated with MS.
- Muscle relaxants: Muscle stiffness or spasms, particularly in your legs, may be painful or uncontrollable. Muscle relaxants such baclofen (Lioresal, Gablofen), tizanidine (Zanaflex), and cyclobenzaprine may be beneficial. Onabotulinumtoxin A therapy is another alternative for people who have spasticity.
- Medications that reduce fatigue: Amantadine (Gocovri, Osmolex), modafinil (Provigil), and methylphenidate (Ritalin) may be beneficial in relieving fatigue caused by MS. Some antidepressant medications, such as selective serotonin reuptake inhibitors, may be prescribed.
- Medication to speed up walking: Dalfampridine (Ampyra) may help some persons boost their walking pace marginally. This drug should not be taken by anyone who has had a seizure or who has kidney problems.
- Other drugs include: Medications may also be administered for MS-related depression, pain, sexual dysfunction, sleeplessness, and bladder or bowel control issues.
Home remedies and lifestyle
To help alleviate the signs and symptoms of MS, consider the following:
- Get a lot of rest: Examine your sleeping patterns to ensure you're getting enough rest. You may need to be checked — and maybe treated — for sleep disorders such as obstructive sleep apnea to ensure you're getting adequate sleep.
- Exercise: Regular exercise can help improve your strength, muscular tone, balance, and coordination if you have mild to moderate MS. If you are affected by heat, swimming or other water exercises are good possibilities. Walking, stretching, low-impact aerobics, stationary bicycling, yoga, and tai chi are other types of mild to moderate exercise recommended for adults with MS.
- Cool down: MS symptoms typically worsen when a person's body temperature rises. Avoiding heat exposure and employing equipment such as cooling scarves or vests can be beneficial.
- Eat a well-balanced diet: Because there is little evidence to support any particular diet, doctors advocate a well-balanced diet. Some evidence suggests that vitamin D may be beneficial to patients with MS.
- Relieve stress: Stress might cause or exacerbate your signs and symptoms. Yoga, tai chi, massage, meditation, or deep breathing exercises may be beneficial.
WHAT ARE THE COMPLICATIONS OF MULTIPLE SCLEROSIS?
Multiple sclerosis patients may also develop:
- Muscle spasms or stiffness
- Paralysis, most commonly in the legs
- Issues with the bladder, bowel, or sexual function
- Changes in mental state, such as forgetfulness or mood swings
- Depression
- Epilepsy