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Multiple sclerosisMultiple Sclerosis: Causes, Symptoms, Types and Treatments

Commonly asked questions about multiple sclerosis:

What is Multiple Sclerosis?

Multiple sclerosis results from an immune-mediated process directed against the central nervous system because of an abnormal response in the brain, spinal cord, and optic nerves.

Within the central nervous system, the immune system attacks the myelin sheath — the fatty substance that surrounds and insulates the nerve fibers. This damaged myelin then forms a scar tissue (sclerosis). Nerve impulses that travel to and from the brain and spinal cord are distorted or interrupted, producing a wide variety of symptoms.

What are the Symptoms of Multiple Sclerosis?

People with multiple sclerosis tend to have their first symptoms between the ages of 20 and 40. While some may disappear after a certain amount of time, others may linger.  Common symptoms of MS include:

Unusual sensations“Pins and needles” sensation; as well as numbness, itching, burning, stabbing, or tearing pains.
Bladder problemsAbout 8 in 10 people have bladder problems that can be treated easily. You may need to urinate more often, or bowel problems such as constipation are also common.
Trouble walkingMS can cause muscle weakness or spasms, including balance problems, numb feet, and fatigue which also contribute in making it more difficult to walk.
DizzinessDizziness or feeling lightheaded are common.
FatigueAbout 8 out of 10 people usually feel very tired in the afternoon due to slowed thinking, weak muscles or sleepiness.
Muscle SpasmsLeg muscles are usually affected — about 40% of people say this is an early symptom of MS. Stiffness or strong muscle spasms affect 6 in 10 people through progressive sclerosis.
Sexual troubleVaginal dryness in women and erection problems in men. Both men and women may be less responsive, or have a lower sex drive in general.
Speech problemsMS can sometimes cause people to pause a long time in between words as well as cause slurred or nasal speech. Swallowing problems occur in more advanced stages.
Thinking problemsAbout 50% of people with multiple sclerosis have trouble concentrating, paying attention, or recalling certain events. Rarely, people experience problems that make it difficult to complete daily tasks, but MS usually does not change your intellect and ability to read and understand a conversation.
TremorsMinor shakes can occur and make it hard to complete every day activities.
Vision problemsEye problems tend to be one of the first symptoms in MS. These usually affect only one eye and go away on their own. However, eye sight may become blurry, gray, or have a dark spot in the center. Eye pain or temporary vision loss may also occur.

What are the Risk Factors of MS?

These factors may increase your risk of developing multiple sclerosis according to MayoClinic.org:

  • Age – MS can occur at any age, but it mostly affects people between the ages of 15 to 60.
  • Sex – Women are about twice as likely as men are to develop MS.
  • Family history – If one person in your family has a history of multiple sclerosis, you are at a higher risk for developing that disease.
  • Certain infections – Epstein-barr, as well as many other viruses, have been linked to MS.
  • Race- White or Caucasian people, specifically those of Northern European descent are at the highest risk of developing MS.
  • Climate – MS is far more common in countries with temperate climates. These include Canada, Northern United States, New Zealand, and Europe.
  • Autoimmune diseases – Thyroid disease, type 1 diabetes or inflammatory bowel disease increase your risk of developing multiple sclerosis.
  • Smoking – Smokers who experience an initial event of symptoms that signal MS are more likely than nonsmokers to develop a relapsing-remitting MS.

What is the Cause of Multiple Sclerosis?

While the cause of multiple sclerosis is still unknown, scientists believe that a variety of factors may be involved in the development of MS, including:

Immunologic Factors

An abnormal immune-mediated response attacks the myelin coating around nerve fibers in the central nervous system, as well as the nerve fibers themselves. Researchers have been able to identify which immune cells are mounting the attack, factors that cause them to attack, and some of the receptor sites that appear to be attracted to the myelin to begin the destructive process. These findings are bringing us closer to understanding the direct cause of multiple sclerosis.

