Multiple sclerosis, or MS, is a disease that affects the brain and spinal cord.  It can cause problems with vision, balance, sensation, and muscle control.  This disease affects everyone differently.  Some people have mild symptoms while others have debilitating symptoms that prevent them from doing daily tasks.

Multiple sclerosis occurs when the immune system attacks the nerves in your brain or spinal cord.  When the nerves become damaged the brain isn’t able to send signals through your body correctly.

Relapsing MS is characterized by the unpredictable occurrence of new attacks.  These attacks are sometimes also called an exacerbation, a relapse, or flare.  An attack involves new neurological signs and symptoms, which typically develop over a few days and subside or completely resolve over the ensuing weeks and months.    

Symptoms from MS attacks include:

• Numbness
• Weakness
• Incoordination 
• Visual loss or double vision
• Dizziness

The most common symptom of an MS attack is numbness or sensory loss.  Numbness occurs when the immune system attacks an area of the brain conducting sensory information to the body.  If an attack occurs in an area of the brain transmitting motor information to the limbs, a person may experience weakness in the limbs.  Double vision or dizziness may also occur from an MS attack.  

In patients who have MS it is important to distinguish a true attack from a pseudoexacerbation.  A pseudoexacerbation is when signs and symptoms from an old attack can worsen or reemerge from other causes.  Common causes for pseudoexacerbation include a new illness, elevated body temperature, fatigue, stress, and pain.   

Multiple sclerosis is a clinical diagnosis made when there is evidence of immune system attacks on the brain and spinal cord.  A neurologist looks for evidence of these attacks in a person's symptoms, examination, and MRI scans.  Attacks typically leave scars in the brain that are visualized on MRI.   Scars from MS have a characteristic appearance and pattern that must be carefully discerned from other causes.  The presence of inflammatory and protein markers in the cerebrospinal fluid can also help support the diagnosis.  

MS treatment has three parts:

1. Treating attacks
2. Disease modifying therapy to reduce the likelihood of more attacks
3. Treatment of residual symptoms from prior attacks

MS attacks are treated with high dose steroids over 3-5 days.  Treating attacks with steroids helps decrease the duration and intensity of symptoms. 

Disease modifying therapy (DMT) is central to the care of people with multiple sclerosis.  DMTs are the best strategy to alter the course of MS.  Clinical studies have demonstrated that DMTs:

• Reduce the occurrence of attacks
• Slow progression of disability
• Slow cognitive decline

Until recent years, only a few injectable medications were available to prevent MS attacks.  Now there are many additional medications and these are more effective at preventing attacks.  Some medications are oral pills and others are infusions.

Management of MS also includes treating unresolved symptoms from prior attacks. For example:

• Physical therapy helps with motor weakness and instability
• Urinary urgency or incontinence may be alleviated with medicine
• Excessive stiffness in muscles from nerve injury may be alleviated with medicine
• Painful sensory loss or disturbance may be treated with medicine

• National Multiple Sclerosis Society and Multiple Sclerosis Association of America are reliable sources for accurate information regarding MS
• Weighing only 3 pounds and operating on 12 watts, the brain sends electrical signals over 200 mph
• The nervous system is capable of detecting grooves as small as two millionths of an inch, discerning differences as small as 0.01 degree Fahrenheit, and differentiating more than seven million colors

Dr. Brett Alldredge is a neurologist at the McKay-Dee Neurology Clinic. He specialists in the diagnosis and management of multiple sclerosis. He also provides general neurology care, including treatment for Alzheimer’s disease, Parkinson’s disease, headaches, and stroke.