What you need to know about MS

nerve illustration affected by MS

Multiple sclerosis (MS) is the most common neurological disease in young adults, usually striking between the ages of 20 and 40. Each person with MS experiences different symptoms at different times. These must-know facts help make sense of this progressive disease.

No one knows the root cause of MS.

While there can be a genetic link, just because you’re related to someone with multiple sclerosis doesn’t mean you’ll get it too. In fact, there’s only a 2 to 3 percent chance of a sibling or child of someone with MS developing it. There is, however, a possibility that you can inherit your gut bacterial makeup from your biological mother. It’s this gut or microbiome that influences health and immunity throughout life, as well as being linked to chronic diseases like MS.

MS is caused by inflammation in the body, which can be triggered by diet, lifestyle, and even an underlying infection or latent virus in the body like the Epstein Barr virus. This progressive neurological disease has also been associated with low vitamin D and B12 levels.

type of neurons graphic
interneurons illustration

MS develops when the immune system attacks nerve cells.

The immune system is a powerful protective mechanism; its main goal is to keep us healthy. It does so by attacking “invaders” like bacteria and viruses, triggering inflammation (p. 10). This normal immune process misfires, however, in chronic inflammatory diseases like multiple sclerosis.

If you have multiple sclerosis, your immune system mistakenly sees healthy nerve cells or neurons in the central nervous system (the brain, spinal cord, and/or optic nerves in the back of the eyes) as “invaders” and attacks. This is why MS is considered to be an autoimmune disease; autoimmunity is an abnormal immune response against our own healthy cells and tissues. This immune attack by immune cells like T cells triggers inflammation and, in those with MS, damages the myelin or fatty protective sheath around axons, the long nerve fibers that transmit nerve impulses. The inflammation can also damage the nerve fibers themselves, triggering the formation of hardened areas called lesions or plaque. (“Sclerosis” means hardening.) It’s these lesions that can be detected on an MRI. What also can be damaged are oligodendrocytes (oh-le-go-den-dro-cytes), nerve cells that produce myelin for up to 50 axons at a time, allowing for myelin to repair and regenerate itself.

Nerve cell damage triggers the symptoms of MS.

The myelin sheath surrounding nerve cells, or neurons, insulates the nerves and helps them send electrical signals, with speed and efficiency. It’s these electrical signals that control movement, thought, sight, hearing, speech, feeling, and bowel and bladder function. This protective layer of myelin is similar to the insulation that can be found around electrical wires.

When inflammation begins and myelin is damaged during MS, the axon—whose job it is to transmit nerve impulses away from the nerve cell body—can be damaged as well. The result is that nerve messages aren’t transmitted properly with normal speed and accuracy. (MS is considered to be what’s called a demyelinating disease of the central nervous system because the immune system attacks this myelin sheath.) Most cells in the body, including nerve cells, can repair and regenerate themselves. If the oligodendrocytes or myelin-regenerating cells are not damaged, the nerve cells can be repaired and lesions can heal naturally. This is what can happen during relapsing- remitting MS, the most common type of MS.

ms vision green insert

If, however, oligodendrocytes and the axons are severely damaged, which is what can happen if MS goes untreated for too long and/or progresses quickly, the underlying nerve fiber can die. The result is that nerve function cannot return. This is one reason why treating MS early along with reducing triggers of inflammation in the body (p. 10) can help prevent the disease from progressing.

Symptoms of MS are unpredictable and can vary in intensity, with no one case of MS being exactly the same. There are some symptoms, however, that are common:

vision problems including optic neuritis, a painful swelling of the eye that interferes with vision

■ tingling and/or numbness in the face, arms, legs, and fingers

■ pain and muscle spasms

■ stiff muscles and joints

■ weakness or fatigue (more than 80 percent of people with early MS have unexplained fatigue)

■ balance problems or dizziness

■ bladder issues

■ sexual dysfunction

■ cognitive problems

Lesser-known symptoms include unexplained irritability, mood swings, hearing loss, trouble swallowing, memory problems, shortened attention span, and loss of bowel function.

MS is diagnosed through different tests.

When symptoms first arise, it’s important to get tested to determine what’s causing them.

The first step in diagnosing MS is your clinical history. This includes a discussion of symptoms and a physical exam by a neurologist. An MRI, or Magnetic Resonance Imaging, a non-invasive scan, is typically next. Roughly 90 percent of people of people with MS have plaques or lesions that show up on an MRI. A spinal tap may also be done. During this procedure, a needle is inserted into the lower spine and spinal fluid is removed and tested. A spinal tap is often performed when a patient’s clinical history is suspicious and the MRI is normal. Spinal fluid can reveal multiple things, most specifically oligoclonal bands, which are proteins or antibodies that up to 95 percent of MS patients have. Electrical activity tests (aka evoked potentials) can assess the electrical activity of neurons and are used to diagnose MS. Bloodwork can rule out other autoimmune conditions or infections such as HIV, syphilis (which can cause neurologic symptoms years after infection), Sjögren’s syndrome (an autoimmune disease with neurologic symptoms), and Lyme disease.

Pseudo-Relapse or True Flare?

If symptoms flare but clear up in less than 24 hours, it’s called a pseudo-relapse or pseudoexacerbation because no real damage has been done to the nerves. True flares can last from a few days to a few weeks and occur at least 30 days after any previous flares. Pseudo-relapses can result from fatigue, stress, infection, and/or heat exposure. Always call your doctor, however, to alert him/her to any changes in your condition.