By: Jessica Baity, MD, Neurologist, Thibodaux Regional Health System
Multiple Sclerosis is one of the many disorders diagnosed and treated by
neurologists. It is a condition that has been researched extensively over
the past few decades and we are more knowledgeable than ever in terms
of diagnosis and treatment.
What is Multiple Sclerosis?
Multiple Sclerosis (MS) is an autoimmune disorder, meaning the body produces
antibodies that attack its own normal cells. It is the most common neurologic
autoimmune disorder and affects nearly one million adults in the United
States. Women are more than 3x likely to suffer as men, and disease onset
usually occurs between the ages of 20-50. Interestingly, it is more common
in colder climates farther from the equator.
What happens in MS?
The part of our nerves that carry impulses are called axons and they transmit
instructions to our muscles. Axons have a fatty insulating material around
them called myelin which allows conduction down the nerve axons to go
faster. In MS, the myelin of the central nervous system (the brain and
spinal cord) is attacked by autoantibodies. There is also inflammation
and damage to the axons themselves. As a result, nerve impulses are slowed
or blocked and cannot get where they need to go.
After these attacks occur, nerves remake myelin and the nerves slowly recover
and symptoms may resolve. Recovery, however is not always complete, and
residual symptoms can remain. At a later time, another attack may occur
in a different location and a new symptom may appear. These attacks are
also called ‘flares” or “exacerbations.”
What are the symptoms of MS?
MS symptoms are extremely variable because nerves can be attacked anywhere
throughout the brain or spine. Therefore, symptoms will depend on where
the attack happened. Some of the more common MS symptoms that we encounter
are: pain, blindness or vision changes in one eye, numbness in odd places,
weakness in a limb, bladder or bowel problems, muscle aches and fatigue.
These symptoms are often worse with heat and improve in colder temperatures.
How is MS diagnosed?
When myelin has been disrupted, inflammation occurs, or axons are damaged
we can see this on MRI. If your doctor suspects MS, the first thing they
may do is order an MRI of your brain and spinal cord. There is strict
diagnosis criteria regarding MS diagnosis and if the lesions seen on MRI
meet these and correlate with symptoms, we diagnose with the patient with
MS. Sometimes we may also order a lumbar puncture (spinal tap) if the
diagnosis is less clear.
How is MS treated?
The answer is- it depends. During flares or exacerbations, patients are
admitted to the hospital for steroids or other IV treatments over the
course of 3-5 days. The true goal of treatment, however, is to avoid these
exacerbations entirely with treatments called DMTs, or Disease Modifying
Therapies. There are over 12 DMTs now, and more are released every year.
DMTs work to prevent flares and therefore the progression of MS. There
are a variety of DMTs, including oral, IV, and infusions and the correct
one is very dependent on the unique situation of each patient.
It is an exciting time in the field of multiple sclerosis, as today we
have more treatments than ever to help patients. If you suspect you may
have MS or have questions, schedule an appointment with a neurologist
to be evaluated at Thibodaux Regional Neurology Clinic, 985.493.3090.