Multiple Sclerosis Basics I: Types, Causes, Symptoms

What is MS? Multiple sclerosis (MS) is a mysterious and frequently distressing disease. MS affects the brain and spinal cord, causing vision, balance, and muscular function issues. The effects of the condition are often diverse, with the majority of patients with MS diagnosed between the ages of 20 and 40. Read on to find out more about MS types, symptoms, causes, and risk factors. 

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic disorder affecting your central nervous system – the brain, spinal cord, and optic nerves. It is classified as an autoimmune illness, which occurs when the body’s immune system attacks its own tissues.

MS occurs when your immune system attacks myelin, a fatty substance that wraps around your nerve fibres to protect them. Your nerves will be destroyed without this outer coat. When the protective myelin is damaged and nerve fibre is exposed, messages travelling along that nerve fibre may be slowed or blocked, and scar tissue could occur. Because of this injury, your brain is unable to transmit impulses to your body correctly. Your nerves are also not working correctly to help you move and feel. The condition might eventually cause permanent nerve injury or degeneration.

Most people with MS experience attacks, often known as relapses, when their disease deteriorates substantially. They are frequently followed by periods of recovery during which symptoms improve. For others, the condition worsens with time. 

Multiple sclerosis has no known cure. However, appropriate treatment can help patients recover faster after attacks, alter the course of the disease, and manage symptoms.

What are the different types of multiple sclerosis?

There are four types of multiple sclerosis: 

Clinically isolated syndrome (CIS)

When someone experiences their first episode of symptoms that could indicate MS, doctors classify it as CIS. Not every patient with CIS will end up developing multiple sclerosis.

Relapsing-remitting MS (RRMS)

This is the most common type of multiple sclerosis. People with RRMS experience flare-ups of new or worsened symptoms – also known as relapses. There will be periods of remission when symptoms stabilise or go away.

Primary progressive MS (PPMS)

People with PPMS experience symptoms that progress slowly and progressively, without any relapse or remission.

Secondary progressive MS (SPMS)

People who are first diagnosed with relapsing-remitting MS frequently develop SPMS. With secondary-progressive multiple sclerosis, nerve damage accumulates and symptoms worsen over time. While you may still experience relapses or flare-ups, you may not have periods of remission when symptoms stabilise or go away.

Progression of multiple sclerosis is less common in Asia; a survey found that 79% of MS patients remained in the relapsing-remitting phase over an average illness duration of 9.3 years. Only 7% of patients progressed to the secondary progressive stage.

What causes multiple sclerosis, and what are the risk factors?

Researchers are working to figure out what causes some people’s immune cells to mistakenly attack healthy cells. It is not known what causes MS, but there are several factors that appear to increase the likelihood of the condition. 

1. Genes – Certain genes may increase one’s chances of contracting it. Therefore, having a family member with MS also increases your risk of getting MS. 
2. Smoking may also increase the risk.
3. Low levels of vitamin D – People who get less sun have lower amounts of vitamin D, which is a risk factor for MS. Hence, MS is more common among people who live in areas farthest from the equator, where there is less sunlight.
4. Viral infections – Some people get MS after contracting a viral infection, such as the Epstein-Barr virus, which causes their immune system to malfunction. The condition could set off the disease or trigger relapses.
5. Autoimmune conditions – If you have other autoimmune disorders such as thyroid disease, psoriasis, type 1 diabetes, or inflammatory bowel disease, you are at a slightly greater risk of getting MS.

How do multiple sclerosis symptoms present themselves?

MS symptoms vary greatly depending on the extent of nerve damage and the location of the affected nerve fibres. Some persons with severe MS may lose the ability to walk independently, whilst others may go through long periods of remission without experiencing any new symptoms.

One of the earliest signs of multiple sclerosis would be vision issues such as optic neuritis (blurriness and pain in one eye). Other common symptoms include: 

• Fatigue 
• Changes in gait or difficulties in walking 
• Electric-shock sensations that occur with specific neck movements, particularly when you bend your neck forward
• Muscle spasms and weakness 
• Numbness in your limbs occurring on one side of your body at a time 
• Loss of balance and dizziness 
• Double vision 
• Speech that is slurred
• Poor bladder control 

Other complications may include leg paralysis, bowel or sexual function problems, depression, epilepsy, memory issues or mood swings. 

What’s next?

Having armed yourself with an informed understanding of multiple sclerosis, find out more about MS diagnosis, treatment options, and how to prevent it next. This is part of a three-part series on multiple sclerosis. You can find part 2 and part 3 here. 

Article is written in conjunction with World MS Day 2021, held on 30 May.