What is Multiple Sclerosis (MS)?

MS is an autoimmune disease. The affected persons immune system inappropriately targets their nervous system and damages the myelin sheath (a fat layer that surrounds the nerve cells) leading to dysfunction of the nerve cells and their connection.

Who gets MS?

It is still unknown, who is prone to get MS. Multifactorial causes including early life exposure to viral infection with Ebstein Barr Virus, poor sunlight exposure , Vitamin D deficiency play with genetic predisposition leading to the disease. It generally affects people of age group 20-40 years and women more than men.

What are the symptoms of MS?

Multiple sclerosis is characterised by immunological attack on certain parts of the nervous system. This includes the optic nerve, white matter of the brain, brain stem, cerebellum and the spinal cord. Multiple sclerosis does not affect the peripheral nerves. MS can have presentation of varied severity. The classical presentations are as follows

Optic neuritis

Optic neuritis- Visual blurring and diminution of colour vision predominantly in one eye with or without associated eye pain.

Incoordination

Incoordination: Patients may have swaying and imbalance on walking. Some may find it clumsy to hold or reach out to objects.

Fatigue

Fatigue: Extreme tiredness and unable to cope up with the activities that they did previously, especially in the absence of anemia, diabetes, endocrine disorders etc.,

 

Transverse myelitis

Transverse myelitis- Numbness +/- weakness on one half of the body below the neck. It may involve only a single limb and can have an associated bladder issue (urgency and incontinence)

Double vision

Double vision: Affected persons may report blurry vision or seeing a copy of the same object adjacent to the true image that improves on closing one eye.

Cognitive issues

Cognitive issues: Difficulty sustaining attention and easy forgetfulness, especially in the absence of anemia, diabetes, endocrine disorders etc.,

Some of these symptoms may occur with milder intensity and may go missed if the affected person doesn’t report it.

How to diagnose MS?

The first step towards diagnosis is to suspect MS. In most cases person with MS (PwMS) gets evaluated with a non – neurological speciality. If there are no obvious reasons or evidence to support the patients symptoms it is better to refer the patient to a neurologist especially if they are young. The Neurologist would do a careful history and examine and order a few tests if there is strong suspicion towards the disease. It includes

  • MRI brain and spinal cord
  • Blood tests to rule out non-MS causes
  • CSF analysis
  • Evoked potential studies

Treatment of MS

Once the diagnosis of MS is established, there are a good number of disease modifying therapies (DMT) available to keep the disease under control and sometimes even give a cure. The choice of these medications depends on a variety of factors including the safety, efficacy, availability and affordability of the medications. It also depends on the severity of the MS, rapidity of the disease evolution, choice of pregnancy and others. Starting on medications early in the course of the disease can change the natural course of the disease and provide a better quality of life. The Neurologist will choose the medication after careful consideration of all the above factors.

The DMT’s available for MS treatment are as follows

Injectables

Injectables- taken as Intramuscular or subcutaneous injections (thrice a week/ weekly/ fortnightly/ monthly)- Interferon- Beta 1 a, Glatiramer acetate, Ofatumumab

Intravenous medications

Intravenous medications- Natalizumab, Rituximab, Alemtuzumab

 

Oral medication

Oral medication- taken daily- Teriflunomide, Dimethyl fumarate, Fingolimod

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    The Need for holistic approach:

    MS is not as simple as it looks in the above paragraphs. The disease has a tendency to progress silently without clinical attacks that happen early in the course. Patients with progression see themselves unable to cope up with the physical and mental activities that they used to easily do a few months ago. A detailed education on the natural course of the disease from The Neurologist is the key step towards the holistic management.

    A number of symptoms including fatigue, imbalance, bladder and bowel issues, insomnia, depression, body aches are more common with PwMS. Medications have to be properly titrated for each of these symptoms keeping in mind the middle ground that needs to be stuck between the symptom improvement and the adverse effects.

    Medicines alone cannot win the battle against many symptoms like fatigue, pain , cognitive issues, muscular weakness. A comprehensive and a holistic approach is required for the management of the symptoms of the disease. A Multidisciplinary team lead by a MS specialised Neurologist consisting of Physiotherapist, cognitive therapist, Specialists from other fields including Urology, Gastroenterology help in caring for the MS person as a whole.

    Why Choose Kauvery Hospital for MS?

    • MS care supervised by MS ologist (Neurologist who subspecialises in MS)
    • Dedicated op slots
    • Exclusive Fatigue management clinic (all Fridays)
    • Day care packages for MS treatment
    • State of art laboratory and MRI
    • Multi-speciality support for the sequalae of MS
    • Rehab unit