Multiple Sclerosis is a disease of the brain and nervous system. The body immune systems create a response that destroys the insulation sheath (myelin) that protects nerves. As the disease progresses, it can disrupt the messages carried from the brain to the rest of the body that can potentially become crippling over time. A common presentation interferes with the ability to walk but may initially return to normal for extended periods of time.
Depending on the nerves involved, symptoms may include numbness or weakness that may occur in limbs, electric shock sensations in limbs, and / or tremor or lack of coordination when put to task. Balance issues may be another that may present temporarily. Many of these signs will improve spontaneously at first. Eye complaints may include partial or full loss of vision and may be associated with eye pain. Double vision or blurring of sight may also present. Additional nerve complaints may include slurring of speech, fatigue, dizziness, or bladder / bowel control difficulties.
The typical presentation of MS initially develops varied symptoms over days or weeks but then improve either partially or completely for a duration of months to even years. This is the most usual form of MS that follow such a relapsing / remitting course. About half of these cases will show a steady degree of progression over the next ten to twenty years of the onset known as secondary progressive MS.
The cause of MS is unknown. The usual onset is in those between twenty and forty years old but may vary above or below those ranges. Women are two to three times more likely to develop MS. Those with parents or siblings with a history of disease have a higher risk as well. White people have the highest risk associated. Asian, African, and Native American descent have the lowest risk.
There are other health related issues that may increase the likelihood of MS. Those with low vitamin D levels and minimal exposure to sunlight may be at risk. As well, other autoimmune diseases such as thyroid disorders, pernicious anemia, psoriasis, type one diabetes, and inflammatory bowel disease are shown to have an increased risk as well. And smokers, as with many other health problems, are at a higher risk of developing MS than non-smokers.
With progression of the disease, muscle spasm or paralysis may develop directly. Other effects may include worsening problems with bowel, bladder, or sexual function. Additionally, the onset of depression or even epilepsy may occur. There are associations from infections such the Epstein-Barr virus responsible for mononucleosis, as well as those with Guillain-Barre that directly affects the spinal cord. Conversely, there is no increased risk of developing MS after receiving any of the following immunizations: HBP, HPV, influenza, MMR, variola, tetanus, BCG, polio, or diphtheria. There have been only two reported cases of MS relapse after receiving the COVID-19 vaccine, which were due to exacerbating the known underlying disease rather than causing it.
There are no specific tests that diagnose MS, the diagnosis is made from the clinical course combined with radiologic imaging and nerve studies. As well, there are no medications or treatments that will cure the disease, but there are medications and therapies designed to improve current symptoms and manage the progression of symptom development. Earlier intervention typically leads to best outcomes. Should you have concerns or questions about MS, consult your health care provider.
Bradford Croft, DO
East Flagstaff Family Medicine