Multiple sclerosis is a chronic disease involving the central nervous system, which leads to demyelination of nerve fibers. This is induced by immune system attacking the myelin sheath at various levels in the brain, spinal cord and optic nerve, secondary to genetic factors complicated by environmental factors. Demyelination increases the chances of nerve damage and disruption in conduction of nerve impulses, leading to various symptoms associated with the disease. It is twice more common in women and Caucasians are at higher risk of developing the disease along with people living in northern areas away from equator. It has genetic predisposition and first degree relatives at greater risk of developing it.
The clinical course of the disease is varied with presenting symptoms of fatigue, paresthesias, weakness, pain, spasms, visual disturbance, dizziness, walking difficulty, speech problems, dysphagia, hearing difficulty, sexual dysfunction, bowel and bladder disturbances. The symptoms are usually abrupt in nature.
Does Multiple Sclerosis Always Get Worse?
When we look at the 4 different types of MS, namely, relapsing-remitting multiple sclerosis, secondary progressive MS, primary progressive MS and progressive relapsing MS; we will note that 3 forms of MS are progressive in nature, which means that they get worse over the course of time. Relapsing-remitting multiple sclerosis, which is the most common type of MS affecting the majority of MS patients, initially, is not progressive in the beginning. Therefore, it can be said that this form of MS does not get worse. However, over time this form of multiple sclerosis also progresses to secondary progressive MS. It is noted that about 1/3rd people with multiple sclerosis do not have continued disability and only suffer transient exacerbation of symptoms. Data suggests that 60% people are ambulatory without assistance and with minimal disability, after 15 years of onset of MS. 20% may require wheelchair, crutches or cane to ambulate and another 20% are bedridden or institutionalized.
This data suggests that the course of MS is highly variable, abrupt and diverse. It may progress in some and may just flare-up in others. However, it is difficult to predict in which patients the disease will take a worsening course and which patients will only be affected by flare-ups.
Diagnosis Of Multiple Sclerosis
The diagnosis of multiple sclerosis is often complex as there is no single diagnostic test for MS. It can be diagnosed with the assistance of an MRI, which helps in identifying new lesions (at least presence of 2 lesions disseminated over space and time) in the CNS (showing white matter symptoms) that should consort with the presenting clinical evidence. As in the presence of lesions on MRI and absence of clinical symptoms or presence of clinical symptoms and absence of lesions on MRI is not suggestive of MS diagnosis. Multiple sclerosis diagnosis can only be considered in the absence of any other appropriate alternative explanation to the neurological features. In addition to MRI, CSF fluid can also be tested for abnormalities suggesting increased IgG levels and oligoclonal bands on CSF electrophoresis reflecting underlying activation of autoimmunity.
Based on the clinical course of multiple sclerosis, it is divided into 4 types:
The most common type of multiple sclerosis that afflicts about 85% of people suffering from this disease is relapsing-remitting MS, in which there is exacerbation of symptoms abruptly followed by periods of complete or partial recovery. Over time relapsing-remitting MS progresses to secondary progressive MS, in which the flares are more common with less resolution and more persistence and worsening of the disease. Primary progressive multiple sclerosis is yet another form of MS in which there is worsening and progression of the disease form from the very beginning and the disability starts from the initial stages without any relapses or remissions. Progressive relapsing is a very rare form of multiple sclerosis in which there is steady worsening of the disease from the very beginning accompanied by periods of exacerbations, but no remissions.
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