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   what is multiple sclerosis disease
Neurology

What is Multiple Sclerosis: Types, Causes, Symptoms, & Diagnosis

Dr. Neetu Ramrakhiani Apr 10, 2024

What is multiple sclerosis?

Multiple sclerosis (MS) is a disease of the central nervous system. It is an autoimmune disorder, where the body’s natural immune system mistakenly attacks normal body tissues.

The brain and the spinal cord generate as well as transmit thousands of signals to different body parts, with MS these signals become interrupted leading to a wide range of symptoms. 

Approximately 2.5 million people are affected by MS

What are the symptoms of MS?

  • Weakness
  • Numbness
  • Blurring of vision or changes in vision
  • Paralysis
  • Loss of balance
  • Shaking (tremors)
  • Bladder and bowel problems
  • Pain and fatigue

What causes MS?

There are many possible causes of MS, including:

  • Autoimmune disorders
  • Infectious agents, such as viruses
  • Environmental factors
  • Genetic factors

What are the types of MS?

  • Clinically Isolated Syndrome (CIS) – Single episode, lasting for >24 hours with evidence of CNS demyelination
  • Relapsing-Remitting Multiple Sclerosis (RRMS) – Repeated episode of CNS demyelination with near complete recovery in each episode and no evidence of disease progression
  • Primary-Progressive Multiple Sclerosis (PPMS) – Neurological functions worsens steadily from the beginning, there are no relapses or remissions.  There can be periods of short-term (temporary) minor improvements.

How is MS diagnosed?

  • Discussing your symptoms with your doctor
  • Physical examination of nerves and symptoms
  • MRI scans of brain and spinal cord
  • Optical Coherence Tomography (OCT) to test nerve fibres in the retina
  • Spinal tap for checking signs of MS
  • Visual evoked potentials (VEP) to check the functioning of the optic nerves. 

How do I know if my disease is getting better?

If you feel relief in the symptoms such as tremors, loss of balance, blurring of vision then your disease is getting better. 

Living with MS?

  • Discuss with your doctor regarding your clinical condition symptoms and your concerns for the future. The more you understand about MS the better you can take treatment decisions.
  • Starting the treatment is the important first step – The goal is to interrupt the natural course of MS and hence early initiation of treatment helps to reduce flare-ups and future disabilities.
  • Live a healthy lifestyle – Healthy changes to your lifestyle can give you more strength and confidence to deal with MS. Cut back on junk for add more fruits and vegetable to your diet. Exercise regularly. Quit smoking. Consult your doctor regarding a suitable diet plan. 

At Fortis MS and autoimmune disease clinic: 

At Fortis, we provide Holistic and Comprehensive care to patients with Multiple Sclerosis

Diagnosis

A detailed clinical assessment: history and examination are done by the neurologists.

Investigations

  • MRI brain and spine (MS protocol) with 3 Tesla machines. 
  • Blood Tests
  • Visual Evoked Potentials Tests

Test help on comparison 

Specialised Serological and immunological blood tests as well in CSF. 

Therapy

1. Helpline for acute worsening

2. Disease Modifying Therapies and their monitoring

3. Symptomatic treatment

4. Neuro-rehabilitation with our experienced physiotherapy team

5. Support and counselling from psychologist. 

Types of therapies

  • Symptomatic therapies
  • Disease modifying therapies (includes different types of medication including oral, injectables, and other therapies) such as interferon, PEG interferon, Di-methyl fumarate, Rituximab, Natalizumab. 

Other demyelinating disorders – Neuromyelitis Optica Spectrum Disorders (NMOSD)

NMOSD is a relatively recent autoimmune demylinating disease which mainly effects the optic nerve and spinal cord. It often leads to sudden vision loss, paralysis, or both. Sometimes it is also confused with MS. 

How common is NMOSD?

NMOSD prevalence ratio in Indian population is 1.09/100 000. It affects 4-10 times more women than men. 

At Fortis MS and autoimmune disease clinic: 

At Fortis, we provide Holistic and Comprehensive care to patients with NMOSD.

Symptoms of NMOSD:

  • Blurry vision or blindness in one or both eyes.
  • Weakness or paralysis in the legs or arms
  • Painful spasms
  • Numbness of loss of sensation throughout the body
  • Persistent nausea
  • Uncontrollable vomiting
  • Persistent hiccups
  • Bladder or bowel dysfunction

Diagnosis of NMOSD:

The diagnosis process includes:

  • Medical history
  • Neurological exam
  • MRI
  • Spinal Tap
  • Eye tests
  • Blood tests

 

Cranial nerve

Parameter

Right

Left

I

Smell sensation

 

 

 

 

 

II

 

 

 

  

Pupils

 

 

Light reflex (D/I)

 

 

Visual Acuity

 

 

Fundus

 

 

Colour Perception

 

 

RAPD?

