What is Multiple Sclerosis?

Multiple sclerosis (MS) is an autoimmune disorder in which the sheath that protects our brain and spinal cord nerve fibers, called myelin, undergoes changes and becomes damaged by a person’s own body. This is a disease of the central nervous system where communication between the brain and body through the nerves that make up our neural network is disrupted. 

What do MS Symptoms Look Like?

Symptoms and signs of MS vary widely patient to patient. In some cases, the damage to nerves is rapid and the person may lose their ability to walk. Others will have long remission periods where no new symptoms appear. MS has no cure at this time, but managing symptoms and maintaining a healthy lifestyle can improve quality of life.

 Symptoms often affect movement, such as:

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or your legs and trunk
• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (called Lhermitte sign)
• Tremor, lack of coordination or unsteady gait
• Vision problems are also common, including:

• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Blurry vision

Multiple sclerosis symptoms may also include:

• Slurred speech
• Fatigue
• Dizziness
• Tingling or pain in parts of your body
• Problems with sexual, bowel and bladder function

The National MS Society defines three types: 

• Relapsing-remitting MS (RRMS) 

The most common disease course. It is characterized by clearly defined attacks of new or increasing neurologic symptoms. These attacks – also called relapses or exacerbations – are followed by periods of partial or complete recovery (remissions). During remissions, all symptoms may disappear, or some symptoms may continue and become permanent. However, there is no apparent progression of the disease during the periods of remission. RRMS can be further characterized as either active (with relapses and/or evidence of new MRI activity over a specified period of time) or not active, as well as worsening (a confirmed increase in disability following a relapse) or not worsening. Approximately 85 percent of people with MS are initially diagnosed with RRMS.

• Secondary progressive MS (SPMS) 

 SPMS follows an initial relapsing-remitting course. Some people who are diagnosed with RRMS will eventually transition to a secondary progressive course in which there is a progressive worsening of neurologic function (accumulation of disability) over time. SPMS can be further characterized as either active (with relapses and/or evidence of new MRI activity during a specified period of time) or not active, as well as with progression (evidence of disability accumulation over time, with or without relapses or new MRI activity) or without progression. 

• Primary progressive MS (PPMS)

PPMS is characterized by worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions. PPMS can be further characterized as either active (with an occasional relapse and/or evidence of new MRI activity over a specified period of time) or not active, as well as with progression (evidence of disability accumulation over time, with or without relapse or new MRI activity) or without progression.
Approximately 15 percent of people with MS are diagnosed with PPMS.

Risk factors and Triggers

The cause of multiple sclerosis is unknown, but it is thought to be a combination of genetics and environmental factors. An article in Science Jan. 13, 2022 discusses a study that provides strong evidence of causality between Epstein -Barr virus and multiple sclerosis. It suggests possibly we could largely reduce cases of MS by stopping the Epstein -Barr virus infection. 

These factors may increase your risk of developing multiple sclerosis:

• Age. MS can occur at any age, but onset usually occurs around 20 and 40 years of age. However, younger and older people can be affected.
• Sex. Women are more than two to three times as likely as men are to have relapsing-remitting MS.
• Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.

• Certain infections. A variety of viruses have been linked to MS as I mentioned above.  Epstein-Barr is the virus that causes infectious mononucleosis.
• Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.

• Climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe.
• Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of MS.

• Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have other autoimmune disorders such as thyroid disease, pernicious anemia, psoriasis, type 1 diabetes, or inflammatory bowel disease.
• Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.

Complementary and Alternative Medicine

The complementary and alternative medicine used most often for MS include a low-fat Mediterranean type diet, omega-3 fatty acids, antioxidant supplements, as well as lipoic acid and vitamin D supplementation. The objective is to fight inflammation. Acetyl-L-carnitine, an amino acid, is thought to help with fatigue in some patients. More research is needed into these types of remedies for MS.