Multiple sclerosis, also known as MS, is a chronic neurological disease. The disease mainly affects the brain, spinal cord, and nerves of the eye. It is a disease caused by certain germs that work against the body's immunity system. MS is one of the most common autoimmune diseases. On World Multiple Sclerosis Day (May 30th), Dr. Shruthi S. Nair, who is the Associate Professor, Department of Neurology, Sree Chitra Thirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, explains the causes of the disease, its symptoms, treatment and complications.
There is no definite answer as to why this disease occurs. Environmental factors are the main cause of this disease. People who are infected with a virus that causes fever at a young age are more likely to develop MS. Smoking, childhood obesity, and vitamin D deficiency are said to be the main causes of the disease. At the same time, people with all of these conditions do not necessarily get sick. It is said that a healthy lifestyle should be followed but that alone does not guarantee the prevention of the disease.
These patients occasionally experience demyelination, a loss of coating on the brain, spinal cord, and optic nerve. When demyelination happens very often, it leads to MS. Once the germs enter our body, we are more likely to have another attack.
Depending on which part of the body the disease is affected the patient may experience different symptoms. Some of the common symptoms include poor eyesight, weakness of the limbs, slurred speech, double vision, swelling of the hands, sprains, and difficulty urinating.
The disease can occur in two ways—relapsing type and progressive type. In relapse type, it can occur as attacks. You may start experiencing some difficulties within a few days or weeks. For example, if vision gets blurred, it may subside by itself or by medication after three weeks. You might not face difficulties for a while. But then, months later something else might come up. Then the symptom will be in the form of swelling of the legs. So it keeps coming back and forth. This is the Relapsing MS. There are a number of options available for treating Relapse MS. But the main treatment is always to make sure these attacks are prevented. When it occurs these many times, the cure will not be complete. Not only will there be difficulties but within a short period, you might face some disabilities like difficulty in walking, vision and speech, and lack of balance. These difficulties are also likely to get worse.
The progressive type comes not as attacks, but as a gradual deterioration of health. Only 10 or 15 percent of people develop the progressive type early on. In the absence of treatment, a good percentage of patients who begin with a relapse would go into this progression type, but studies show that less than twenty percent of patients go into the progression type because of the availability of medication now. Relapse is not as easy to treat as MS when it comes to progression.
MS is most common in people between the ages of 15 and 45. Women are more likely to be affected than men. And women are twice likely to get this disease than men.
The most worrying aspect of this disease is that it affects you at a very young and energetic age. This can affect your studies, and employment and even cause problems in having a family life. The biggest problem with this disease is that your fertility might be affected. Moreover, the disability comes many years after the onset of the disease. At first, the patient might not have any issues. But as the years go by, they will have difficulty in walking, and other changes, and difficulties that come with the disease.
MS patients will also show a lot of invisible difficulties. Fatigue is the main one. MS patients may experience extreme fatigue. But that doesn’t mean everyone who is fatigued would be affected by MS. You may have minor memory problems, such as difficulty doing things quickly, calculating quickly, and doing two things together. This may seem overwhelming at times. You may feel a lack of balance every time you shake your head. Urinary tract problems, inability to control urination and urinary incontinence are the other issues. There may also have constipation. Anxiety and depression are more common in these patients.
Diagnosis and treatment
It is when a patient approaches a doctor for diagnosis following the symptoms that the disease can be diagnosed. MS can be confirmed by a blood test and a spinal test.
Once the disease is diagnosed, there will be two types of treatments. First, they will treat you to solve your immediate difficulties. When patients take the steroid injections for three to five days, 75–90% of the patients will notice a positive difference. Preventive medications should be given as it is a recurring disease. This is commonly referred to as disease-modifying therapy. Currently, MS has about 15 medicines in India. There are also pills, injections, and drip medications. This is done to suppress abnormal heart disease. The drugs used in the beginning do not affect our immune system very strongly. The effect will be selective. Some people may have seizures while taking this drug. They may need to be given more potent immunotherapy. It may affect the natural defenses. The decision as to which medication to give should be based on the patient's risk of seizures and walking difficulties. Drugs are now available that costs between Rs 2,000 and Rs 3,000 per month. In addition to the tests, MRI may need to be taken every year at the onset of the disease.
There are guidelines for the treatment of MS. The drug can be discontinued after the age of 60-65 years or when the patient has difficulty walking or needs to use a wheelchair. But in practice, it is not necessary. Not all MS cases are the same. About 20–30% of people will only have a mild case of MS. They should decide whether to continue or not based on the side effects of the drugs. Most people may need to take medication for the rest of their lives. MS is a disease that requires long-term treatment.