Multiple Sclerosis (MS)

Overview

Multiple sclerosis (MS) is a chronic condition that develops when an abnormal response from the immune system is directed against the brain, spinal cord, and optic nerves—collectively known as the central nervous system.

This abnormal immune response damages nerve fibers and their protective myelin coating. This damaged myelin then forms scar tissue, or sclerosis, and disrupts the communication between the brain and the rest of the body, causing a host of complex symptoms.

Multiple sclerosis can be divided into three types, also known as disease courses. They are:

• Relapsing-remitting MS (RRMS): The most common form of MS—85% of all cases—this type is characterized by periods of active inflammation or relapses, followed by periods of little to no discomfort.
• Primary-progressive MS (PPMS): About 10% of people with MS are diagnosed with PPMS, which involves symptoms that worsen gradually. While there may be brief periods of improvement, the general course of the disease is marked by decreasing functionality.
• Secondary-progressive MS (SPMS): This type of MS develops after the relapsing-remitting (RRMS) type. Some cases of RRMS will eventually evolve into SPMS.

What causes multiple sclerosis?

Although the exact cause of multiple sclerosis is unknown, what is known is that MS is a condition that combines elements from someone’s genetic makeup, lifestyle, environment, and exposure to infectious agents or viruses. In other words, MS appears when each of these factors collide simultaneously in an individual.

Symptoms you or someone you know with multiple sclerosis might notice include:

• Fatigue: Regularly feeling extremely tired, even after rest.
• Walking and coordination difficulties or changes in gait: Muscle tightness (spasticity), difficulty balancing, or numbness in the lower extremities.
• Numbness or tingling: Sensations of pins and needles that often happen in the arms, legs, feet, or face.
• Muscle spasms: This can feel like a sharp pain or a dull ache of stiff muscles.
• Weakness: This can look like new or unusual effects involving muscle strength.
• Dizziness and vertigo: This can include persistent sensations like light-headedness, spinning (vertigo), and loss of balance.
• Vision problems: Blurred vision, double vision, or pain during eye movement.
• Bladder or bowel problems: These can range from incontinence or constipation to more severe issues.
• Sexual problems: Shared equally between men and women, this can include reduced libido, erectile dysfunction, and inability to orgasm.
• Chronic pain: This is a persistent or habitual pain in muscles or joints.
• Cognitive changes: Problems with memory, attention, and decision-making are the primary cognitive shifts.
• Emotional changes: These changes can include an onset of mood swings, depression, or anxiety.

Multiple Sclerosis Diagnosis

A multiple sclerosis diagnosis is often a complex process, as symptoms can overlap with other conditions, and there’s no single test to definitively confirm MS. The diagnostic process may involve multiple visits and tests to establish a clear picture of the condition—generally speaking, a diagnosis calls for evidence of at least two areas of damage in the central nervous system that have happened on separate occasions.

each a diagnosis:

• Detailed medical history: MS symptoms can vary widely, from vision problems, muscle weakness, balance issues, numbness, or tingling to fatigue and cognitive difficulties. Your healthcare provider will also inquire about any family history of MS or other autoimmune diseases.
• Neurological exam: A neurological exam is generally done to assess functions controlled by the central nervous system, or the brain and spinal cord. This can include testing reflexes, coordination, muscle strength, sensation, and vision.
• Magnetic resonance imaging (MRI): MRI is a crucial tool in diagnosing MS because it allows for visualization of the brain and spinal cord to identify areas of inflammation, demyelination (damage to myelin, the protective covering of nerve fibers), and scarring.
• Lumbar puncture (spinal tap): In some cases, a lumbar puncture may be done to analyze cerebrospinal fluid for abnormalities, like elevated levels of specific proteins and the presence of immune system cells called oligoclonal bands. These findings can also support a diagnosis of MS.
• Evoked potential tests: These tests measure electrical activity in the brain in response to stimuli, like visual or auditory signals. Abnormal results can indicate damage to nerves caused by MS.
• Blood tests: Blood tests may be done to rule out other conditions that can mimic MS, as well as to assess overall health.

Once diagnosed, it’s vital for your healthcare team to develop a treatment plan specific to your multiple sclerosis. With a plethora of treatments and support systems to help manage the condition, many individuals diagnosed with MS go on to live fulfilling lives.

Treatments for Multiple Sclerosis

While there’s currently no cure for multiple sclerosis, it’s a very treatable condition, thanks to decades of MS-specific research. Treatment will focus on managing your symptoms, slowing the progression of the disease, and improving your overall quality of life.

Typically, treatments are broken down into three categories, all of which are FDA-approved: injectable medications, oral medications, and IV-infused medications.

Injectable Medications

Injectable medications are administered using a needle and a syringe, similar to a vaccine. In many cases, your MS care team can teach you to administer these medications yourself at home. Commonly used injectable medications include:

• Avonex (interferon beta-1a)
• Betaseron (interferon beta-1b)
• Copaxone (glatiramer acetate)
• Extavia (interferon beta-1b)
• Glatopa (glatiramer acetate)
• Kesimpta (ofatumumab)
• Plegridy (peginterferon beta-1a)
• Rebif (interferon beta-1a)

Oral Medications

Oral medications are considered to have moderate efficacy, except Mavenclad, which has been proven to have high efficacy. Each of these medications aids in recovery after an attack while slowing the progression of the disease. Commonly prescribed oral medications include:

• Aubagio (teriflunomide)
• Bafiertam (monomethyl fumarate)
• Gilenya (fingolimod)
• Mayzent (siponimod)
• Mavenclad (cladribine)
• Ponvory (ponesimod)
• Tascenso ODT (dimethyl fumarate)
• Tecfidera (dimethyl fumarate)
• Vumerity (diroximel fumarate)
• Zeposia (ozanimod)

Intravenous (IV) Infused Medications

IV-infused medications are considered to be highly effective in stopping the immune response against the brain. IV infusions are much less disruptive overall because they can be given once a month or even once every six months. What’s more, an infusion typically takes between two and six hours at an infusion center, so people often return to work the same day.

Commonly prescribed IV-infused medications include:

• Briumvi (ublituximab-xiiy)
• Lemtrada (alemtuzumab)
• Novantrone (mitoxantrone)
• Ocrevus (ocrelizumab)
• Tysabri (natalizumab)
• Tyruko (natalizumab-sztn)

Physical therapy, occupational therapy, and other rehabilitative approaches can also be helpful in symptom management.

In Phoenix, Arizona, Barrow Neurological Institute is home to a robust Multiple Sclerosis Program with a team of specialists who work tirelessly to empower patients through extensive clinical knowledge, state-of-the-art facilities, and access to clinical trials.