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
VII	Taste
VIII	Rinnes
VIII	Webers
Lower cranial Nerves

Examination parameter	Right		Left
Examination parameter	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