Multiple Sclerosis

Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system (CNS) that is unpredictable. MS can be relatively benign or entirely disabling. Symptoms experienced are due to area(s) of inflammation and scarring (sclerosis) in different parts of the CNS.

Cause of MS is unknown. However, based on available evidence, it is believed to be due to an interaction between a genetic predisposition and environmental factors (possibly a viral infection), that set up the immune mediated inflammatory changes causing the disease.

MS symptoms are unpredictable and erratic at times. They range from mild to severe, have variable duration and combinations depending on the area(s) involved. Often after a disease relapse (also called attack, flare or exacerbation), there is a period of stability called remission. This type is called relapsing remitting MS.

MS patients often present with one or more of these symptoms:

• Impaired or loss of vision, associated with eye pain due to optic neuritis
• Difficulty walking due to weakness or imbalance
  
• Paresthesia (numbness, tingling or “pins and needles”) and loss of sensation
  

Other possible symptoms that occur throughout the disease course may include:

• Difficulty with coordination, balance, walking and standing
• Partial or complete paralysis
• Muscle spasticity
• Tremor
• Bladder, bowel and sexual dysfunction

Many people with MS may experience mood and anxiety disorder and cognitive impairment (poor attention and concentration, impaired memory or poor judgment).

Due to lack of specific test for MS, diagnosis can be challenging particularly at disease onset. There is strict diagnostic criteria that was revised multiple times in the past. This criteria is based on developing recurrent attacks in different places of the CNS at different times. MS attacks present with new symptom(s) or worsening of old symptom(s) that last at least 24 hours.

Your physician will collect a complete history, perform a complete neurological examination in addition to obtaining many diagnostic tests to exclude other diseases and confirm the MS disease. They include brain and/or spine MRI (detects MS plaques), evoked potentials (detects slowing at plaque sites) and lumbar puncture (spinal tap) looking for evidence of inflammation in the cerebral spinal fluid. Other sets of blood tests are often done to rule out other things that may mimic MS.

Currently there is no cure for MS. However, there are numerous medications available to suppress disease activity, prevent further relapses and possibly preserve functions. These medications are called disease modifying drugs (DMDs). A DMD may be used based on disease activity/severity, benefit-risk analysis or patient characteristics. The drug would be assessed periodically and changed if needed based on efficacy and tolerability.

Acute MS relapses are often treated with high-dose corticosteroids (often through an IV) in order to speed up recovery. Other MS symptoms and complications can be treated and helped as needed.

MS symptoms can be disabling. Based on symptom types and severity, a specific rehabilitation program may be needed to help you return to the highest level possible of function and independence while improving overall physical, emotional and social quality of life.

MS rehabilitation can help affected patients accomplish the following:

• Improved motor skills for maximal independence
• Promote muscle strength, endurance and control
• Restore functions that are essential to activities of daily living
• Use of assistive devices (canes, braces, walkers) if needed
• Manage bladder and bowel incontinence
• Adopt the home environment to emphasize function, safety, accessibility and mobility
• Improve communication skills for those who have weak and uncoordinated speech