CHENNAI: Multiple Sclerosis (MS) is an autoimmune disorder that affects the central nervous system causing demyelination, a condition where the protective covering (myelin sheath) that surrounds nerve fibres in the brain, optic nerves, and spinal cord is damaged. Hence, nerve impulses slow or even stop, causing neurological problems. Due to this, the brain will not be able to send and receive signals. Normally, people between the age of 20 to 40 years are affected with this disease.
MS presents with varied symptoms. Some patients have mild symptoms and don’t need treatment, whereas others will have trouble doing daily tasks. The most common is loss of vision in one or both eyes. Symptoms could be in the form of weakness and sensory disturbances involving both the limbs or one limb, bowel, and bladder disturbances. Other symptoms include muscle weakness, pain and, sometimes, depression. Some of these symptoms can also be misunderstood as any other nerve disorders, but it is advisable to get a neurologist opinion.
There are four major categories in MS :
Relapsing Remitting MS (RRMS): This is the most common form of MS wherein the patient will have one attack and will settle down. After a few weeks, they will have another attack and it’d settle down again. So, patients have relapses of MS and periods of stability in between relapses. Younger patients are more likely to have this form of MS.
Secondary progressive MS (SPMS): This follows after RRMS. Around 65% of people with RRMS develop SPMS. In this case, there will be relapse and remission and after a point, the illness progresses continuously without any remission. The progression from RRMS to SPMS is fairly common in the absence of treatment.
Primary progressive MS (PPMS): It is characterised by a deteriorating neurological function — accumulation of disability — from the inception of symptoms, without early relapses or remissions.
Progressive-Relapsing MS (PRMS): This is a rare form of MS, characterised by a steadily worsening state, with acute relapses but no remissions, with or without recovery.
The first step of diagnosis for MS is made on the basis of medical signs and patient-reported symptoms. Several strategies are used to determine if the patient meets the MS diagnostic criteria. These strategies comprise examining the patient’s medical history, a neurological exam and various tests including MRI, spinal fluid analysis, and blood tests. If the patient shows positive results after clinical diagnosis then an MRI is done for further evaluation.
There is currently no cure for MS, but it is possible to manage with medications and other treatments. Treatment of relapse or acute phase can be done with intravenous steroids. Prevention of remission is done by employing disease-modifying agents such as interferons, mitoxantrone, and natalizumab. As most of the drugs are immune moderators, patients are susceptible to secondary infection and bone marrow suppression.(The writer is a consultant, Neurology, Fortis Malar Hospital)
20-40
Age at which people get affected with MS