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Multiple Sclerosis Basics II: Diagnosis, Treatment, Prevention

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Multiple sclerosis (MS) is one of the most common neurological diseases of the central nervous system. In the first part of our series on multiple sclerosis, we talked about what causes MS, the different types of MS, its symptoms, and risk factors. Worldwide, women are more likely than men to suffer from multiple sclerosis in a ratio of 2 to 1. Keep reading to find out more about multiple sclerosis diagnosis criteria, as well as prevention and treatment. 

How to diagnose multiple sclerosis?

MS usually begins with symptoms such as eye pain that worsens with movement, vision loss, limb numbness or weakness, slurred speech, or loss of balance.

For multiple sclerosis, doctors conduct a differential diagnosis. Differential diagnosis is based on ruling out other illnesses that may cause similar signs and symptoms. Diseases that have similar symptoms include stroke, tumours, or spinal cord pressure. They will also need to look for damage to at least two areas of your brain and prove that it happened at different points in time.

Your doctor will most likely begin with a comprehensive medical history and examination. This may include: 

Blood tests

Blood tests do not diagnose MS. However, they help rule out other diseases with symptoms similar to MS by looking for specific biomarkers associated with the condition.

Magnetic Resonance Imaging (MRI)

An MRI allows the doctor to examine your brain in greater detail and detect changes caused by multiple sclerosis. Changes include inflammation in your spinal cord or deep areas of your brain. An injection of a contrast substance into your veins may be done to highlight lesions that show your disease is active.

Spinal tap

A spinal tap (lumbar puncture) is a procedure that takes a tiny sample of fluid from your spinal canal for laboratory testing. This sample may reveal anomalies in antibodies linked to MS. A spinal tap can also help rule out infections and other illnesses that resemble the symptoms of MS.

Evoked potential tests

Evoked potential tests capture the electrical signals generated by your nervous system in response to stimuli. These electrical nerve tests assist doctors in determining whether MS has impacted the regions of your brain that allow you to see, hear, and feel. During these tests, you will either be asked to look at a moving visual pattern or have short electrical impulses delivered to nerves in your legs or arms. Electrodes assess the speed at which information passes through your nerve pathways.

Eye examination

An eye examination may uncover issues that MS could cause. Possible MS-related eye conditions include: 

Optic neuritis: damage to the optic nerve frequently results in discomfort and blind regions surrounded by areas of normal vision.

Diplopia: an early sign of MS, characterised by double vision caused by impairment to the nerve pathways that govern the eyes.

Nystagmus: a condition in which the eyes move rhythmically back and forth or up and down without conscious effort. It could be caused by nerve injury in the brainstem or cerebellum.

Most patients with relapsing-remitting MS have a relatively straightforward diagnosis based on symptoms consistent with the condition, as well as validation by brain imaging scans such as an MRI. Diagnosis of MS is harder for patients with an atypical or evolving course of disease. Additional testing such as evoked potential testing, spinal fluid analyses, and imaging may be required.

What are the treatment options?

Unfortunately, there is currently no cure for MS. Treatment primarily focuses on accelerating recovery from relapses, slowing disease progression, and managing MS symptoms. Work closely with your doctor to determine the best treatment for you that has the fewest adverse effects.

Treatment options for MS attacks

Corticosteroids

To reduce nerve inflammation, corticosteroids such as intravenous methylprednisolone and oral prednisone are administered. Side effects include:

  • Insomnia
  • Increased blood glucose
  • Increased blood pressure
  • Mood fluctuations
  • Fluid retention

Plasma exchange (plasmapheresis)

The liquid element of your blood (plasma) is extracted and separated from your blood cells. After that, the blood cells are combined with a protein solution (albumin) and reintroduced into your body. The doctor may recommend a plasma exchange if your body has not responded well to corticosteroids. 

Treatment options to modify the course of the disease

The majority of the immune response associated with MS happens in the early stages of the disease. Early aggressive therapy with disease-modifying therapies (DMTs) can help in many ways, including:

  • Decrease the formation of new lesions
  • Lower relapse rate
  • Potentially lessen the risk of brain cells loss and disability accumulation.

These medications work by suppressing the immune system so it doesn’t attack the protective layer known as myelin that covers the nerve cells. The only FDA-approved DMT for primary-progressive MS is ocrelizumab. Those who undergo this treatment have a slightly lower chance of progressing. 

Several disease-modifying treatments are available for relapsing-remitting MS. They may come in injectable treatments, oral medications, or intravenous infusion. Refer to this extensive list from the National Multiple Sclerosis Society for more information about the different types of medications.

Your doctor may also recommend physical therapy to build muscle strengths and ease MS symptoms.

Are there any ways to prevent multiple sclerosis?

There are no proven ways to prevent multiple sclerosis. However, studies have shown that higher vitamin D intake may prevent MS. A daily intake of vitamin D3 of 600 international units is recommended for adults below 70 years old. 

MS symptoms often worsen when the body temperature rises. Heat sensitivity in MS is associated with the negative effects of higher temperature on saltatory conduction. This is a process where electrical signals travel faster in nerve cells that are insulated with myelin, and results in conduction slowing or blockage. Avoiding exposure to heat and using devices such as cooling scarves may help. If you have mild to moderate MS, regular exercise can help improve your strength and coordination. Swimming, yoga, low-impact aerobics are all excellent options. 

What’s next?

Having learnt about the symptoms and treatment of MS, check out our article next week, on ‘Living with MS’ to find out how to manage your MS journey.

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

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