Understanding the Signs and Symptoms of Multiple Sclerosis

More than 200 people each week get the clinical news that have multiple sclerosis or MS, and that they now are among the 1 million Americans who face this autoimmune disorder.

“MS affects the central nervous system, and it can lead to weakness, slurred speech, clumsiness and other problems,” said neurologist Jeffrey Boyle, MD, PhD, Avera Medical Group Neurology in Sioux Falls. “While MS can happen at any age, most patients we help are between 20-50 years old.”

The condition often comes in waves, where the onset or flare-up occurs and slowly crescendos – then subsides. “The scars remain on the brain or spine,” said Boyle. “MS is a lifelong condition, but treatment can stop permanent damage.”

What Causes Multiple Sclerosis

No one has established the basic cause of MS. Risk factors for it include:

• Smoking and stress
• Female hormones
• Getting enough vitamin D
• Inflammation
• Obesity

Researchers study a wide range of environmental triggers coupled with specific genetics that might lead to MS onset. It occurs more in women than men, and it happens more often in the northeastern and midwestern parts of the U.S. Other MS facts include:

• It usually occurs between ages 20-40
• Your immune system’s response is what leads to MS, as T cells and B cells cause inflammation and damage in the nerve fibers and the cells that create them
• MS is not a strongly inherited disease, yet it can run in some families
• Losses in mobility, vision or numbness can be temporary or long-lasting

What are Early Signs of Multiple Sclerosis

Patients first report MS symptoms such as:

• Double vision or blindness in one eye
• An increase in trips, slips or general clumsiness
• Slurred speech or trouble with choosing words
• Weakening or numbness

“We use imaging when a patient reports to an emergency room,” Boyle said. Many patients come to the emergency room first because the symptoms are frightening.

Other patients are referred to neurology specialist via their primary care provider.

“Lesions will show on CT or MRI of the brain and spine,” Boyle added. “We’ll conduct a lumbar puncture to test spinal fluid and confirm the diagnosis.” Boyle said the anxiety about this method – often called a spinal tap – is worse than the actual procedure. It’s not as painful as people think. “It’s about like a blood draw from a vein,” he said.

The fluid test can help eliminate other conditions, such as Lyme disease and West Nile virus, as well as a number of rare conditions, from consideration for the brain and spine experts.

Since MS comes in many forms, initial signs may seem minor yet worsen over time. Others may come and not return for months. “There’s no real distinction between early signs and ones that come later,” Boyle said. “MS varies greatly from person to person.”

How MS Affects You

The location of lesions in the brain or spine determines what part of the body – from speech to walking – may be impacted by MS limitations. Men tend to have a slightly higher incidence of MS spinal lesions, which can affect walking and control of the bladder. Women with MS have fewer spinal lesions.

Once diagnosed, patients work closely with care teams to manage their MS. MS is usually categorized as:

• Relapsing-remitting: People have MS attacks of symptoms that are somewhat like a cold – they come up, get worse, then subside. Then later, it returns, with the symptoms sometimes changing. About 85% of patients have this.
• Secondary Progressive: Patients who have relapsing MS can get this form, where disease-caused disabilities build up over time, even though they are not relapsing.
• Primary Progressive: Symptoms such as difficulty walking gradually worsen – without an attack. About 10-15% of patients who have MS have this form.

Clinicians also explain MS as active, not active and whether or not it has progressed.

In some cases, two syndromes – clinically isolated syndrome or radiologically isolated syndrome – occur in people as an early sign of MS. Not all people who have these syndromes go on to develop MS.

• Clinically isolated syndrome happens when someone experiences a first episode of neurologic symptoms.
• Radiologically isolated syndrome means lesions show up on images without symptoms.

Doctors may also refer to benign MS, when symptoms are mild or only occur after long periods with no symptoms.

How Patients with MS Are Treated

Even though some people feel they’re strong enough to just go it alone, no MS patient should do so.

“New treatment options continue to emerge, every year,” Boyle said.

Treatment includes approaches such as:

• Therapy, including physical, occupational and speech: “This is the cornerstone of treatment, and can benefit patients greatly,” Boyle said. The right combination is uniquely crafted for each person.
• Injectable medications: While used less, daily or near-daily insulin-like injections can be the best approach to help some MS patients. They lessen the effects of the illness.
• Infusions: This option is becoming more common and usually occurs every six months, thus making it more convenient and more likely for patients to comply.
• Oral medications and clinical trials: Developments occur in neuropharmacology regularly, and with an experienced team, can give patients new options. Boyle holds a PhD in this field.

Managing your Mental Health and Well-Being With MS

MS patients may face depression and anxiety as the effects of MS limit mobility. Lesions can also affect parts of the brain that trigger overwhelming feelings.

“Getting control and having a sense of hope is a vital tool in MS,” said Boyle. Behavioral health care can help, as well as nutrition. “Since the illness affects so many parts of the body, supplements and an overall healthy approach to eating and drinking is important,” he said.

Working with a care team, keeping hope in hand, exercise and good eating can help anyone live with MS.

Talk to your provider about any MS symptoms you might have – and your best treatment options. If you have MS, you can work with Avera experts in MS who use the most up-to-date methods.