Multiple Sclerosis which is also known as MS is a potentially disabling disease of the central nervous system involving the brain & spinal cord. Immune system attacks myelin which is the protective sheath covering nerve fibers & thereby causing communication problems between brain & other parts of the body in MS patients. This disease may eventually cause nerves to deteriorate or damage permanently. MS signs & symptoms widely vary depending upon the amount of damage to nerves & which section of nerves that are affected. Quite a few patients with severe MS lose their ability to walk, while some others may experience long periods of remission without developing any new symptoms. Nevertheless, there is no cure for multiple sclerosis. Known treatments can only help speed-up recovery from attacks & modify course of disease in order to manage symptoms.
The central nervous system is attacked by the person’s own immune system in multiple sclerosis. This is the reason why MS is also known as an auto-immune disease. Nerve fibers are generally surrounded by a sheath called myelin which protects them. Myelin also helps conduct electrical impulses by facilitating good flow of electricity from brain to the entire nervous system. Myelin is found to regulate a key protein which is involved in sending long-distance signals. Myelin among MS patients disappears in multiple sites & leave behind scars called sclerosis. Multiple sclerosis therefore literally means as ‘scar tissue in multiple locations’. These areas are where there is not enough or no myelin & are called lesions or plaques. In such situations nerve fibers can either break or become damaged as lesions get worse. Nerve fibers with less myelin cannot allow smooth flow of electrical impulses received from brain to targeted nerves, while nerve fibers with no myelin cannot conduct electrical impulses at all. These electrical impulses are basically instructions from brain to carry out certain actions like moving a muscle. Therefore MS patients cannot get the body to perform what the brain commands.
Signs & Symptoms of Multiple Sclerosis
Affecting the central nervous system which controls all actions within the body, MS symptoms generally occur when nerve fibers carrying messages to & from the brain get damaged. Signs & symptoms of MS generally appear among people between the ages of 20 – 40 years. In some patients MS is so mild that that they are unable to notice anything until later in course of the disease. Most other MS patients may however be aware of the disease very early in time.
Most Common Symptoms of Multiple Sclerosis
Bladder Problems – MS patients usually have difficulty in emptying the bladder completely & will need to go to the toilet more frequently. Urge incontinence or sudden pressure or unintentional passing of urine, & Nocturia or need to frequently go during night, are some common symptoms.
Bowel Problems – More than half of MS patients are frequently affected with constipation. Fecal impaction can sometimes even be serious. This problem may sometimes lead to bowel incontinence in case fecal impaction is not resolved.
Cognitive Functions – About 50 % of MS patients experience cognitive problems to some extent of which almost 80% are most severe cases. Commonly reported cognitive abnormalities include problems with attention, abstraction, memory & finding words. Studies have revealed that warmer weather makes a negative impact on cognitive performance of MS patients.
Emotional Changes – MS may have a profound emotional effect on individuals when first diagnosed. They may find it hard to adjust to diagnosis of this unpredictable disorder which carries some risk of physical disability. Demyelination & nerve fiber damage in brain can also cause emotional changes. Therefore, people with MS may invariably experience emotional changes either for physical or psychological reasons, or both. Research has also shown that stress management & treatment has considerably reduced formation of new brain lesions among MS patients.
Depression – Researchers say that MS patients have a 50% chance of developing depression & which is not psychological but linked to atrophy in hippocampus part of the brain.
Dizziness & Vertigo – MS patients commonly experience dizziness & problems associated with balance. While vertigo is not dizziness, dizziness is a sensation where the person feels that the room around him/her is spinning or moving.
Fatigue – One of the most common symptoms of MS, fatigue affects approximately 80% of MS patients whereby ability to function properly at home or work is seriously undermined by fatigue. This is one of the main reasons why MS patients leave their jobs.
Head Movements – This may often cause electric-shock like sensations in the body.
Weakness or Numbness – It is usually felt in one or more limbs which typically affects one side of the body at a time. It may also affect just the bottom half of the body.
Pain or Tingling – This is felt in some parts of the body.
Tremor – Involuntary quivering movements are felt by MS patients.
Vision Problems – This includes blurred or double vision. Partial or total loss of vision which generally affects one eye at a time is also experienced by MS patients. Pain is often felt by eye movement among MS patients due to inflammation of optic nerve, a condition known as optic neuritis.
Spasticity & Muscle Problems – Damaged nerve fibers in brain & spinal cord may cause spasms of muscles when they painfully contract to tighten. These muscles may eventually get stiff & become resistant to movement causing spasticity.
Sexual Dysfunction – Loss of interest in sex is common among MS patients. Male MS patients commonly find it difficult to build or maintain an erection & may also take longer time to ejaculate. Female MS patients may find it more difficult to achieve orgasm.
