Types of Multiple Sclerosis?
Four main types of MS can affect adults, these are:
Relapsing-Remitting Multiple Sclerosis The disease course is characterized by clearly defined attacks or relapses that last a relatively short time, with full recovery in between attacks. About 85% of patients have the RR form of MS when they are diagnosed. Secondary Progressive Multiple Sclerosis The rate at which disability accumulates increases after the first few years but later stabilizes.
Once this occurs it becomes difficult to distinguish from Primary Progressive MS, so many patients may only be diagnosed correctly years after their initial symptoms began. Primary Progressive Multiple Sclerosis (PPMS) Disability continues to increase from the start and there are no distinct periods where all symptoms disappear. Around 10% of patients have the PPMS form.
Progressive Relapsing Multiple Sclerosis (PRMS) People with PRMS can make some recovery after attacks but do not go back to exactly how they were before the original MS symptoms started, like those with RRMS do.
Multiple sclerosis diagnosis:
The Multiple Sclerosis International Federation has standardized the assessment of disability in MS. The resulting form, the expanded disability status scale or EDSS, is designed to measure neurologic damage in MS patients. The scale assigns a number between 0 and 10, with higher numbers representing increasing degrees of functional impairment.
Symptoms of multiple sclerosis:
Multiple sclerosis can cause a variety of symptoms, including problems with:
Muscle control and strength (called “spasticity” or “spasms”) Bladder and bowel function Vision Thinking and memory Balance Senses of touch, heat, cold Pain Other neurological functions including speech, balance, sensation, emotional stability
Causes of multiple sclerosis:
The causes of MS remain elusive. Three patterns for the appearance and distribution of lesions in the brain MRI scans have been observed:
1) discontinuous focal lesions;
2) diffuse white matter involvement;
3) confluent grey matter pathology. The first type corresponds to acute disseminated encephalomyelitis (ADEM), which has also been hypothesized as the trigger for MS relapses. The second type is also believed to correspond to ADEM, while the third type aligns with multiple sclerosis.
The cause of MS is unknown (occasionally genetic factors are thought to play a role) and it is believed that there are probably both environmental and genetic causes that lead to its onset. The presence of oligoclonal IgG bands in the spinal fluid has been correlated with relapse rate, but not with disability.
Thus no diagnostic test for MS currently exists. Diagnosis involves excluding other conditions that can mimic or contribute to symptoms, based on the presenting history and examination findings. Laboratory investigations may be performed, including blood tests measuring biological markers of disease activity such as serum albumin, total cholesterol, thyroid-stimulating hormone level, Lyme disease serology, and tests for celiac disease.
Multiple sclerosis is a neurodegenerative disease that affects the central nervous system (brain, optic nerves), as well as the autonomic nervous system, which controls bodily functions such as blood pressure, body temperature, and bladder function. The most common symptoms are problems with coordination, balance, vision, or speech. Other symptoms include numbness or tingling in the limbs and torso, chronic fatigue, cognitive impairment, and difficulties with dexterity.
Swallowing can be a problem leading to a trophic ulcer of the throat. Fatigue is often profound and may be exacerbated by physiotherapy or physical therapy which involves contraction of muscles against resistance. Some patients have vision problems including blurred vision from inflammation at the back of the eye ( uveitis ) and optic neuritis which can lead to blindness.
Stages of multiple sclerosis:
Multiple sclerosis has four courses of disease categorized by the relapsing-remitting, secondary progressive, primary progressive, and progressive relapsing forms. The course is classified based on disease progression followed through time.
The relapsing-remitting form is characterized by unpredictable attacks (relapses) with complete or partial recovery from neurological symptoms. Between attacks, there are few or no symptoms apart from occasional “silent” lesions detected only by MRI that are not causing clinical problems.
When a new attack occurs, or when existing symptoms start to get worse it indicates the onset of secondary progression. Over years to decades, some people go on to develop chronic disability which does not progress, but it cannot be predicted who will have this outcome. There are currently no laboratory tests available to predict prognosis.
Multiple sclerosis treatment:
There is no known cure. Treatments attempt to improve function after an attack and prevent new ones. Medications used to treat MS throughout the disease, typically refer to five categories: symptomatic treatments; treatments targeting acute relapses (exacerbations); immunomodulatory therapy; treatment for comorbidities that may arise from it such as depression, fatigue, and pain; and neuroprotective medications that aim to slow down or halt the worsening of neurologic deficits due to MS. All therapies have modest effects.
Symptomatic therapy aims at reducing symptoms by dealing with problems directly related to them: physical therapy for possible gait difficulties, physiotherapy, occupational therapy, and respiratory therapy can help with coordination and speech problems, respectively. Speech therapy may also help with swallowing problems called dysphagia. Physical therapists can teach people with MS exercises to help them retain or improve their mobility if they have muscle weakness.
Some medications for pain relief are all-purpose treatments for neuropathic pain, including tricyclic antidepressants, gabapentinoids (gabapentin and pregabalin), and paracetamol. Medications that modify the disease course are symptomatic therapies directed at relapses, including corticosteroids given by mouth or intravenously, as well as other immunomodulatory agents such as mitoxantrone, azathioprine derivatives, cyclophosphamide methotrexate, and mycophenolate mofetil.
Disease-modifying therapies are primarily symptomatic treatments that aim to reduce the rate of disease progression. Interferon-beta reduces the frequency of relapses in about 30% more people than placebo but is associated with the development of neutralizing antibodies and flu-like symptoms. No other disease-modifying therapy is effective in preventing progressive disability.
Several medications have been shown to slow down or halt the worsening of neurologic deficits due to MS, but none change the outcome. They can also cause serious side effects, so are reserved for people who do not improve with the first drug they are given.
They include interferon beta drugs such as interferon beta-1a, which reduces the number of relapses in about a third of people but increases the risk of infections. Another is glatiramer acetate, which both reduces attacks and produces milder side effects than interferon beta-1a.
Natalizumab works by blocking a protein expressed on certain white blood cells that allows them to enter the brain; it reduces relapses in around a third more people than interferon beta-1a but carries a small risk of causing progressive multifocal leukoencephalopathy if given after five years because it may interact with JC virus in the brain. Dimethyl fumarate, under investigation since 2005, also shows promise in reducing relapse rates.