Multiple sclerosis (MS) is an abnormal response of the body’s immune system.  Instead of the immune system protecting the body by attacking harmful microorganisms, the immune system attacks healthy nerves in the central nervous system (the brain and spinal cord). More specifically, the protective covering surrounding a nerve (myelin).  This causes scaring on the nerves, or lesions.

Healthy nerveNerve damaged by multiple sclerosis

Lesions on the nerves disrupt communication between the brain and the body.

This disruption in communication causes a variety of neurologic symptoms including the following:

  • Vision problems
  • Numbness and tingling in the hands and feet
  • Pain and itching
  • Fatigue
  • Gait disturbance
  • Spasticity
  • Weakness
  • Dizziness and vertigo
  • Bowel and bladder problems
  • Cognitive (thinking) problems
  • Depression
  • Emotional changes

The type and severity of symptoms will vary among people with MS.

 

What are the types of MS?

Relapsing-Remitting Multiple Sclerosis

The most common type of MS is relapsing-remitting MS (RRMS) and usually effects people in there 20s-30s.

People who have RRMS will have times when symptoms “flare up” (relapse) followed by a period when there are little to no symptoms (remission). 

Secondary Progressive Multiple Sclerosis

People with secondary progressive multiple sclerosis (SPMS) usually starts out as RRMS.  RRMS turns into SPMS when relapses start to trend toward worsening of symptoms with little to no remission between relapses. This shift from RRMS to SPMS usually occurs 15-20 years after the initially diagnosis of MS. 

Primary Progressive Multiple Sclerosis

Primary progressive multiple sclerosis (PPMS) accounts for 10-15% of the cases of multiple sclerosis.  Weakness in the legs and difficulty walking are the most common symptoms initially.  Symptoms progressively worsen over time.  PPMS does not have any relapses or remissions. 

What is the treatment for multiple sclerosis? 

There is no cure of multiple sclerosis. Treatment usually focuses on speeding up recovery from a relapse and slowing down the progression of the disease and managing the symptoms. 

Treatment for MS relapses (attacks)

Corticosteroids:

Oral and/or intravenous steroids are prescribed to treat the inflammation around the nerves. 

Plasmapheresis:

Plasmapheresis (also known as plasma exchange) is when the plasma portion of the blood is separated from the red blood cells.  The red blood cells are then mixed with albumin and put back onto the body. 

Treatment to slow the progression of the disease

For primary progressive multiple sclerosis, ocrelizumab (Ocreves) is the only FDA approved disease modifying therapy. 

Treatment to Manage MS Symptoms

Physical Therapy:

Physical therapy focus on stretching muscles that may become shortened due to spasticity, balance retraining, and gait (walking) training.  A physical therapist can also prescribe the appropriate assistive device to improve your safety with walking and also be involved in prescribing appropriate braces to protect joints around weakened muscles and improve the overall quality of movement.

Muscle Relaxants:

MS may also cause pain in the muscles and involuntary muscle contractions (spasticity). A doctor may prescribe muscle relaxants, for example, baclofen or Zanaflex.

Medication to manage fatigue: 

Fatigue can be a major problem of the disease. A doctor may prescribe medication to help with this

Medication to increase walking speed:

There are some medications that claim to increase walking speed. Talk with your doctor to learn more about this.

 

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