Gait Changes – This is often a problem with MS patients as the disease can alter the way they walk. This is usually because MS patients muscles are weaker & therefore they have dizziness plus fatigue & problems with balance.
Causes for Multiple Sclerosis
Causes of MS are still unknown, but it is generally considered an autoimmune disease where the body’s immune system attacks patient’s own tissues. This immune system malfunction destroys myelin, the fatty substance coating & protecting nerve fibers in brain & spinal cord. Myelin can be symbolically compared to insulation coating on electrical wires. Therefore when myelin is damaged & nerve fibers exposed, messages traveling along the nerves get slowed or blocked, or may become damaged. It is however not yet clear as to why MS develops in some people & not among others. Combination of environmental & genetic factors appears to be responsible as per medical knowledge available now.
Diagnosing Multiple Sclerosis
Medical history & a complete neurological examination is required so as to diagnose MS. While there are no specific tests for MS, diagnosis often relies on ruling out other conditions which might produce similar signs & symptoms. This type of procedure is known as differential diagnosis. Starting with a thorough medical history check-up & examination, following tests may be recommended for differential diagnosis of MS.
Blood Tests – These are done to rule out other diseases with similar symptoms. Tests to check for MS specific biomarkers are currently under development & which may further aid in future so as to diagnose this disease.
Spinal Tap or Lumbar Puncture – A small sample of fluid is removed from spinal canal for lab analysis in this procedure. This test sample can reveal abnormalities in antibodies which are associated with MS. Lumbar puncture can also help rule out other infections & conditions which bear similar symptoms to MS.
MRI or Magnetic Resonance Imaging – MRI can reveal lesion areas of MS on brain & spinal cord. Prospective MS patients may receive intravenous injections of contrast material which can highlight & indicate disease in an active phase.
Evoked Potential Tests – These are designed to record electrical signals which are produced by nervous system in response to stimuli. Evoked potential tests may use electrical or visual stimuli where patients may watch a moving visual pattern or short electrical impulses may be applied to nerves of patients in arms & legs. Electrodes are used in these tests to measure how quickly information travels through nerve pathways.
Diagnosis is fairly straightforward & based on pattern of symptoms consistent with disease & confirmed by brain imaging scans like MRI, in people with relapsing–remitting MS conditions. Diagnosing MS can however be more difficult among people with progressive disease & unusual symptoms. Further testing with evoked potentials, spinal fluid analysis & additional imaging may be required in these type of cases.
Treatments for Multiple Sclerosis
While there is no cure for MS, treatments typically focus on speeding-up recovery from attacks alongside managing symptoms & slowing progression of MS disease. MS patients having very mild symptoms do not require any treatment at all.
Common Treatments for MS Attacks
Corticosteroids – These include intravenous methylprednisolone & oral prednisone which are prescribed in order to reduce nerve inflammation. Corticosteroid side effects generally include fluid retention, mood swings, increased blood pressure & insomnia.
Plasmapheresis or Plasma Exchange – Liquid portion of part of blood plasma is removed & separated from blood cells. Blood cells are subsequently mixed with albumin protein solution & put back into the body. Plasma exchange can be effectively used for MS patients having newer & severe symptoms & have not responded well to steroids.
MS Treatments to Modify Progression
There are no known therapies that have shown any benefit in slowing progress of primary-progressive MS conditions. However, several disease-modifying therapies are available for relapsing-remitting MS patients. Most of the immune response associated with MS usually occurs in early stages of disease. Aggressive treatments using medications as early as possible can however lower relapse rate, & slow formation of new lesions. Many disease-modifying therapies utilized for treating MS carry significant amount of health risks. Selecting a therapy which is right will depend upon careful consideration of several factors including severity & duration of disease, effectiveness of prior MS treatments & other relative health issues.
Treatment Options for Relapsing–Remitting MS
Beta Interferons – Among the most common medications prescribed to treat MS, beta interferons are injected under skin or into muscles in order to reduce severity & frequency of relapses. Side effects of these medications include injection-site reactions & flu-like symptoms. MS patients undergoing this treatment will require blood tests to monitor liver enzymes since damage to liver is a possible side effect. Patients taking interferons may also develop neutralizing antibodies which can reduce effectiveness of this drug.
Glatiramer Acetate – Medications like Copaxone which are injected subcutaneously may help block immune system’s attack on myelin. Side effects of this drug may include skin irritation at the site of injection.
Dimethyl Fumarate – Tecfidera is an oral medication which should be taken twice-daily so as to reduce relapses of MS attacks. Side effects of this drug include nausea, diarrhea, flushing & lowered count of white blood cells.
