Learn the symptoms, types, treatments and management of this autoimmune disease.
An estimated 1 million adults in the U.S. live with multiple sclerosis (MS), according to the National Multiple Sclerosis Society. MS is an autoimmune disease of the central nervous system, meaning the condition affects the brain and spinal cord.
“The average age at the time of diagnosis is around 29 years old, with a female-to-male ratio approaching 4:1,” said John Kramer, a physician assistant with the Vanderbilt Multiple Sclerosis Center. “So this is commonly a condition that affects young women.” He added that the typical age range at the time of diagnosis is 20 to 50. About 5% of cases affect people under 18 in what’s known as pediatric-onset MS.
Multiple sclerosis symptoms
Early MS symptoms may include tingling, numbness or weakness in the arms or legs, or visual symptoms, often in one eye, such as blurred vision, a decrease in color vision or vision loss.
“Almost any neurological symptom that lasts for at least 24 hours or longer and that is not due to some other underlying medical problem could be the first presenting symptom of MS,” Kramer said.
Diagnosing multiple sclerosis
“MS remains what we call a ‘clinical’ diagnosis, meaning patients must have symptoms and/or findings from a neurological exam to be considered as a possible diagnosis,” Kramer said. An MRI scan of the brain and or spinal cord may also be needed. “Sometimes, clinicians need to also order a lumbar puncture to analyze a patient’s spinal fluid for MS,” Kramer added.
Your physician may also obtain blood samples or additional lab work to rule out other conditions, such as a vitamin deficiency, thyroid disease or a different autoimmune disorder.
Types of multiple sclerosis
About 85% of patients will have relapsing MS at the time of diagnosis, Kramer explained. What this means is that a patient will have an accumulation of physical symptoms that cause a relapse or an attack, and these symptoms may improve over time, which is called remission. There can be complete or partial remission from MS relapses.
Some patients living with relapsing MS will develop a gradual worsening of neurological symptoms that occurs even without an active relapse. “We now call this ‘smoldering MS,’” Kramer said. This usually manifests as progressive weakness or stiffness in the arms or legs or progressive cognitive difficulties.
Approximately 10% to 15% of patients will have primary progressive MS at the time of their diagnosis. “Primary progressive MS is an insidious progressive accumulation of neurological disability, most commonly related to spinal cord dysfunction,” Kramer said. “Patients will develop tingling, numbness, weakness and stiffness in their arms or legs. Symptoms gradually worsen over time.”
Treatments for multiple sclerosis
Unfortunately, there is no cure for MS, but there are treatments to help ease symptoms and slow disease progression.
“This is the golden age of therapeutics for multiple sclerosis,” Kramer said. “Before 1993, with the advent of a medicine called Betaseron, we had no FDA-approved drugs for MS. And now, if you look at the therapeutic landscape, there are more than 20 different medications that come in different routes of administration.”
Medications for MS are called disease-modifying therapies, and they may be available as an injectable, an oral medication or as an intravenous (IV) infusion therapy.
“When a patient is started on one of these medications,” Kramer said, “the goals of treatment are threefold: to reduce the number of relapses that occur in that given patient, reduce the number of new lesion formation on MRI and reduce the risk of accumulation of further disability down the road.”
Living with MS
Some lifestyle factors, like smoking, may worsen MS, while others may be protective.
“There is some evidence that a Mediterranean-style diet can produce an anti-inflammatory environment in the body, compared to our typical standard Western diet,” Kramer said. Exercise is also helpful for MS management. “The number one most bothersome symptom described by patients with MS is fatigue,” Kramer added. “So it can be hard sometimes to motivate people to start exercising, but when they do, their level of fatigue can improve and they may also become less stiff and gain strength in their arms and legs.”
Finally, if you have MS, following up with your doctor regularly, taking prescribed medications and monitoring symptoms is crucial. “Compliance with the treatment regimen is critical, just like with any other chronic disease management,” Kramer explained.
The Multiple Sclerosis Center at Vanderbilt University Medical Center evaluates and treats adults and children with multiple sclerosis and similar conditions.
