MULTIPLE SCLEROSIS

Doctors have identified a few major types of MS. The categories are important, because they help predict how severe the disease can be and how well treatment will work.

Relapsing-Remitting Multiple Sclerosis

Most people with multiple sclerosis — around 85% — have this type. They usually have their first signs of the disease in their early 20s. After that, they have attacks of symptoms (called relapses) from time to time, followed by weeks, months, or years of recovery (called remissions).

Primary Progressive Multiple Sclerosis

In primary progressive multiple sclerosis, the disease gradually gets worse over time. There are no well-defined attacks of symptoms, and there is little or no recovery. In addition, MS treatments don’t work as well with this type of MS. About 10% of people with MS have this type.

Secondary Progressive Multiple Sclerosis

After living with relapsing-remitting MS for many years, most people will get secondary progressive MS. In this type, symptoms begin a steady march without relapses or remissions. (In this way, it’s like primary progressive MS.) The change typically happens between 10 and 20 years after you’re diagnosed with relapsing-remitting MS.

This type is rare enough that doctors don’t know much about it. Probably around 5% of people with multiple sclerosis have this form. In many ways, it seems similar to primary progressive MS.

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. They may include:

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Tingling or pain in parts of your body
• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
• Tremor, lack of coordination or unsteady gait
• Slurred speech
• Fatigue
• Dizziness
• Problems with bowel and bladder function

DIAGNOSIS

It can be a challenge for doctors to diagnose multiple sclerosis (MS). There’s no one test that can definitely show if someone has it. And there are many conditions with symptoms that can seem like MS.

There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis

Your doctor will start by asking you about your medical history and your symptoms. She’ll also do a few tests to see if your brain and spinal cord are working as they should. These include:

• Imaging tests, like an MRI, to take a closer look at your brain
• Spinal taps, also called lumbar punctures, to check the fluid that runs through your spinal column
• Electrical tests, called evoked potentials, to see if MS has affected your nerve pathways
• Blood tests

RECOMMENDED MEDICATIONS

There is no cure for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary.

Controlling a relapse

These medicines can shorten a sudden relapse and help you feel better sooner. They have not been shown to affect the long-term course of the disease or to prevent disability.

• Corticosteroids (such as methylprednisolone)
• ACTH (adrenocorticotropic hormone)
• Intravenous immunoglobulin (IVIG)
• Plasma exchange

Disease-modifying treatment

The most commonly used disease-modifying therapies are:

• Interferon beta (such as Betaseron), for clinically isolated syndrome (first MS attack), relapsing-remitting MS, and secondary progressive MS.
• Glatiramer (Copaxone), for clinically isolated syndrome and relapsing-remitting MS.
• Dimethyl fumarate (Tecfidera).
• Fingolimod (Gilenya).
• Mitoxantrone (Novantrone).
• Natalizumab (Tysabri).
• Teriflunomide (Aubagio).

 Relieving symptoms

Treating specific symptoms can be effective, even if it doesn’t stop the progression of the disease. Symptoms that can often be controlled or relieved with medicine include:

• Fatigue
• Muscle stiffness (spasticity).
• Urinary problems.
• Constipation
• Pain and abnormal sensations.
• Depression