Multiple Sclerosis

upset woman

Great Strides

Medical science has developed almost-miracle medications for multiple sclerosis (MS).  Since the mid 1990s many, many medications have been discovered, developed, and launched that successfully slow MS progression.  (Before 1990 MS was usually a slow decline to disability and an early death, except for a few lucky ones.)  Treating a waxing and waning, appearing and disappearing medical condition remains a clinical challenge. however.  It’s not easy and takes conscientious care and cooperation of the health care provider, the treatment team, and the person with MS.  You do need to locate a trained, skilled, and experienced MS expert.  There are multiple types of MS, many choices of medication, and almost monthly the medical literature updates information about better treatment approaches.  The correct doctor and treatment team will give you the best hope for a long, healthy, happy life.

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Did You Know That…  Selma Blair has MS.  The television and film actress announced in 2018, at age 46, that she had been diagnosed with MS.  Her highly successful roles in comedies include Legally Blond (2001), Hellboy (2004), and Hellboy II: The Golden Army (2008).  She is now (in 2019) the star in the television science fiction series Another Life, playing the character Harper Glass.  For her, the MS diagnosis was finally made based on an MRI scan.  She had symptoms for years, maybe as long as 15 years, but was never taken seriously until she fell due to a “pinched nerve”.  On the film set her costumer helps her dress and steadies her.  The producers at Netflix have been supportive and understanding.  She does at times fall or drops things.

Now It’s Broken, Now It’s Fixed

MS is a frustrating condition.  The unpredictable nature of signs and symptoms as they come and go, the surprises at just the wrong times, can be maddening.  It is better once the diagnosis is made because at least then the person can understand what is happening to them.  Until the diagnosis is made one cannot understand why one leg that won’t work right one day.  Or why she has nerve tingles that won’t go away.  Then at some later time it’s all back to normal.  But everything does not always go back to normal.  Over time new dysfunctions linger and a real disability starts to build.

A Few Signs and Symptoms Examples

Here are a few typical example of signs and symptoms that people with MS might have.  Maybe a bit of trouble walking.  Maybe tired all the time, fatigued.  Some odd bladder problem, maybe incontinence.  Vision that’s not right.  A muscle that refuses to work.  Nerve tingles somewhere.  Sexually you’ve seemed to go dead.  You can’t think clearly for a while.  A new pain somewhere.  Bowels not working right.  Your mood is down though you’ve always been a cheerful person.  The list goes on.  The good news is that there are now new ways to diagnose MS early in its course.  An early diagnosis means that treatment can start right away.  One’s quality of life remains good and disability is kept to a minimum with early treatment.

The Great Medical Imitator

Because of the many and varied symptoms that come and go, before about 20 years ago it was really difficult to confirm a diagnosis of MS.  It was nearly impossible to identify and diagnose it early in its course.  The medical community referred to MS as “the great imitator” because it could present and mimic so many other medical conditions.  It was not until MS became more advanced and the person disabled that the diagnosis became clear.

Your Body Fighting Itself

MS is caused by your body’s immune system attacking your nervous system.  It’s the most common immune system vs. nervous system disorder.  Your combined central and peripheral nervous systems connect to everywhere in your body.  There are even connections from one part of your brain to other brain areas, in addition to the connections from your brain and spinal cord to all body organs and systems.  Which of these many nerve connections fail and when and where the communication links break are random.  The protecting myelin sheath is destroyed by immune cells and cytokines and the nerve conduction fails, then later the neuroglia might be able to repair the myelin.  Over time these repair processes work less well and fail more.  The sum of the nerve conduction failures over time result in disability.

MS Hits During The Best Years

MS hits young to middle age adults in their most productive career years.  People age 20 to 50.  It’s about 2 to 3 times more common in women than in men.  As we said above, it’s a common disorder.  It’s the most common neurological disability in this age range.

Treatment for MS

While it is true that MS can be treated, it require effort, focus, and persistence.  There is no complete cure (yet) but many research labs and pharmaceutical companies are working on it.  See our article on MS treatment to learn more (https://www.neuroscirandd.com/multiple-sclerosis-treatment/).  The current medications are effective, but we need better.

Beyond Just Medication, What Helps?

Physical therapy is a great help.  Keep moving, stay with exercising, build muscle, fight muscle loss, stay strong.  Your whole treatment plan will be aimed at keeping and improving all that you can do, moving and thinking. 

What About “Alternative Medicine”?

As much as we like and appreciate new approaches and innovative thinking, going the “alternative medicine” direction for MS is a bad idea.  Alternative medicine in MS is a trap.  There are many, many promoted “alternate” treatments for MS and none of them work.  We understand that many people will try just about anything out of desperation.  But don’t go this direction.  Really, none of these work.  If you just like one that is harmless, that’s fine, go ahead and pursue it.  But it won’t treat the MS, so don’t stray from your real medical treatment plan.

Types of MS

As we noted above, there are many different types.  The onset of MS can present in several different ways and the progression of MS can take different paths.  These different patterns of onset and progression can be divided into four main types.

First Type – RRMS

This one, the most common, is called relapsing-remitting MS, or RRMS.  The signs and symptoms start, gets worse, and then get better.  The MS might stay in remission for months or years.  But sometimes there are residual symptoms, little parts that don’t completely resolve.  Over several or many years these small bits of “not all the way better” can add up to a real disability.

Second Type – PPMS

This one, primary progressive MS, or PPMS, occurs in about 1 out of every 10 people who get MS.  Once the symptoms start they never go into remission.  This type is a curse that just keeps on cursing.

Third Type – SPMS

The people who start with that first type, the RRMS, at some point progress to this more problematic third type, called secondary progressive MS, or SPMS.  Those small residual symptoms from the RRMS add to bigger symptom complexes and disability.  Sometimes there is a small, brief remission but overall the disease course is downhill.

Fourth Type – CIS

After the two troubling ones above, PPMS and SPMS, this last type, the fourth type, is a bit of a relief.  It’s called Clinically Isolated Syndrome (CIS).  One gets symptoms of MS for a day or more then they resolve.  The problems might never come back.  But…  The possibility is also there that the symptoms might return and turn into real MS, the RRMS.  Most of the time a health care professional in a well-equipped center can have brain imaging done and be able to predict fairly well who with CIS will have another attack and who will not.

So What Eventually Happens?

It depends.  That’s why finding MS early is so important.  If is it found early and the person works hard with a skilled and experienced health care professional and the whole treatment team, modern medicine can help most people to live a full lifespan.  If the person has had MS for a long time at the time of initial diagnosis he or she might have to live with a less favorable disease course.  This same unfortunate situation can occur if the individual does not or cannot work hard to stay with the treatment plan.

A Bit of Medical History – The earliest descriptions of medical conditions that might have been MS were in the 1400 and 1500s.  A Dutch woman who died in 1433, Lidwina, might have had MS.  It is thought that the grandson of King George III had MS, dying of the disorder in 1848.  Dr. Jean-Martin Charcot described the medical condition of MS in 1868, calling it sclerose en plaques because at autopsy he found brain lesions.  Indeed, in 1916, the Scottish physician James Dawson described brain cell myelinization and local inflammation.  Through the 20th century medical science became ever better at MS diagnosis and treatment.

Helpful links:

National Institutes of Health, National Institute of Neurological Disease and Stroke

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Multiple-Sclerosis-Hope-Through-Research

National Library of Medicine (United States), Medline Plus

https://medlineplus.gov/multiplesclerosis.html

National Multiple Sclerosis Society

https://www.nationalmssociety.org/What-is-MS

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269