 

 

Visual field testing

 

 

III, VI, VI

Extraocular movements

 

 

V (V1, V2, V3)

Facial sensation

 

 

VII

Facial movements

 

 

Taste

VIII

Rinnes

 

 

Webers

Lower cranial Nerves

 

 

 

 

 

Examination parameter

Right

Left

UL

LL

UL

LL

Muscle Bulk

 

 

 

 

Tone

 

 

 

 

Power

 

 

 

 

Sensory (Pain, temprature, fine touch, JPS, Vibration)

 

 

 

 

Deep Tendon Reflexes

 

 

 

 

Plantar 

 

 

 

 

Cerebellar signs

 

 

 

 

Gait

 

 

 

 

 

 INVESTIGATIONS

Date



Investigations

 

 

 

 

 

 

Hb

 

 

 

 

 

 

TLC

 

 

 

 

 

 

PC

 

 

 

 

 

 

ESR/CRP

 

 

 

 

 

 

S.Bili

 

 

 

 

 

 

SGOT

 

 

 

 

 

 

SGPT

 

 

 

 

 

 

BU/SCr

 

 

 

 

 

 

Vit D

 

 

 

 

 

 

Vit B12

 

 

 

 

 

 

HIV/HBsAg/HCV

 

 

 

 

 

 

JC Virus Status

 

 

 

 

 

 

Other immunisation status

 

 

 

 

 

 

CSF OCBs

 

 

 

 

 

 

NMO/MOG

 

 

 

 

 

 

ANA/ENA

 

 

 

 

 

 

S. ACE level

 

 

 

 

 

 

VEP

 

 

 

 

 

 

OCT

 

 

 

 

 

 

 

 

IMAGING

MRI BRAIN

 

Supratentorial lesions

Infratentorial lesions

Enhancing lesions

 

MRI Spine







 

USG KUB (Pre and post void)








 
  

 

 

Diagnosis and treatment record

Treatment

Start date

End date

Response

    
    
    
    
    

 

 

 

Questionnaire

1

Do you have difficulty seeing?

Yes

No

2

Blurry vision

Yes

No

3

Double vision

Yes

No

4

Wear glasses or contacts

Yes

No

5

Eye Pain

Yes

No

6

Loss of vision

Yes

No

7

Do you see black in an area of your vision?

Yes

No

8

Do you have difficulty moving your eyes?

Yes

No

9

Do you have pain when moving your eyes?

Yes

No

10

Do colors ever look different to you?

Yes

No

11

Do you have any numbness on your face?

Yes

No

12

Do you have any facial pain?

Yes

No

13

Do you have any weakness in your face?

Yes

No

14

Do you have hearing loss?

Yes

No

15

Do you have difficulty with speech?

Yes

No

16

Do you have difficulty swallowing foods?

Yes

No

17

Do you have difficulty swallowing liquids?

Yes

No

18

Do you have any weakness?

Yes

No

19

Do you have any spasms (tight muscles)?

Yes

No

20

Do you have muscle spasms in your neck or back?

Yes

No

21

Do you have balance difficulty?

Yes

No

22

Are you able to sit without assistance?

Yes

No

23

Do you have shaking or tremors?

Yes

No

24

Are you clumsy?

Yes

No

25

Do you have unsteady walking?

Yes

No

26

Do you fall frequently?

Yes

No

27

Do you get vertigo or dizziness?

Yes

No

28

Do you have any sensory problems? (Pain, Numbness, Tingling, Itching, Painful cold, burning sensation, shock-like sensation, increased sense to touch)

Yes

No

29

Do you have difficulty emptying your bladder?

Yes

No

30

Do you have frequent urinary tract infections?

Yes

No

31

Do you self-catheterize?

Yes

No

32

Do you have urinary incontinence (lose control of urine)?

Yes

No

33

Do you have constipation?

Yes

No

34

Do you need an enema or manual measures to evacuate bowels?

Yes

No

35

Do you have bowel incontinence (loss of control of stool)?

Yes

No

36

Do you wear pads because of bowel incontinence?

Yes

No

37

Have you seen a urologist?

Yes

No

38

Have you seen a gastrointestinal doctor?

Yes

No

What is Multiple Sclerosis?

Categories

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Meet the doctor

Dr. Neetu Ramrakhiani
Dr. Neetu Ramrakhiani
DIRECTOR NEUROLOGY | Fortis Jaipur
  • Neurology | Neurology
  • Date 21 Years
  • INR 1000

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