Multiple Sclerosis

If you or someone you love is fighting Multiple Sclerosis (MS), you know that the disease affects individuals in different ways. Symptoms vary widely. So does the time between episodes, the rate of progression and response to treatment. Advances in medications have improved the course of this disease for many but identifying the right treatment for the right patient at the right time remains a challenge.

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What is MS?

Multiple sclerosis is a chronic, unpredictable disease of the central nervous system (CNS), which can be relatively benign, disabling, or even devastating. Some people with MS may be mildly affected, while others may lose their ability to see clearly, write, speak, or walk when communication between the brain and other parts of the body becomes disrupted. In Multiple Sclerosis the immune system incorrectly attacks healthy tissue in the CNS. Most people are diagnosed between the ages of 20 and 50, although children and older adults may develop it.

 


What are the types of MS?

Four basic disease courses have been defined:

  • Clinically isolated syndrome (CIS)-first episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system.
  • Relapsing-remitting MS -characterized by periods of relapses (new symptoms or a new worsening of older symptoms also called attacks or exacerbations) that subside, with full or partial recovery, and no disease progression (worsening) between attacks.
  • Primary progressive MS is characterized by a gradual but steady progression of disability from the onset of symptoms, with few or no relapses or remissions.
  • Secondary progressive MS- follows relapsing-remitting MS in some people and is characterized by a more progressive course, with or without relapses or new MRI activity.

 


Who gets MS?

Anyone may develop MS but there are some patterns. More than two to three times as many women as men develop MS and this gender difference has been increasing over the past 50 years. Studies suggest that genetic factors increase the risk of developing MS, but there is no evidence that MS is directly inherited. Environmental factors, such as low Vitamin D and cigarette smoking have also been shown to increase the risk of MS. MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is most common in Caucasians of northern European ancestry.

 


What are the typical signs & symptoms of MS?

Symptoms can be mild or severe and can last a long time or short time. Also, depending on what areas are affected, they can present in many different combinations. The most common symptoms of MS include that a patient may notice first are:

  • Blurred or double vision
  • Visual color distortion
  • Pain and loss of vision
  • Difficulty walking
  • Sensations of pain, numbness, or “pins and needles”

As the disease progresses other symptoms may be noticed, including:

  • Muscle weakness in the limbs
  • Difficulty with coordination
  • Impaired walking or standing
  • Partial or complete paralysis
  • Muscle stiffness
  • Involuntary muscle spasms
  • Fatigue
  • Speech difficulty
  • Tremor
  • Dizziness
  • Hearing loss
  • Bowel and bladder disturbances
  • Depression
  • Changes in sexual function

Of all patients with MS, many experience some form of cognitive impairment – sometimes mild and only detectable through testing and other times, apparent. Common cognitive impairments include:

  • Concentration
  • Attention
  • Memory
  • Poor judgment

 


Why is MS difficult to diagnose?

Diagnosing MS can be a challenging process. In early MS, symptoms may be non-specific and suggestive of several disorders of the nervous system. Early symptoms that come and go may be ignored. While no single laboratory test is yet available to prove or rule out MS, magnetic resonance imaging (MRI) is a great help in reaching a definitive diagnosis.  Diagnostic criteria that incorporate MRI findings and spinal fluid analysis have been developed and revised by experts in the field to help providers make an accurate and timely diagnosis.

 


Why is early treatment so important?

Early damage in the CNS can occur even before you are experiencing any symptoms. Studies show that the best chance for reducing long-term disability is during the early relapsing phase of the disease, which is characterized by inflammation. Given that the medications currently available all primarily target inflammation, early and ongoing treatment helps to minimize this inflammation and reduces damage to nerve fibers (axons) and loss of brain tissue. Treatment can be divided to:

  1. Relapse management therapies
  2. Disease modifying therapies (DMTs).
  3. Symptoms Management therapies
  4. Treatments in development.

For more details, please visit the MS Society of Canada website

https://mssociety.ca/managing-ms/treatments/medications

 


How can I manage my symptoms?

There are a number of medications that can treat different symptoms of MS, including: Bladder and bowel dysfunction,  depression, fatigue, numbness, pain, spasticity, speech and swallowing dysfunction, tremor, vertigo, vision problems, walking and sexual dysfunction. Please discuss your symptoms with your health care provider to optimize your treatment.

                           

                           

Diet & Nutrition

MS specialists recommend that people follow the same high fiber, low fat diet that is recommended for all adults. Vitamin D has also been shown to have a direct effect on the immune system. As a result, researchers are determining the relationship between inadequate vitamin D and risk of MS, as well as the effect of vitamin D intake in treating MS .

Exercise

Current research has provided evidence to support that exercise is beneficial and safe for people living with MS and it is now considered to be an important aspect of the overall management of the disease. Exercise offers many benefits for people with MS. In addition to improving your overall health, aerobic and strength exercise reduce fatigue and improve bladder and bowel function, strength, balance, mobility, and mood. Stretching exercises reduce stiffness and increase mobility

Vaccinations

Many people with MS have concerns about the safety of routine vaccinations and vaccinations required for travel to other countries. In general, it is recommended that people with MS receive vaccines according to the standard vaccine schedule. Discuss your vaccination question with your health care provider.

Heat Intolerance

Heat generally produces only temporary worsening of symptoms. It does not cause more disease activity (demyelination or damage to the nerves themselves). The symptoms improve after you cool down.

Strategies for easing the effects of heat

  • Stay in an air-conditioned environment during periods of extreme heat and humidity. If an air conditioner is needed to help minimize symptoms, the cost of this equipment may be tax-deductible if your healthcare provider has written a prescription for it.
  • Use cooling products such as vests, neck wraps, and bandana during exercise or outdoor activity.
  • Wear lightweight, loose, breathable clothing.
  • Drink cold fluids and eat popsicles.
  • Exercise in a cool pool (<85 degrees) or a cool environment. If you are exercising outside, pick cooler times of the day, usually early morning, or evening.
  • Try pre- and post-cooling to decrease the heating effects of exercise. Get into a bathtub of tepid water and continue adding cooler water over a period of 20 to 30 minutes. A cool bath or shower can also help reduce core body temperature following activity or exposure to a hot environment.

 


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Next Steps

For Physicians

Please complete the referral form to refer a patient to the Multiple Sclerosis & Demyelinating Disease clinic.

Refer a Patient

For Patients

Are you concerned you may have Multiple Sclerosis or a demyelinating disease?


Patient Form