Multiple sclerosis is a neurological disorder that affects as many as 2.5 million people worldwide. It is an autoimmune disease, meaning it works against the immune system. In particular, it attacks the central nervous system: your nerves, spinal cord and brain. While normally the immune system would defend your body against such an attack, in multiple sclerosis your immune system’s defensive cells get confused, and mistake myelin (a fatty sheath protecting nerve fibers) for something that needs to be destroyed. As a result, in multiple sclerosis, the body attacks itself.
Why the Myelin?
Researchers still don’t understand why the immune system attacks the nervous system, or why it confuses the myelin sheath for a foreign substance. While research does suggest that there may be certain environmental and genetic factors, other researchers also suspect various viruses may be responsible. In short, there is still a tremendous need for further multiple sclerosis research.
How does Multiple Sclerosis Present?
This varies wildly, unfortunately, which is one of the many problems in diagnosing multiple sclerosis. There is no definitive order in which symptoms will appear, nor do the same symptoms appear for all patients.
In some patients, symptoms may be mild and go unnoticed for years, while in other patients, symptoms show up abruptly and uncomfortably. Though the disease can present itself at any age, it most commonly appears between the ages of 20 and 40—ages otherwise generally considered the prime of life.
Symptoms vary, depending on how the central nervous system is affected. Most often, symptoms include: fatigue, balance and coordination issues, tingling sensations, emotional changes, muscle cramps and dysfunction, dizziness, numbness, bladder and bowel issues and even sexual dysfunction. Given that these symptoms can appear during a person’s prime years, it can be especially frustrating and debilitating.
Just as frustrating, there is no clear progression to symptoms. One symptom may appear, persist, and then disappear without explanation. For other patients, multiple symptoms may show up all at once.
Difficulties in Diagnosis
There is no set of tests for multiple sclerosis. In fact, a diagnosis often relies upon ruling out many other things first. For instance, fibromyalgia is similar in enough ways that it often needs to be ruled out first. Additionally, a diagnosis of multiple sclerosis requires multiple episodes and symptoms in order for most doctors to consider diagnosing it as such.
As a result, many patients with multiple sclerosis can suffer for years before a doctor gives a diagnosis, which can additionally complicate their treatment and management plans.
As part of working toward a diagnosis of multiple sclerosis, all other possible causes of the symptoms are generally first ruled out, and a wide array of neurological tests may be required, including imaging, CSF analysis, MRIs and more. MRIs, for instance, can be particularly useful in helping to identify where damage has occurred in the body.
Needless to say, the many steps toward a diagnosis make things difficult for patients just looking for answers.
Management vs Treatment
As there is no curative treatment currently available for multiple sclerosis, current treatment focuses on management of symptoms and lifestyle changes that may make patients more comfortable, therefore improving their quality of life.