Multiple Sclerosis Explained: Symptoms, Types, and Treatment Options
Multiple Sclerosis, commonly referred to as MS, is a chronic autoimmune condition primarily affecting the central nervous system. It is characterized by inflammation and damage to the myelin sheath that protects nerve fibers. While the exact cause remains unknown, researchers believe it may be linked to a combination of genetic predisposition, environmental factors, and viral infections. One of the defining features of MS is its tendency to present with lesions that occur in different locations and at different times throughout the nervous system.
Who Is Most Affected by Multiple Sclerosis?
MS typically affects young adults, with a higher prevalence among women than men. The gender ratio is approximately 1:1.5 to 1:2, indicating that women are more likely to develop the condition. Symptoms can vary widely from person to person, but common manifestations include vision loss, double vision, sensory disturbances, motor impairments, balance issues, and dysfunction of the bladder or bowel.
Types of Multiple Sclerosis
1. Relapsing-Remitting MS (RRMS)
This is the most common form of MS, affecting about 80–85% of patients at the onset of the disease. It is marked by clear relapses followed by periods of partial or complete recovery. During remission, symptoms may improve significantly or even disappear entirely, though some minor symptoms may persist.
2. Secondary Progressive MS (SPMS)
Approximately half of those initially diagnosed with RRMS will transition to SPMS within 10 to 15 years. This type is characterized by a steady worsening of symptoms without clear relapses or remissions, although occasional flare-ups may still occur.
3. Primary Progressive MS (PPMS)
About 10% of people with MS are diagnosed with the primary progressive form. This type involves a gradual accumulation of disability from the onset of symptoms, without early relapses or remissions. The progression is generally slower but more consistent than other forms.
4. Other Less Common Variants
Benevolent MS: A rare type where individuals experience very mild symptoms with minimal neurological deficits over a period of at least 15 years. Daily functioning remains largely unaffected.
Malignant MS: Also known as Marburg variant MS, this aggressive form can lead to severe neurological deterioration or even death within a short time after onset. It often presents with rapid, severe attacks.
Multiple Sclerosis in Children
In pediatric cases, approximately 95% are diagnosed with the relapsing-remitting form. About 80% share similar MRI characteristics with adult-onset MS, including dissemination in time and space. However, around 15–20% of children, especially those under 11 years old, may initially present with symptoms resembling acute encephalopathy or acute disseminated encephalomyelitis (ADEM). Additionally, 10–15% of pediatric MS patients may show signs of long-segment spinal cord inflammation. For accurate diagnosis, doctors often recommend ongoing MRI monitoring to detect new lesions that are not typical of ADEM.
Treatment Approaches for Multiple Sclerosis
1. Acute Attack Management
Corticosteroids: High-dose, short-term steroid therapy is commonly used during flare-ups. Adults typically receive intravenous methylprednisolone at 1g per day over 3–5 days. If improvement is seen, treatment may be stopped. If not, a tapering oral steroid regimen may follow. For children, the dosage is weight-based at 20–30mg/kg/day for 5 days, with a similar tapering schedule if needed.
Plasma Exchange: For severe cases or those unresponsive to steroids, plasmapheresis may be administered within the first 2–3 weeks of symptom onset for a course of 5–7 sessions.
Intravenous Immunoglobulin (IVIG): Although evidence for its effectiveness is limited, IVIG can be used in special cases such as during pregnancy or breastfeeding. The standard regimen is 0.4g/kg/day for five consecutive days. If no improvement is seen, continuation is not recommended. If partial improvement occurs, weekly maintenance doses for 3–4 weeks may be considered.
2. Disease-Modifying Therapies (DMTs)
Since MS is a lifelong condition, long-term management focuses on slowing disease progression. Disease-modifying therapies are the cornerstone of treatment during remission. Commonly prescribed medications include teriflunomide, interferon beta-1b, alemtuzumab, and mitoxantrone.
3. Symptomatic Treatment
MS can cause a wide range of symptoms, including painful spasms, chronic pain, sensory abnormalities, depression, anxiety, tremors, and cognitive issues. Each of these symptoms requires targeted, individualized treatment to improve quality of life.
4. Rehabilitation and Lifestyle Guidance
For patients experiencing motor, speech, or swallowing difficulties, early intervention with professional rehabilitation is crucial. Under the supervision of a specialist, tailored physical therapy, occupational therapy, and speech therapy can significantly improve functional outcomes and daily living activities.