I'm Dr. Oliver Tobin, a neurologist specializing in multiple
sclerosis at Mayo Clinic. In this video, we'll be covering the basics of
multiple sclerosis. What is it? Who gets it? The symptoms, diagnosis,
and treatment. Whether you're looking for answers about your own health
or that of someone you love, we're here to provide you with the best
information available. Multiple sclerosis is a disorder in which the
body's immune system attacks the protective covering of the nerve cells
in the brain, optic nerve and spinal cord, called the myelin sheath. And
this sheath is often compared to the insulation on an electrical wire.
When that covering is damaged, it exposes the actual nerve fiber, which
can slow or block the signals being transmitted within it. The nerve
fibers themselves might also be damaged. The body can repair damage to
the myelin sheath, but it's not perfect. The resulting damage leaves
lesions or scars, and this is where the name comes from: multiple
sclerosis, multiple scars. Now everyone loses brain cells and spinal
cord cells as they get older. But if part of the brain or spinal cord
has been damaged by MS, the nerve cells in that area will die off faster
than the areas around it that are normal. This happens very slowly,
usually over decades and typically shows up as gradual walking
difficulty happening over several years. When you read about multiple
sclerosis, you may hear about different types -- the most frequent being
relapsing-remitting multiple sclerosis. And this is characterized by
attacks, or relapses.
We don't know what causes MS, but there are certain factors that may
increase the risk or trigger its onset. So while MS can occur at any
age, it mostly makes its first appearance in people between the ages of
20 and 40. Low levels of vitamin D and low exposure to sunlight, which
enables our body to make vitamin D, are associated with an increased
risk of developing MS. As people who have MS who have low vitamin D tend
to have more severe disease. So people who are overweight are more
likely to develop MS and people who have MS and are overweight tend to
have more severe disease and a faster onset of progression. People who
have MS and who smoke tend to have more relapses, worse progressive
disease, and worse cognitive symptoms. Women are up to three times as
likely as men to have relapsing-remitting MS. The risk for MS in the
general population is about 0.5%. If a parent or sibling has MS, your
risk is about twice that or about 1%. Certain infections are also
important. A variety of viruses have been linked to MS, including
Epstein-Barr virus, which causes mono. Northern and southern latitudes
have a higher prevalence, including Canada, the northern US, New
Zealand, southeastern Australia, and Europe. White people, especially of
northern European descent, are at the highest risk. People of Asian,
African, and Native American ancestry have the lowest risk. A slightly
increased risk is seen if a patient already has autoimmune thyroid
disease, pernicious anemia, psoriasis, type 1 diabetes, or inflammatory
bowel disease.
Symptoms of a relapse usually come on over 24 to 48 hours, last for a
few days to a few weeks and then improve in the region of 80 to a 100
percent. Those symptoms include loss of vision in an eye, loss of power
in an arm or leg or a rising sense of numbness in the legs. Other common
symptoms associated with MS include spasms, fatigue, depression,
incontinence issues, sexual dysfunction, and walking difficulties.
There's currently no single test to make a diagnosis of MS. However,
there are four key features which help to secure the diagnosis. Firstly,
are there typical symptoms of multiple sclerosis? Again, those are loss
of vision in an eye, loss of power in an arm or leg, or sensory
disturbance in an arm or leg lasting for more than 24 hours. Secondly,
do you have any physical examination findings consistent with MS? Next,
is the MRI of your brain or spine consistent with MS? Now here it's
important to note that 95 percent of people over the age of 40 have an
abnormal brain MRI, just the same as many of us have wrinkles on our
skin. Lastly, are the results of the spinal fluid analysis consistent
with MS? Your doctor may recommend blood tests to check for other
diseases that share the same symptoms. They may also recommend an OCT
test or optical coherence tomography. This is a short scan of the
thickness of the layers at the back of your eye.
So the best thing to do when living with MS is to find a trusted
interdisciplinary medical team that can help you monitor and manage your
health. Having a multidisciplinary team is essential for addressing the
individual symptoms that you're experiencing. If you have an MS attack
or relapse, your doctor may prescribe you corticosteroids to reduce or
improve your symptoms. And if your attack symptoms do not respond to
steroids, another option is plasmapheresis or plasma exchange, which is a
treatment similar to dialysis. About 50 percent of people who do not
respond to steroids have a significant improvement with a short course
of plasma exchange. There are over 20 medications currently approved for
prevention of MS attacks and prevention of new MRI lesions.
As learning to function with MS can be challenging, there are medical
experts ready to work with you to help you manage it, so you can still
live a full life. Consulting with a physiatrist, physical or
occupational therapist can help you deal with physical difficulties.
Physical activity is strongly recommended for all people with MS. Mental
health is also an important consideration. So keeping up personal
connections with friends and family and trying to stay involved with
your hobbies is important. But also be kind to yourself and realistic
about what you're up for. This can change from day to day, so it's okay
to give yourself permission if something seems like too much or if you
need to cancel plans. You may also find support groups helpful to
connect with people who understand what you are going through and
discuss your feelings and concerns with a doctor or a counselor.
Meanwhile, scientists are hard at work, expanding our understanding of
this disease and developing new treatments and medications which are
ever more effective. If you want to learn more, watch more of our videos
or visit mayoclinic.org. We wish you well.
Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).
In MS, the immune system
attacks the protective sheath (myelin) that covers nerve fibers and
causes communication problems between your brain and the rest of your
body. Eventually, the disease can cause permanent damage or
deterioration of the nerve fibers.
Signs and symptoms of MS vary
widely between patients and depend on the location and severity of
nerve fiber damage in the central nevous system. Some people with severe
MS may lose the ability to walk
independently or ambulate at all. Other individuals may experience long
periods of remission without any new symptoms depending on the type of MS they have.
There's no cure for multiple sclerosis. However, there are treatments
to help speed the recovery from attacks, modify the course of the
disease and manage symptoms.
Symptoms
Multiple sclerosis signs and symptoms may differ greatly from person
to person and over the course of the disease depending on the location
of affected nerve fibers.
Common symptoms include:
- Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time
- Tingling
- Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
- Lack of coordination
- Unsteady gait or inability to walk
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
- Prolonged double vision
- Blurry vision
- Vertigo
- Problems with sexual, bowel and bladder function
- Fatigue
- Slurred speech
- Cognitive problems
- Mood disturbances
When to see a doctor
See a doctor if you experience any of the above symptoms for unknown reasons.
Disease course
Most people with MS
have a relapsing-remitting disease course. They experience periods of
new symptoms or relapses that develop over days or weeks and usually
improve partially or completely. These relapses are followed by quiet
periods of disease remission that can last months or even years.
Small increases in body temperature can temporarily worsen signs and symptoms of MS. These aren't considered true disease relapses but pseudorelapses.
At least 20% to 40% of those with relapsing-remitting MS
can eventually develop a steady progression of symptoms, with or
without periods of remission, within 10 to 20 years from disease onset.
This is known as secondary-progressive MS.
The worsening of symptoms usually includes problems with mobility and
gait. The rate of disease progression varies greatly among people with
secondary-progressive MS.
Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses, known as primary-progressive MS.
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