Who is at high risk for multiple sclerosis?
Many factors may put an individual at a higher risk for MS, including genetics, obesity, environment, smoking, and more.
The cause of multiple sclerosis (MS) is not known. But scientists believe that a combination of various factors may put an individual at a higher risk for MS. These factors include:
- Immunologic factors: Abnormal responses by the body’s immune system that may cause inflammation and damage in the central nervous system.
- Environmental factors: Exposure to some environmental toxins before puberty may predispose a person to develop MS later in life.
- Vitamin D: Low vitamin D levels in the blood due to less exposure to sunlight have been proposed to trigger the development of MS.
- Smoking: Smoking can cause MS to become more severe and progress rapidly.
- Obesity: Obesity in childhood and adolescence increases the risk of later developing MS.
- Infectious factors: Evidence suggests that previous infection with Epstein-Barr virus contributes to the risk of developing MS.
- Genetic factors: About 200 genes have been identified that play a role in developing MS.
- Female gender: Women are twice as likely as men to develop MS particularly during childbearing years and during the early postpartum period.
Environmental allergies, exposure to household pets, exposure to the heavy metals, and consumption of the artificial sweetener aspartame do not play any role in causing MS.
How do you diagnose multiple sclerosis?
Diagnosis of multiple sclerosis (MS) takes a very long time to diagnose because many times the symptoms stay for a short time, go away, and take several months or years to come back. It takes time for the signs of MS to show up in any diagnostic test and there is no single test that can prove that a person has MS.
Many conditions have symptoms similar to MS and MS may be mistaken for another disease initially.
The doctor who specializes in treating MS (neurologist) will order a few tests to see if the brain and spinal cord are working as they should. These include:
- Magnetic resonance imaging (MRI): This imaging test lets the doctor check for any inflammatory changes of MS in the deep parts of the brain or spinal cord.
- Lumbar puncture: Doctors draw out a small amount of fluid known as cerebrospinal fluid (CSF) from the spinal cord and send it to the laboratory for its analysis.
- Evoked potentials: The doctor will place wires on the patient’s scalp to check if the brain's response to certain things is altered as happens in MS.
- Blood tests: Blood tests may help the doctor support the MS diagnosis and rule out other conditions.
What is the best medicine for MS?
More than a dozen disease-modifying therapies are available that are approved by the U.S. Food and Drug Administration (FDA) to treat MS. The best medicine for MS varies among patients. Research is ongoing all around the world to find more effective therapies for MS.
Although doctors are not unsure of the underlying or triggering mechanism for MS and MS attacks, several drugs have been shown to have beneficial effects in people with MS. These drugs fall under two categories: immunomodulatory therapy (IMT) for the underlying autoimmune disorder and therapies to relieve symptoms.
Some of the immunomodulatory medications include:
- Interferons
- Glatiramer acetate (Copaxone)
- Natalizumab (Tysabri)
- Methylprednisolone
- Immunoglobulin
General treatment to relieve the symptoms of MS includes:
- Methylprednisolone (Solu-Medrol)
- Plasma exchange or plasmapheresis (a method to remove autoantibodies from the blood)
- Dexamethasone
The FDA recently approved the drug ocrelizumab (Ocrevus) to treat adult patients with RRMS and PPMS. Stem cell therapy, though not approved by the FDA, is available for MS, which offers a promising option for some of the patients with MS.
Other drugs are used as required to relieve the specific symptoms in MS such as pain, sexual inability, eye problems, bladder/bowel problems, depression, and so on. Examples include:
- Tricyclic antidepressants
- Anticonvulsants
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Acetaminophen (Tylenol)
- Sildenafil (Viagra)
- Amantadine
- Fluoxetine (Prozac, Sarafem)
- Modafinil (Provigil)
- Baclofen (Lioresal),
- Gabapentin
- Tizanidine (Zanaflex)
- Prednisone
- Injecting Botox into the bladder
- Stool softeners
- Serotonin reuptake inhibitors (SSRIs)
- Cladribine (Mavenclad) is an oral medication used in people with MS who have failed to respond to all other therapies.
What happens with untreated MS?
- More than 30% of untreated patients with MS develop physical disability within 20-25 years.
- In 50 to 60% of deaths from MS is usually due to complications, such as kidney or lung problems.
- RRMS is generally associated with a better treatment outcome and chances of survival than PPMS.
- Another variant of MS—the Marburg variant—can lead to coma or death within days.