Understanding Multiple Sclerosis, Its Diagnosis and Treatment

By Dr. Padma Kumari Muthuswamy | Published: June 2nd, 2016

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Multiple sclerosis is the most common disabling illness of young adults. It is twice as common in women as in men. MS is an autoimmune disease affecting the brain and spinal cord, where the myelin sheath, which protects the nerves, is affected.

The sheath gets inflamed and later scarring happens. The inflammation around the myelin sheath stops the affected nerve fibres from working properly and symptoms develop. When inflammation stops, the sheath heals and symptoms settle. However, the inflammation, or repeated bouts of inflammation, can leave a small scar (sclerosis) that can permanently damage nerve fibres.

These scars may also be called plaques. Causes MS is not strictly a hereditary disease. However, there is an increased chance of MS developing in close relatives of affected people. Something may trigger the immune system to act against the myelin sheath. One theory is that a virus or another factor in the environment triggers the immune system in some people with a certain genetic makeup.

Symptoms depend on which part of your nervous system is affected and include:

  • Double or blurred vision
  • Fatigue
  • Numbness or tingling
  • Weakness or spasms of some muscles
  • Dizziness or balance problems
  • Problems passing water

Emotional problems and depression:

  • You may find that you laugh or cry more easily, even for no reason. Many people with MS have symptoms of depression or anxiety at some stage.
  • Difficulty speaking Types of MS
  • Relapsing-remitting MS where symptoms last a few weeks, go away completely or nearly, and different symptoms appear several months or even years later. About 9 in 10 people with MS have this kind
  • Primary progressive MS where symptoms don’t settle and gradually get worse
  •  Secondary progressive MS where after several years of relapsing-remitting MS, the symptoms gradually become permanent

Benign MS where there are only a few relapses in a lifetime and no symptoms remain permanent. This is the least serious form of the disease Diagnosis It is done only after 2 episodes of neurological symptoms occur. Some tests are helpful like Magnetic Resonance Imaging (MRI), which shows the areas of inflammation and scarring and Lumbar Puncture, cerebrospinal fluid (CSF) is taken and tested for certain protein viz oligoclonal immunoglobulins.

Treatment:

  • The neurologist and the patient need to discuss and choose the best course of treatment.
  • Medicines that modify the disease progress
  • Steroid for relapses
  • Adjunct medications to help with symptoms

Other supportive therapies:

Physiotherapy, Occupational therapy, Speech therapy, Specialist nurse advice and support, Psychological therapies The link between Vitamin D and MS The ‘sunshine vitamin’ may protect against MS. If vitamin D deficiency is present, based on the existing guideline, the patient should be treated with 50,000 IU of vitamin D3 once a week for 8 weeks, followed by maintenance therapy of 2,000–3,000 IU/d. Nevertheless, if serum levels of 25(OH) D are above 30 ng/ml, only vitamin D maintenance therapy (2,000–3,000 IU/d) should be initiated.

About the author

Dr. Padma Kumari Muthuswamy

Dr. Padmakumari Muthuswamy MBBS, MRCGP (UK), DRCOG (UK) Dr. Padma’s special interest is Primary healthcare (PHC). A graduate of Sri Ramachandra Medical College and Research Institute, Chennai, she trained in Family Medicine at Nottingham, UK for 4 years and worked as a General Practice Partner for over 5 years after obtaining her MRCGP from the Royal College of General Practitioners, London. Other credentials include a DRCOG from the Royal college of Obstetricians and Gynaecologists, London as a part of primary health care delivery, a University Certificate in Palliative Care for General Practice from Teesside University, Newcastle, UK and a Diploma in Entrepreneurship and Business Laws from NUJS Kolkata. Dr. Padma is keen to be a part of the change in India’s health system, with an emphasis on primary and preventive healthcare.