Environmental Factors

MS is known to occur more frequently in areas that are further from the equator. Epidemiologists study variations in geography, demographics, genetics, and infections that can cause migration patterns when relating to multiple sclerosis.

  • Vitamin D – People living closer to the equator are exposed to greater amounts of sunlight all year, and as a result they have higher levels of natural-produced vitamin D. The possible relationship between MS and sunlight exposure is currently in research.
  • Smoking – Studies have shown that smoking increases a person’s risk of developing MS and is associated with a more severe case and a rapid progression of it. However, stopping smoking before or after the onset of MS is proven to slow the progression of the disability.
  • Clusters – “Clusters” is the perception that a large amount of multiple sclerosis cases occur in a specific time or location. Although this may provide clues to environmental or genetic risks for the disease, it hasn’t been proven for causing or triggering factors in MS.

Infectious Factors

Initial exposure to numerous viruses, bacteria, and other microbes occur during childhood. Because viruses cause demyelination and inflammation, it is possible that a virus or other infectious agent is the triggering factor in multiple sclerosis.

Measles, canine distemper, human herpes virus-6, Epstein-barr, and chlamydia pneumonia are not yet proven to trigger MS, but they are being investigated to determine if they play a role in its onset.

Genetic Factors

While MS is not hereditary, a first-degree relative such as a parent or a sibling with MS does significantly increase an individual’s risk of developing the disease. Common genetic factors are also found in some families where there is more than one person with MS. New techniques for identifying genes are helping to answer questions about the role of genes in the development of MS.

What are the Types of Multiple Sclerosis?

Patients usually experience a first neurological event known as “Clinically Isolated Syndrome,” which lasts for at least 24 hours and is suggestive of MS. Symptoms and signs can indicate either a single lesion (monofocal) or more than one lesion (multifocal) within the central nervous system.

There are 4 types of MS according to MultipleSclerosis.com. Each name indicates the way the disease affects the body over time.

  • Relapsing-Remitting MS (RRMS) – Most common form of multiple sclerosis. About 85% of people with MS are initially diagnosed with RRMS and have relapses, flare-ups or exacerbations when new symptoms appear.
  • Secondary-Progressive MS (SPMS) – In SPMS, symptoms worsen steadily over time with or without relapses and remissions. Most people diagnosed with RRMS will transition to SPMS later on.
  • Primary-Progressive MS (PPMS) – Not a common type of multiple sclerosis, as it only occurs in 10% of people. PPMS is characterized by slowly worsening symptoms from the beginning, with no relapses or remissions.
  • Progressive-Relapsing MS (PRMS) – A rare form of MS (5%), PRMS is characterized by steadily worsening disease state from the beginning, with acute relapses, no remissions, with or without recovery.

What Drugs are Used to Treat Multiple Sclerosis?

Medications used to modify the disease course in multiple sclerosis, reduce disease activity and disease progression in many people with relapsing forms of MS. The following are U.S. Food and Drug Administration (FDA)-approved disease-modifying agents.

Injectable Medications

  • Avonex (interferon beta-1a)
  • Betaseron (interferon beta-1b)
  • Copaxone (glatiramer acetate)
  • Extavia (interferon beta-1b)
  • Glatopa (glatiramer-acetate)
  • Plegridy (peginterferon beta-1a)
  • Rebif (interferon beta-1a)
  • Zinbryta (daclizumab)

Oral Medications

  • Aubagio (teriflunomide)
  • Gilenya (fingolimod)
  • Tecfidera (dimethyl fumarate)

Infused Medications

  • Lemtrada (alemtuzumab)
  • Novantrone (mitoxantrone)
  • Tysabri (natalizumab)

How do I Prevent Multiple Sclerosis?

There is no particular way to prevent MS or its episodes; For people with relapsing-remitting MS and secondary progressive MS, treatment with medicine may help reduce the frequency of relapses and delay the disability altogether.

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