Multiple sclerosis (MS) is an autoimmune disease that causes damage to the brain and spinal cord in the central nervous system.
In MS, the immune system attacks ‘insulation’ that covers nerve fibres, which causes problems with communication between nerve cells, the brain, and the spinal cord with the rest of the body.
Symptoms of MS depend on the amount and localisation of nerve damage. The disease can affect any part of the brain or spinal cord, which can cause problems with movement or feeling in the limbs or other parts of the body, instability, visual problems, problems with urination, and cognitive and psychiatric problems.
Most people with MS have a relapsing-remitting form of the disease, typically with periods of new symptoms (relapses) that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods (remissions), without the acute activity of the disease. Remissions can last months or even years.
After 10-20 years, patients with relapsing-remitting MS usually stop having relapses and the disease starts to slowly progress. This stage of the disease is known as secondary-progressive MS. Some patients with MS experience might only experience a slow progression of the symptoms without relapses, which is typical for primary-progressive MS.
The disease is usually progressive and causes irreversible neuro-disability, but treatment can manage symptoms effectively and slow down the progression of the disease.
Symptoms of MS are very variable and might fluctuate, depending on the location of affected nerve fibres and the activity of the disease.
The disease often causes:
Numbness or weakness in one or more limbs, often just on one side of the body.
Tingling or pain in parts of the body.
Issues with vision, such as partial or complete loss of vision, usually in one eye at a time, or double vision.
Tiredness and fatigue.
Electric-shock sensations from the area of the neck spine (Lhermitte sign).
Problems with coordination or loss of balance.
Issues with speech, such as slurred speech.
Sexual, bowel or bladder problems.
The diagnostic process begins with a neurological examination. The neurologist will usually recommend MRI, blood tests, and lumbar puncture to confirm the diagnosis. Sometimes, electrophysiological tests called Evoked Potentials are indicated to review various central nervous pathways.
In the case of the most common form of MS, relapsing-remitting, the diagnosis is quite straightforward based on a pattern of symptoms, confirmed by MRI findings, blood, and lumbar puncture results. The diagnosis can be more difficult in cases of unusual symptoms or progressive disease.
To prevent and minimise acute relapses, treatment is needed with drugs called corticosteroids. Based on the form of the disease, the neurologist may offer disease-modifying therapies to slow down its' activity and the onset and progression of neurodisability. An essential part of the therapy is also neurorehabilitation, neurodisability management and symptomatic treatments.