Multiple Sclerosis

Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is thought to be an autoimmune disorder. It is an unpredictable condition that leaves some patients mildly affected, while others may lose their ability to see clearly, write, speak, or walk.

MS involves the loss of myelin, a fatty tissue that surrounds and protects nerve fibers. This loss of myelin forms areas of scar tissue called sclerosis (also called plaques or lesions). When damaged in this way, the nerves can no longer send electrical impulses, which disrupts communication between the brain and other parts of the body.

Symptoms of Multiple Sclerosis

The symptoms of MS are erratic. They may be mild or severe; they may linger or go away quickly. They may appear in various combinations, depending on the area of the nervous system affected. While each person may experience MS differently, common symptoms include:

Initial symptoms of MS

  • Blurred or double vision
  • Red-green color distortion
  • Pain and loss of vision due to optic neuritis, an inflammation of the optic nerve
  • Difficulty walking
  • Paresthesia (pains or sensations such as numbness, prickling, or "pins and needles")

Other symptoms of MS

Throughout the course of the illness, an individual may experience any or all of the following:

  • Muscle weakness in the extremities
  • Difficulty with coordination (which may impair walking or standing and could lead to paralysis)
  • Spasticity (increased muscle tone leading to stiffness and spasms)
  • Fatigue
  • Loss of sensation
  • Speech impediments
  • Tremor
  • Dizziness
  • Hearing loss
  • Bowel and bladder disturbances
  • Depression
  • Changes in sexual function

Cognitive impairments

Approximately half of all people with MS experience cognitive impairments related to their disease. The effects of these impairments may be mild, often detectable only after comprehensive testing, and may include difficulty with any or all of the following:

  • Concentration
  • Attention
  • Memory
  • Poor judgment

Symptoms of multiple sclerosis are also divided into three categories, which are as follows:

Primary symptoms

The destruction of myelin may directly cause the following:

  • Weakness
  • Numbness
  • Tremor
  • Loss of vision
  • Pain
  • Paralysis
  • Loss of balance
  • Bladder and bowel dysfunction

Secondary symptoms

There are complications that may arise from primary symptoms, for example:

  • Paralysis, which can lead to bedsores
  • Bladder dysfunction, which may cause repeated urinary tract infections
  • Inactivity, which can result in weakness, poor posture, muscle imbalances, decreased bone density, and shallow breathing
  • Becoming less mobile because of weakness and difficulty swallowing can lead to an increased risk of pneumonia

Tertiary symptoms

There are social, vocational, and psychological complications of the primary and secondary symptoms, for example:

  • Inability to walk or drive may lead to loss of livelihood
  • Strain of dealing with a chronic neurological illness may disrupt personal relationships
  • Depression is often seen among people with MS

Causes of Multiple Sclerosis

Multiple sclerosis is generally believed to be an autoimmune disorder. A variety of immune modulating therapies are now available to reduce the likelihood of MS attacks or progression.

Diagnosing Multiple Sclerosis

MS is typically diagnosed by a neurologist, based on the pattern of symptoms, and findings on imaging (primarily MRI).

Evaluation for MS involves a complete medical history and neurological exam, which includes:

  • Mental functions
  • Emotional functions
  • Language functions
  • Movement and coordination
  • Vision
  • Balance
  • Functions of the five senses

The following may be used when evaluating for multiple sclerosis:

  • MRI: A diagnostic procedure that produces detailed images to detect plaques or scarring caused by MS.
  • Evoked potentials: Procedures that record the brain's electrical response to stimuli to show if there is a slowing of messages in parts of the brain.
  • Cerebral spinal fluid analysis (also called spinal tap or lumbar puncture): A diagnostic procedure that checks fluid drawn from the spinal column for abnormalities associated with MS.
  • Blood tests:¬†Lab tests to rule out other causes for various neurological symptoms.

Treatments for Multiple Sclerosis

There is no cure yet for MS. However, there are strategies to modify the disease course using medications that reduce the frequency of attacks or disease progression, treat exacerbations, manage symptoms, and improve function.

Your doctor will work with you to determine the best treatment plan based on your age, overall health, and medical history; the extent of the disease; expectations for the course of the disease; and your tolerance of certain medications or therapies.

Treatments for the conditions associated with MS may include the following:

  • Medication
  • Clinical trials
  • Assistive technology
  • Rehabilitation activities

Rehabilitation for People with MS

Rehabilitation varies depending on the range, severity, and progression of symptoms. MS rehabilitation may help to accomplish the following:

  • Restore functions that are essential to the activities of daily living (ADLs)
  • Help the patient to reach maximum independence
  • Promote family involvement
  • Educate the patient regarding the use of assistive devices (for example, canes, braces, or¬†walkers)
  • Establish an appropriate exercise program that promotes muscle strength, endurance, and control
  • Reestablish motor skills
  • Improve communication skills for patients who have difficulty speaking because of weakness or incoordination of face and tongue muscles
  • Manage bowel or bladder incontinence
  • Provide cognitive retraining
  • Adapt the home environment to emphasize function, safety, accessibility, and mobility
  • Spasticity management using medications, botulinum toxin or other injections, and intrathecal baclofen pumps

Why Choose Columbia for Multiple Sclerosis Care

Our expert team is highly skilled in the rehabilitation of multiple sclerosis, and we will partner with you, your neurologist, and your family to make sure you achieve the best possible outcomes. Combining clinical expertise and personal attention, our specialists have extensive experience in all areas of MS rehabilitation, including mobility, bowel or bladder symptoms, spasticity management, and helping the patient and their family adjust to lifestyle changes.