Multiple Sclerosis: What You Need to Know

Dr Brett Alldredge

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

How Does MS Start?

Multiple sclerosis occurs when your immune system attacks the myelin in your central nervous system. Myelin wraps around your nerve fibers and protects them. Without the outer shell, your nerves become damaged. When this happens, your brain isn’t able to send signals through your body correctly. Your nerves also don’t work as they should to help you move and feel. 

How Can You Recognize an MS attack?

A multiple sclerosis attack involves new neurological signs and symptoms, which typically develop over a 24-hour period and subside or completely resolve over the ensuing weeks and months.  

  • If an attack occurs in an area of the brain conducting sensory information to the limbs, a person may experience sensory loss or numbness and tingling in the limbs.
  • If an attack occurs in an area of the brain transmitting motor information to the limbs, a person may experience weakness in the limbs.

 The most common symptoms from MS attacks include:

  • Difficulty walking
  • Feeling tired
  • Muscle weakness or spasms
  • Blurred or double vision
  • Numbness and tingling

The classic form of MS, relapsing and remitting, is characterized by the unpredictable occurrence of new inflammatory attacks. An attack can also be called an exacerbation, a relapse, or flare. In MS patients, it’s important to distinguish a true attack or exacerbation from old signs and symptoms worsening or reemerging from other causes due to what’s called a “pseudoexacerbation.” 

Common causes for pseudoexacerbation include a new illness, elevated body temperature, fatigue, stress, pain, and infections, such as a urinary tract infection. Neurological signs and symptoms from a pseudoexacerbation are not due to a new inflammatory attack and are not treated with steroids.  

How Is MS diagnosed?

Multiple sclerosis is a clinical diagnosis made when a person has evidence from the history, examination, or magnetic resonance imaging (MRI) of inflammation of the myelin. Inflammatory 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.   

How Do You Treat MS?

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 for three to five days. Steroid treatment of attacks may decrease the duration and intensity of neurological dysfunction. 

Disease modifying therapy (DMT) is a central component to comprehensive care for multiple sclerosis. DMTs are currently the best strategy to positively alter the course of MS. While some improvement in symptoms may be noted following initiation of a DMT, these therapies do not treat symptoms from prior relapses or brain lesions.

Clinical studies have demonstrated that DMTs:

  • Reduce clinical relapses
  • Reduce the formation of new lesions on MRI
  • Slow progression of disability
  • Slow cognitive decline

Until recent years, medications called interferons (e.g., Rebif, Betaseron, Avonex) and glatiramer acetate (e.g., Copaxone) have been the mainstay of treatment. Additional medications with greater efficacy have been developed including oral medications and infusions. Disease modifying therapies treat MS by interrupting or altering the abnormal inflammatory activity.

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

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

What's on the Horizon for Treatment?

We are in an exciting era of treatment for MS. Since 2010, several new treatments have been FDA approved, including the first ever treatment for a form of MS called primary progressive.

Several additional therapies are being studied and hold promise in treating MS. In addition to novel oral medications and infusions, stem cell transplant is showing promise as a treatment for MS. In stem cell transplant, a patient’s stem cells are used to "reset" the immune system with the hope of eliminating the overactive inflammatory activity in MS.

Did you know?

  • National Multiple Sclerosis Society and Multiple Sclerosis Association of America are reliable sources for accurate information regarding MS
  • There are 15 medications to treat MS and more under research
  • 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.