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  4. Multiple Sclerosis (MS)

What is Multiple Sclerosis (MS)?

Multiple Sclerosis is a long-lasting, potentially disabling disease that damages the nerves in the brain and spinal cord (central nervous system). The nerve fibers in the human body have a protective fatty tissue wrapped around it (called myelin). In MS, the immune system attacks this tissue damaging the nerves. This damage stops the brain from sending out signals to other parts of the body in the manner it should. And over time, the disease can cause the nerve themselves to deteriorate or become permanently damaged.

MS is most commonly diagnosed in people in their 20s and 30s, although it can develop at any age, and it is more common in women than in men.

If multiple sclerosis is not a blood disorder, why is it mentioned on a Haematology Website?

Yes, Multiple Sclerosis is a disorder of the Central Nervous System and not a blood disorder, however, research and medical advancements have proven that a Hematopioetic Stem Cell or Bone Marrow Transplant is an effective treatment of the disease. Haematologists or Haemato-Oncologists specialise in doing a Bone Marrow Transplant.

What are the Symptoms of Multiple Sclerosis (MS)?

The signs and symptoms of MS appear between the ages of 20 and 40 years. They vary widely from person to person and depend on two things – the amount of nerve damage & which nerves are affected. People suffering from severe MS may lose the ability to walk independently or walk at all, while others may experience long periods of remission without any new symptoms.

Early Symptoms of MS:

  • Blurred or double vision
  • Thinking problems
  • Clumsiness or a lack of coordination
  • Loss of balance
  • Numbness
  • Tingling
  • Weakness in one arm or leg

Common Symptoms of MS:

While these are the most common changes to the mind and the body in someone with MS, do note that the severity of symptoms varies greatly and many people go years with only mild symptoms that come and go:

  • Unusual Sensations – People with MS often complain of a “pins and needles” sensation along with numbness, itching, burning, stabbing or tearing pains. About half of the people suffering from MS experience these uncomfortable symptoms. Fortunately, these can be managed or treated.
  • Bladder Problems – Excessive urination or trouble emptying the bladder fully, along with bowel problems especially constipation are some common issues.
  • Trouble Walking – MS can cause muscle weakness or spasms, which make it difficult for the patient to walk. This is generally accompanied by balance problems, numb feet and fatigue, making walking more difficult.
  • Dizziness – Dizziness or lightheadedness is another common sign.

IF ONE EXPERIENCES ANY OF THE ABOVE SYMPTOMS FOR UNKNOWN REASONS, IT IS ALWAYS BEST TO CONSULT A DOCTOR IMMEDIATELY.

What are the types of Multiple Sclerosis (MS)?

MS starts in one of two general ways:

  • Relapsing-remitting MS
  • Primary Progressive MS

Relapsing-Remitting MS:

8 out of 10 people suffering from MS are diagnosed with the Relapsing-Remitting type of MS – the patient will have episodes of new or worsening symptoms, known as “Relapses”. These episodes generally worsen over a few days, may last for days to weeks to months, and then slowly improve. These relapses often occur without warning, and may be sometimes associated with a period of illness or stress.

The symptoms during a relapse may disappear altogether, with or without treatment, however, some symptoms might persist, with repeated attacks or relapses over a long period.

Periods between relapses are known as periods of “Remission” and these can last for years at a time. After many years, maybe decades, some people suffering from Relapsing-Remitting MS may go on to develop secondary Progressive MS. In this type of MS, the symptoms gradually worsen.

Primary Progressive MS:

Just over 1 in 10 people with the condition start with a Primary Progressive MS – a type of MS where symptoms gradual worsen. There are no periods of remission, however, patients often have periods where their condition appears to stabilise.

What causes Multiple Sclerosis (MS)?

Multiple Sclerosis is an autoimmune disease – a disease in which the body’s immune system attacks its own tissues. The immune system malfunction destroys the sheath or fatty substance that coats and protects nerve fibres in the brain and spinal cord, called myelin. When this protective layer is damaged or destroyed, it exposes the nerve fibre and this result in the messages that travel along the nerve either slow down or get blocked. And in some cases, the nerves can also get damaged.

