Kevin Lutz, MD, FACP
Feb 1 2019

MS is a chronic neurological condition that affects the central nervous system, which is comprised of the brain and spinal cord. Stay with me, we’re going in deep on this.

Brain Health

MS is a chronic neurological condition that affects the central nervous system, which is comprised of the brain and spinal cord. Stay with me, we’re going in deep on this. In the central nervous system, nerve fibers (called axons) are protected by a fatty layer of insulation called myelin. Myelin allows nerve signals to travel properly. MS is an immune-mediated inflammatory disease that attacks myelinated axons, this is called demyelination. Wherever the myelin is destroyed, a damaged area of white matter known as a lesion will occur. Over time, hardened scar tissue develops at the lesion site. This hardened scar tissue, or sclerosis, may develop at multiple sites throughout the central nervous system, hence the name multiple sclerosis. This scarring disrupts the transmission of nerve signals that communicate a desired action from the brain, through the spinal cord, to various parts of the body.

What causes MS?

Most physicians and researchers agree there is no single cause of MS. Instead, it is believed that MS is the result of a combination of several different factors. An incredible amount of research is being done to find out what role these different factors play and just how large their effect might be. It has been theorized that MS results when an environmental agent or event (examples are viral or bacterial infection, exposure to chemicals, lack of sun exposure) acts in concert with a genetic predisposition to immune dysfunction. This means that the immune system, which normally protects us from disease and infection, reacts against certain proteins in the body as if they were foreign. In other words, the body mistakenly attacks and harms itself. An interesting fact is that geography is clearly an important factor in the etiology of MS. Numerous studies have shown that the occurrence of MS is significantly lower in equatorial regions of the world than in the southernmost and northernmost regions of the world.

What are the classic signs and symptoms of MS?

  • Vision problems. Visual problems are one of the most common and early symptoms of MS. Inflammation affects the optic nerve and disrupts central vision. This can cause blurred vision, double vision or loss of vision.
  • Tingling and numbness. This is another common warning sign of MS. Common sites of numbness include the face, arms, legs and fingers.
  • Pain and spasms. Chronic pain and involuntary muscle spasms are also common with MS. A person with MS might experience stiff muscles or joints as well as uncontrollable, painful jerking movements of the extremities. The legs are most often affected, but back pain is also common.
  • Fatigue and weakness. Unexplained fatigue and weakness affect about 80% of people in the early stages of MS. Chronic fatigue occurs when nerves deteriorate in the spinal column. Usually, the fatigue appears suddenly and lasts for weeks before improving. The weakness is most noticeable in the legs at first.
  • Balance problems and dizziness. People with MS often feel lightheaded, dizzy, or as if their surroundings are spinning, also known as vertigo. This symptom often occurs with standing.
  • Bladder and bowel dysfunction. This can include frequent urination, strong urges to urinate, or inability to hold in urine.
  • Sexual dysfunction. Sexual arousal can also be a problem for people with MS.
  • Cognitive problems. About half of people with MS will develop some kind of issue with their cognitive function, including memory problems, shortened attention span or language problems.

How is MS diagnosed?

A neurologist will perform several tests in order to diagnose MS. A basic neurological exam checking for impaired nerve function and an eye exam will come first, along with an extensive patient medical history. For some people, no tests beyond medical history and a neurological exam many be necessary to diagnose MS. However, some physicians will not rely entirely on this type of evaluation and will do additional tests to confirm the diagnosis. Even a clear-cut diagnosis will usually be confirmed with an MRI. This work up is used to look for damage to the central nervous system in at least two separate areas. They must also determine that at least one month has passed between the episodes that caused damage. These tests are also used to rule out other conditions that could be causing the symptoms.

How is MS treated?

Currently there is no cure or easy fix for MS, so the goal of treatment is to manage the condition, manage the symptoms and learn to live as fully and as normally as possible. Disease-modifying treatments are a class of medications that have been shown to be effective in decreasing the frequency of relapses or exacerbations and decreasing the development of lesions in the brain or spinal cord. Early treatment, beginning at the time of diagnosis, is essential to minimize the damage MS may cause. A MS relapse, often also called an exacerbation, is a sudden onset of new symptoms or a worsening of old symptoms that have previously been stable. The most common method of treating a relapse is to administer brief courses of intravenous, high-dose steroids. This treatment is designed to shorten the duration of acute attacks and decrease swelling and inflammation in lesions. 

The state of a person’s overall health can have a significant effect on their ability to maintain their quality of life with MS. For example, a lack of exercise, combined with an MS symptom such as weakness, could contribute to a loss of mobility. Poor sleep habits, and poor nutrition, can worsen a common MS symptom such as fatigue. When you have good general health, and a healthy daily routine, your body will be better prepared to handle symptoms as they flare-up. For this reason, routine medical care, exercise, nutrition and proper rest are important factors to consider in an MS treatment plan. 

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