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The symptoms of multiple sclerosis are like a chameleon—they can mimic many other conditions. That’s one of the reasons it can take so long to get a diagnosis.
When you do, doctors today are more likely to immediately start you on a disease-modifying therapy. Studies suggest this approach can help slow down your MS progression.
Symptoms
Many symptoms can be experienced in MS, such as vision problems (including blurred or double vision, loss of depth perception or visual field, and uncontrolled horizontal or vertical movements of the eyes called nystagmus), neurological pain, sensitivity to heat or cold, fatigue, urinary tract infections, sexual dysfunction, spasms or tremors in the muscles (especially the legs) and cognitive symptoms including forgetfulness or changes in thinking. Other health problems may also cause these symptoms, so you must see your doctor if you have any.
Scientists don’t know what causes MS, but it combines genetic susceptibility and environmental triggers. It is more common in people with specific family genes and seems twice as likely to affect women as men. Smoking increases the risk of MS, and it can speed up the progression of the disease by increasing the number of relapses and brain shrinkage.
More than 20 medications are used to treat MS. These are sometimes combined into a treatment plan that includes injections or oral medication, lifestyle interventions, and rehabilitation therapy. Treatment is aimed at calming the immune system and decreasing relapses and disability. Lifestyle interventions include exercise, not smoking, a healthy diet, and plenty of sleep. Vitamin D supplements are also necessary because research suggests that lacking this nutrient can increase the chance of developing MS.
Diagnosis
Diagnosing MS is important because early treatment reduces the risk of relapse and slows disability progression. But getting an accurate diagnosis can be challenging. Many see multiple providers for years before a neurologist makes the correct diagnosis. The reason is that many symptoms of MS mimic other diseases, and some symptoms, such as fatigue and pain, are also found in people who are not sick.
A doctor who suspects you may have MS will take a complete history of your symptoms and perform a neurological exam. They will refer you to a specialist for MRI scans to check for brain and spinal cord damage if necessary. They will likely also do a spinal tap to examine cerebrospinal fluid for evidence of inflammation and other proteins associated with MS. They may also order other tests, such as evoked potentials, which measure how quickly and accurately your nervous system responds to stimuli.
The best way to determine whether your symptoms are MS-related is by considering when they happen, how often they occur, and how long they last before relapsing. You may benefit most from medications that can reduce inflammation and protect your nerve fibers. These are known as disease-modifying therapies; more than 20 medications can be prescribed.
Treatment
Studies have shown that MS patients often have increased hospital and GP visits during the prodromal period – before symptoms or diagnosis – for physical conditions such as pain, problems with the genito-urinary system, muscle stiffness, and difficulty walking. Interestingly, people also have 2-4x more physician referrals for mental health and cognitive issues during this time compared to healthy controls. These factors may help clinicians recognize and diagnose MS symptoms earlier, giving treatment options more time to slow down the progression of the disease by reducing the number of relapses.
While MS cannot be cured, new treatments are improving outcomes. They can reduce the rate of progression by slowing down the demyelination process, limiting the number of relapses, and even halting the degeneration of the brain and spinal cord. These medications are called disease-modifying therapies and can be taken as pills or injections.
Other medications can help manage symptoms, including bladder problems, bowel dysfunction, depression, fatigue, dizziness, muscle stiffness, and pain. Some people with more severe symptoms, such as tremors and heat sensitivity, can benefit from devices worn on the skin (like cooling vests) or in the home (like a transcutaneous electrical nerve stimulation device). A physiotherapist can help with exercise strategies or advice about sitting postures. A speech and language therapist can help with difficulties swallowing or articulation. Aside from that, attending MS support groups is highly beneficial. You can make new friends, and discussing your experiences can help to alleviate your stress.
Prevention
The good news is that people who start taking MS medicines early (as soon as they are diagnosed) are less likely to have a disability than those who do not. The medicines stop your immune system from attacking the protective covering of nerves called the myelin sheath. These attacks can disrupt messages traveling along the nerves by slowing them down, jumbling them, or sending them the wrong way. This disturbance causes MS symptoms and indications, and the medications help to heal the damage caused by these attacks.
Your doctor will want to do some tests to check for MS and to rule out other diseases that can cause similar symptoms, like Lyme disease or HIV. These tests will include blood tests, a test that makes detailed pictures of the structures in your body, such as an MRI, and analysis of the liquid surrounding your brain and spinal cord, called cerebrospinal fluid (CSF).
CSF levels of specific proteins can tell doctors if you are at risk of developing MS. Increasing your vitamin D intake, which you can get from food or sun exposure, and reducing your stress level may also lower your risk. In the future, researchers hope to identify a biomarker for MS to diagnose people in its earliest stage (prodromal), before any symptoms occur, and offer preventive treatments.
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