Expert Answers About Treating Multiple Sclerosis
1. What is multiple sclerosis (MS)?
MS is a degenerative disease of the central nervous system that can cause relapsing or progressive neurologic symptoms. The disease causes demyelination, which is a thinning or unwrapping of myelin, the covering around the nerves. Nerves act like wires, and when the myelin is stripped, the nerves cannot work as fast or last as long and can even potentially die due to the damage. MS is categorized as an autoimmune disease, a type of condition in which your immune system gets confused and starts attacking itself.
2. What are the different levels of severity and outcomes?
There’s a very wide range of abilities and disabilities with MS. I have one patient who runs marathons in every state and we have some people who are very disabled and in a wheelchair. The best predictor of how mild or severe the disease will be in a patient is Magnetic Resonance Imaging (MRI). If the MRI results show a lot of lesions on the brain early on, that may signal a worse prognosis, meaning the patient most likely will have some disability.
MS can be relapsing or progressive. Relapsing means the symptoms will come on over a few weeks, last for a few weeks and then gradually improve. Progressive MS comes on more slowly, is less treatable, and typically doesn’t improve with time, although there are recent studies and new treatments showing more promise for progressive MS.
3. What are the signs and symptoms of MS?
A common first symptom is visual loss. There’s something called optic neuritis, or inflammation of the optic nerve, in which a person has pain around their eye and their vision looks like they’re looking through wax paper or cellophane. There’s also something called myelitis, which is inflammation inside the spinal cord that can cause numbness, weakness or a tingling sensation on the skin of your arms, legs or trunk; it can also cause bowel or bladder dysfunction. Other symptoms could be cognitive issues like thinking problems or memory problems, depression, weakness, imbalance, poor coordination and tremors.
4. How is MS diagnosed?
The most definitive way to diagnose MS is with an MRI because the technology is so precise now. Multiple sclerosis stands for multiple scars, so when you look at a detailed picture of the brain, you can see lesions or abnormalities inside the brain tissue. Typically with MS, there are multiple lesions in specific places in the brain, and we know when we see a particular pattern that it’s MS.
Sometimes we use electrical tests to see how fast the impulses are going through the nerves, because with MS, travel time through the nerves can be decreased. There’s also a newer test called Optical Coherence Tomography (OCT) which, in simple terms, is an ultrasound of the back of the eye to measure the nerve fiber layer.
We also spend time ruling out infections and other conditions that cause similar symptoms to MS, using lumbar puncture or screening blood tests to do so. MRI technology has improved so much over the 20-plus years I’ve been practicing that they really are the gold standard for diagnosis now.
5. How is MS treated?
The treatment for a person experiencing a flare-up of symptoms or a new symptom like optic neuritis or myelitis is steroids, as well as physical and occupational therapy to improve function. Most commonly, the steroids are administered intravenously.
There’s also a range of long-term therapy to prevent—or at least minimize—neurodegeneration. There are injectable medicines that have been around since the early 90s (and some new ones in recent years); we also have three oral medicines and IV medication options as well, depending on how aggressive the disease is and how a patient responds to certain medications.
There are acute treatment trials running for repair of MS nerves or remyelination. The hope is that this new treatment would improve nerve connections and therefore improve function in patients, so that’s really exciting news for MS treatment.
6. What can a person do during a relapse to minimize or relieve their symptoms?
Besides steroid treatment, managing your emotional and physical health is very important. Stress management and good emotional health is important because a lot of times, if you’re down and depressed, the MS is more active. So listening to music, meditating, drawing or anything that people do to relieve stress can help.
Exercising is encouraged and safe for patients with MS. So quite often, we’ll have patients go to physical therapy and their physician may even suggest a specific exercise program. Exercise seems to help memory and brain volume and can even fight fatigue. Anything patients can do to keep moving helps.
7. What do you wish your patients knew about treating MS?
I want my patients to know it’s important to treat MS even when they’re feeling good. They can still have active MS lesions on the brain when they aren’t showing symptoms. We like to see patients at least twice a year to keep an eye on the lesions and adjust medications, if need be. We encourage monitoring MS just as you would monitor high blood pressure: even though you can’t always see the symptoms, it could be causing underlying issues.
I’d also recommend they continue to see their primary care doctor to make sure they’re checking their cholesterol, blood pressure and weight because these diseases are cumulative. If they have MS plus another condition, they tend to do physically worse.