Doctors and researchers aren’t sure why MS develops in some people and not others and what causes the immune system to act in this way but it is believed that a combination of genetic and environmental factors is responsible. Some of the factors that have been suggested as possible causes of MS include:

  • Genes: While MS isn’t directly inherited, but people who are related to someone with the condition are more likely to develop it – the chance of a sibling or child of someone with MS also developing it is estimated to be around 2-3%.
  • Lack of Sunlight and Vitamin D: A lack of sunlight and low vitamin D levels may play a role in the condition, although it is not clear whether vitamin D supplements can help prevent MS.
  • Smoking: people who smoke are twice as likely to develop MS as compared to those who don’t smoke.
  • Viral Infections: Researchers believe that infections, particularly those caused by Epstein-Barr virus (responsible for glandular fever) might trigger the immune system, leading to MS in some people.

Multiple sclerosis might prove to be a challenging condition to live with, but medical advancements over the years have considerably improved the quality of life of people living with the condition. While the condition is rarely fatal, complications from severe ms can lead to chest or bladder infections, or swallowing difficulties. The average live expectancy for people with ms is around 5 to 10 years lower than average, and this gap is reducing.

How is Multiple Sclerosis (MS) Diagnosed?

Diagnosis of MS could be a challenge for doctors as there is no one test that can show if someone has it. While, there are many other conditions which have similar symptoms, a neurologist would be able to figure out if the symptoms mean you have MS or another condition.

To diagnose the condition, the doctor is likely to start with a thorough medical history and do a few tests to see if the brain and spinal cord are working as they should. He/ she would probably start with a Neurological Examination to look for abnormalities, changes or weakness in vision, eye movements, hand or leg strength, balance & coordination, speech & reflexes. Further, some of the tests you may need to confirm MS are:

  • Blood Tests: To rule out other causes of the symptoms
  • Lumbar Puncture (Spinal Tap): To help rule out infections and other conditions with symptoms like MS.
  • Evoked Potential Test: To show whether it takes the brain longer than normal to receive messages through recording of electrical signals produced by the nervous system in response to stimuli.
  • Imaging Tests, like an MRI: To show if there’s any damage or scarring of the protective sheath (myelin) surrounding the nerves in the brain and spinal cord.

In most cases of Relapsing-Remitting MS, the diagnosis is based on a pattern of symptoms consistent with the disease and can be confirmed by brain imaging scans, such as an MRI.

In cases of Progressive MS, the diagnosis may be more difficult. In these cases, further testing – spinal fluid analysis, evoked potentials and additional imaging may be needed.

How is multiple sclerosis (ms) Treated?

Since the reasons for MS are still an enigma, the various treatment options focus on speeding recovery from attacks, slowing the progression of the disease. However, with extensive research, Hematopioetic Stem Cell or Bone Marrow Transplant (BMT) has proven to a scientifically proven treatment. While, this is not a new procedure as such, but it has been successful as a relatively new treatment for MS – according to doctors, 60% of the people with RRMS (and active disease) who undergo a BMT may not get long term attacks and 30% get benefitted if they have some disability. There are criteria regarding which patients will be benefitted and who will not.

How can a multiple sclerosis (ms) patient ensure a better quality of life?

A person suffering from this condition may need to adapt his/ her daily life, but with the right care and support, many MS patients can lead, long, active and healthy lives.

  • Self-Care:
    • An MS patient needs to take responsibility for his/ her own health and well-being with support from people involved in their care. Self-care includes all the things one does each day to stay fit, maintain good physical & mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions.
  • Regular Reviews:
    • While an MS patient will be in regular contact with their care team, they should also have a comprehensive review at least once a year. This opportunity should be used to discuss problems, think about any further support required and symptoms or concerns.
  • Healthy Eating & Exercise:
    • While there is no special diet that has been proven to slow the progression of MS, a generally healthy and balance diet can help manage specific issues such as fatigue and constipation. It can also reduce the risk of other health problems, such as heart disease.
  • Stopping Smoking
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