Understanding symptoms, treatments and types of multiple sclerosis (MS)

MS is a disease that attacks the central nervous system (CNS), which is made up of the optic nerves, brain and spinal cord. In patients with MS, the immune system attacks healthy tissue in the CNS. This damage interferes with the transmission of nerve signals between the brain and spinal cord and the rest of the body. One or more areas of the CNS can be targeted during an MS attack. The damage in each area is called a lesion or plaque.

There are four different categories of MS:

• Clinically isolated syndrome (CIS): A diagnosis of CIS is made when an individual experiences an episode of neurological symptoms for the first time that is caused by a CNS lesion typical of MS. CIS can be the presenting episode of MS. A diagnosis of MS is made when there is evidence of multiple inflammatory episodes in the CNS over time.
• Relapsing-remitting: A form of MS that is marked by recurrent episodes of neurological symptoms caused by active inflammation in the CNS (relapses), followed by full or partial recovery (remissions). Symptoms secondary to a relapse typically last weeks or months. Most MS patients initially have a relapsing-remitting course and are diagnosed in their 20s-30s.
• Primary progressive (PPMS): A form of MS that is characterized by steadily worsening neurologic disability, without any previous clinical relapses and remissions. PPMS patients typically receive a diagnosis in their 40s-50s.
• Secondary progressive (SPMS): The phase of MS that follows the relapsing-remitting course in some patients. SPMS is characterized by steadily worsening neurological disability in the absence of clinical relapses, and it typically begins after 15-20 years of relapsing-remitting disease.

 

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Common MS symptoms include fatigue, vision loss, fatigue, impaired coordination, slurring or speech, muscle weakness, vertigo/dizziness, numbness, tingling, burning pains, bowel and bladder problems, and cognitive changes.

While the exact cause of MS is unknown, researchers have identified a number of factors that increase susceptibility:

• Geographic location: People who spend the first 15 years in countries located far from the equator are more likely to develop MS.
• Family history: The lifetime risk of MS in first-degree relatives of people with MS is 2-4%, which is approximately 7-10 times higher than the risk of the general population.
• Genetic makeup: Researchers have identified more than 230 genes that each increase the risk of developing MS. Most of these genes are known to play a role in immune responses, which supports the view that MS is an autoimmune disease.
• Race: While MS can occur in people of any race, people of western European ancestry are more likely to develop the disease.
• Sex: Relapsing-remitting MS is 2-3 times as common in women as in men.
• Viral infection: First-time exposure to Epstein-Barr virus, which causes mononucleosis, as an adult may increase the risk of developing MS.
• Lifestyle: Lifestyle factors like cigarette smoking and absorbing insufficient amounts of vitamin D are associated with higher chances of developing MS or a more severe course once developed.

While there are ways to lower the risk of developing MS, there are no proven ways to prevent it from occurring.

Talk to your doctor about beginning a disease-modifying therapy, which is a drug that can reduce risk of future MS attacks, and, in some cases, slow down the disability over time. Many patients live full, active lives when they are diagnosed quickly and put on an appropriate medication. Your doctor will also want to discuss your symptoms in order to help alleviate them as much as possible. These symptoms may include fatigue, difficulty walking, bladder urgency and pain.

We weigh the risks and benefits of each agent and align them with the goals of individual patients, as well as the stage and severity of their MS. Disease-modifying drugs vary in potency and side effects. Some increase the risk of certain infections. Some are better suited for patients with more active forms of MS. Some are delivered under the skin, some by intravenous infusion, and others come in the form of pills. At The Ohio State University Wexner Medical Center, we take a customized approach to addressing each patient’s specific challenges, concerns and needs when it comes to medication.

Yes. Multiple studies indicate that, like the flu vaccine, the COVID-19 vaccine is safe for people with MS. We encourage people with MS to get the vaccine. There are many ongoing efforts to monitor the effects of the vaccine on people with MS, and, so far, there have been no red flags. It’s important to keep in mind that MS relapses are more likely to occur — and chronic symptoms are more likely to worsen — during viral infections, including COVID-19. We have many active research studies, including a study on COVID-19 vaccine effectiveness in people with MS.