Multiple sclerosis is a disabling disorder of the central nervous system. The course of the disease can be unpredictable, and it often presents differently in each person that has it.
People with most forms of multiple sclerosis (MS) have an abnormal immune response against the cells in the nervous system, which includes the brain and nerve cells. Nerves transmit information and instructions between the brain, the spinal cord, and the rest of the body.
In MS, the immune system attacks the covering of those nerve cells, called myelin. This forms scar tissue, also known as sclerosis, along the damaged nerve cells, interrupting the ability of the nerve to send messages back and forth.
Tests and diagnosis
An MRI scan is a painless scan but may be claustrophobic for some people.
Diagnosing MS can sometimes be difficult because there isn't one single definitive test for the disease. Therefore, if a doctor suspects a person has MS, they may be referred to a neurologist who specializes in caring for people with MS.
The questions the doctor asks and the ability to critically examine the signs and symptoms is crucial in getting an accurate diagnosis. The doctor will perform tests to examine the following:
- Emotions and mental state
- Language functions
- Movement, coordination, and balance
- Vision, smell, taste, touch, and hearing
In addition to taking a thorough history and physical exam, the doctor may recommend some diagnostic tests to help confirm the diagnosis.
Magnetic resonance imaging (MRI)
The scan uses magnetic fields and radio waves rather than radiation. It measures the relative water content in tissues.
The myelin that protects nerve cells is fatty, and so repels water. When this protective coating is damaged, more water is held, and this can be seen on an MRI scan.
Careful examination of the MRI scan is required for accurate diagnosis of MS.
An evoked potential is an electrical test of the nerve pathways. It can help determine which nerve pathways MS has affected.
The doctor will place wires on the scalp and look at the brain's response to certain experiences, like watching a video screen, hearing a particular noise, or feeling certain sensations. Although the test is very sensitive, it is harmless and largely painless.
Electrical conduction is slowed along nerve pathways where myelin is damaged. This test is particularly useful as it can find damage in areas of the central nervous system that has not caused any symptoms.
A lumbar puncture obtains cerebrospinal fluid and may be used to diagnose MS.
A lumbar puncture, also known as a spinal tap, is used to obtain cerebrospinal fluid (CSF). This liquid surrounds the brain and spinal cord and can be used to help make a diagnosis.
To extract CSF, a needle is inserted between bones in the lower spine. Fluid is withdrawn using a syringe and then tested for antibodies and proteins that may signal an abnormal immune response.
Lumbar punctures aren't necessary in every person with suspected MS and are no longer the standard of care. An experienced doctor will decide if a lumbar puncture is needed based on the patient's medical history and physical exam.
There is no blood test that can be done to diagnose MS. However, the doctor may order blood testing to rule out other conditions that have the same symptoms.
When to see a doctor
Anyone experiencing any of the symptoms of MS should see their doctor promptly for further evaluation and possible diagnostic testing.
For a diagnosis of MS to be confirmed, the doctor needs to find evidence of damage in more than one area of the central nervous system. The damage has to have occurred at least 1 month apart, and all other possible causes must be ruled out.
If the cause of their symptoms is MS, treatment should be started as soon as possible to restrict the amount and degree of nerve damage.
Signs and symptoms
The symptoms of MS are very different from person to person, and may change over the course of the disease. The symptoms that a person experiences can also depend on the location of the nerves affected by the disease.
Common symptoms may include:
- Numbness of weakness that occurs in one side of the body, either in the limbs or the legs and trunk
- Partial or loss of vision, with or without pain with eye movement
- Double vision
- Pain or tingling sensation in the body
- Lack of coordination
- Unsteady gait
- Slurred speech
- Bowel or bladder problems
- Lhermitte sign, which is an electric shock sensation that occurs with certain neck movements
Multiple sclerosis can be a serious disease with many potential complications, depending on its severity. Common complications may include:
- Muscle stiffness
- Muscle spasms
- Bladder, bowel, or sexual dysfunction
- Mood swings
Treatment and outlook
It is important for people to find a specialist who is familiar with treating MS. People with MS require a wide-ranging approach to managing their symptoms and disease course.
There are many medications that can be used to slow disease progression and treat the symptoms associated with the relapsing forms of the disease. However, there is currently no drug available to treat primary progressive MS (PPMS), which is a non-relapsing type of MS.
The use of medications will vary from person to person and will depend on the symptoms, stage, and severity of the disease. Medications are also used to treat relapses as needed.
MS may require differing approaches to managing symptoms. It is important to find a healthcare professional who can manage this.
People with MS could consider taking part in a rehabilitation program that focuses on maintaining strength and function of the body muscles.
Finally, it's important to work with a healthcare provider who recognizes the importance of emotional health and coping mechanisms and can provide the appropriate referrals.
MS is not usually fatal. Rather, the major concern for people with this condition is preserving their quality of life.
Despite the belief that MS is a progressive and debilitating disease, only some people with MS have symptoms that will eventually progress to the point where they need assistance to walk.
Many advances in the treatment options for MS have occurred in the past decade. New Disease Modifying Therapies slow the progression and decrease accumulation of disability in relapsing forms of MS. Research continues and offers promising discoveries and treatment for all types of MS.