Fingolimod (Gilenya) – This is another oral medication meant to reduce MS attack relapse rates & is required to be taken once every day. MS patients taking this medication will however need to monitor heart rate for 6 hours after the first dose as heartbeat may slow down in some cases. Other side effects of fingolimod include blurred vision, high blood pressure & headache.
Teriflunomide (Aubagio) – This medication is required to be taken once-daily & is meant to reduce relapse rate of MS attacks. It can cause hair loss, liver damage & other side effects. It is also harmful to developing fetuses & therefore should not be used by who are pregnant or have not been using appropriate contraception & may become pregnant.
Natalizumab (Tysabri) – Considered as a first line of treatment for some people with severe MS & second line of treatment for others, natalizumab is designed to block movement of potentially damaging immune cells from blood stream to brain & spinal cord. This medication is found to increase risk of viral infection of brain called progressive multifocal leukoencephalopathy in some cases.
Alemtuzumab (Lemtrada) – While helping reduce relapses of MS attacks by targeting protein on surface of immune cells & depleting white blood cells, alemtuzumab can limit potential nerve damage caused by white blood cells. Side effects of this medication include autoimmune disorders & risk of infections. Treatment with this drug involves five consecutive days of infusions followed by three more days of infusions a year later. Reactions to infusions are common to alemtuzumab. Moreover, MS patients treated with this drug need to register in a special drug safety monitoring program.
Mitoxantrone – This is an immunosuppressant which can be harmful to heart & is also associated with development of blood cancer. Therefore, mitoxantrone use is extremely limited in treatment of multiple sclerosis & is usually preferred only in treating severe & advanced cases of MS.
Physical Therapy – Occupational or physical therapists can teach MS patients strengthening & stretching exercises. They can also show patients how to use available devices which will make it easier for them to perform daily tasks. Physical therapy combined with mobility aids where necessary can help manage weakness in legs & other problems of gait which are generally associated with MS.
Muscle Relaxants – MS patients often experience uncontrollable or painful stiffness or spasms of muscles, particularly within legs. Therefore, muscle relaxants like tizanidine (Zanaflex) & baclofen (Lioresal) can be very helpful.
Medications to Reduce Fatigue – This can also provide relief.
Other Medications – Medications for sexual dysfunction, pain, depression, & bowel or bladder control which are normally associated with MS can also be prescribed for patients.
Multiple Sclerosis Risk Factors
Following is a list of risk factors which are common to developing multiple sclerosis.
Gender – Women are more prone & about twice as likely as men are to develop multiple sclerosis.
Age – Although MS can occur at any age, it most commonly affects people between the ages of 15 – 60 years.
Family History – People are at higher risk of developing MS in case one parent or siblings have had this condition.
Climate – Multiple sclerosis is more common in temperate climate countries like New Zealand, Southeastern Australia, Canada, Northern United States, & Europe.
Race – White people who are particularly from Northern European descent are at higher risk of developing MS than from people of African, Asian or Native American descent.
Certain Infections – This includes a variety of viruses like Epstein-Barr causing infectious mononucleosis which are linked to MS disease.
Smoking – Smokers having experienced initial bout of MS symptoms are more likely patients than nonsmokers to develop a second event which confirms relapsing-remitting MS.
Certain Autoimmune Diseases – There is a slightly higher risk of developing MS among people having certain autoimmune diseases like Type 1 Diabetes, Thyroid Disease or Inflammatory Bowel Disease.
Multiple Sclerosis Complications
People with MS will most often develop the following complications.
Mental changes like mood swings or forgetfulness
Problems with bowel, bladder or sexual function
Paralysis which is typically in legs
Muscle spasms or stiffness
Alternative Medicine for Multiple Sclerosis
Several people with MS use a wide spectrum of complimentary or alternative treatments so as to help manage symptoms like fatigue & muscle pain. Especially activities like massage, yoga, meditation, exercise, acupuncture, healthy diets & relaxation techniques can help in boosting overall physical & mental well being. American Academy of Neurology guidelines recommend using oral cannabis extract for pain & spasticity of muscles but do not recommend cannabis in any other form due to lack of evidence.
Affordable Multiple Sclerosis Treatments in India
Healthcare in India is at par with international standards & sometimes even exceeds world standards. Indian healthcare professionals have the advantage of working in biologically active regions which enables them experience a variety of treatment regimens targeting many kinds of medical conditions. IndianMedTrip is one of the fastest growing healthcare tourism companies in the country which is associated with the top doctors & a wide range of accredited hospital facilities. Offering all types of affordable medical solutions including treatments for multiple sclerosis for international patients, IndianMedTrip services begin from the initial telephonic conversation & go on to include assisting obtaining medical visa, warm reception on arrival, convenient travel, comfortable accommodation, scheduled treatment sessions, post treatment check-ups, exotic recuperative vacations & successful farewell.