Early Diagnosis and Successful Treatments Make Us Optimistic about Multiple Sclerosis
In just the past seven years medical research has achieved groundbreaking advances in the diagnosis and treatment of multiple sclerosis (MS). With the progress accomplished it’s easy to be optimistic. Seven new medications for relapsing-remitting MS (the most common type) and a first ever medicine for primary progressive MS have been approved by the FDA. Just 30 years ago, except for a lucky few, a diagnosis of MS usually meant a slow medical decline to disability and an early death. However, diagnosing the appearing and disappearing symptoms of MS remains a challenge. Treatment requires conscientious care and cooperation of the person with MS, the doctor, and the treatment team. If you have been diagnosed with MS, you need to find a trained, skilled, and experienced MS neurologist. The right doctor and team will give you the best hope for a long, healthy, happy life.
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What Is MS?
MS is an autoimmune condition, that is, a medical disorder caused by the body’s defenses attacking itself. This immune system defense causes inflammation, attacking nerves in the central nervous system, that is, the brain and spinal cord. Since these nerves are the electrical connections going to every place in the body, what symptoms appear depends on which nerves are attacked and damaged. The result is that the symptoms can be almost anything. MS is a common neurologic disorder. Except for traumatic injury neurologic damage, it’s the most common cause of neurologic disability in people under the age of 40.
The Changing Signs and Symptoms – Now It’s Broken, Now It’s Fixed
MS is a frustrating disorder for both patient and doctor. It’s symptoms are impossible to predict. Symptoms can be almost anything and they come and go. And no one ever wants a surprise problem symptom. Before the condition is diagnosed the person can feel that they’re living in an upsetting, unpredictable world. It’s a relief once the diagnosis is made. Everyone understands what’s happening. Before the diagnosis they can’t understand why suddenly one leg that won’t work right or why there are nerve tingles that won’t go away. Then, after a while, the symptoms go away and it’s all back to normal. But gradually, as time goes by, not all symptoms go back to normal. The repair processes to fix damaged nerves can’t keep up with the new damage. Eventually, some new symptoms hang on long-term, and at this point life gets harder.
A Reader Asked: My uncle died of MS 30 years ago. Do people no longer die of MS?
The range of symptom severity and outcome vary too much to make a blanket statement. It’s true that the most mild course of MS can have rare relapses and overall minimal disability. But the worst clinical course of MS is called “fulminant” and is severe MS with many relapses and fast deterioration toward disability. Most doctors refer to a middle-of-the-road description, using relapsing-remitting (RR) MS as the example. About 85% of people with MS have the RRMS type. Symptoms come and go over time. People recover from the relapses after a few weeks or months even without treatment, but over time they don’t completely recover. As time goes by these residual symptoms built up and cause disability. An early diagnosis helps keep the MS more mild because disease-modifying treatments can be started right away. Effective therapy lessens relapses and, long-term, lessens disability.
What Affects How Severe the MS Becomes?
Again, this is hard to say because the severity varies so much from one person to the next. Studies over time have come up with some things that seem to predict worse disease and some that are found with less severe illness. Things that go with a more benign disease course are female gender, mild relapses with good recovery between relapses, a long interval between the first and second relapse, few brain lesions on MRI scan, having optic nerve neuritis, and full recoveries from relapses. Things that go with a worse disease course are male gender, frequent relapses early on, minimal recovery between relapses, onset in several areas at once, faster disease progression, and a lot of brain lesions and brain atrophy on MRI scans.
Here Are Examples of a Few MS Symptoms
Here are a few examples of symptoms that people with MS might have. Maybe a bit of trouble walking. Maybe tired all the time, fatigued, or can’t think clearly, and it comes and goes. Or, odd bladder problems or bowel problems. Inability to see clearly, eyesight is not good, just not right. There could be a muscle that refuses to work. As we mentioned above, nerve tingles somewhere that won’t go away. It could be that the person seems to go dead regarding sex. Pain is possible, a new pain somewhere. A person who’s always been cheerful might start having a real down mood. As you can tell, the list goes on. An early diagnosis is important. It means that treatment can start right away, which helps keep a good life quality.
MS is Called the Great Medical Imitator
Because there are so many different possible starting symptoms, before about 20 years ago it was really difficult to diagnose MS early. Doctors called MS the “the great imitator” because it could look like so many other disorders. Back then it was not until MS became more long-term and severe, and the individual became disabled, that the diagnosis became clear.
MS Hits A Person During Her/His Best Years
MS mostly hits young to middle age adults. Right when their personal lives are great and their work and careers are productive. Wives and husbands are in the midst of starting their families. Men and women are starting to gain ground and stature at work. These are people age 20 to 50. It’s about two to three times more common in women than in men. And, as we said above, it’s a common disorder. Apart from traumatic nervous system damage, it’s the most common neurologic disability for these ages.
Treatment for MS – Multiple Sclerosis and Optimism
While it is true that MS can be treated, it’s not easy. It requires work, thinking, and planning. We’re all waiting for a real cure, a complete cure, but there isn’t one yet. People are trying hard to find one. The many medications we have now work, but we need better. See our article on MS treatment to learn more.
A Good Physical Therapy / Exercise Program Helps
In addition to disease-modifying medications, physical therapy is a great help, and then an exercise program based on what is learned in physical therapy. It’s really important to keep moving, to exercise frequently and regularly. One needs to work to build new muscle, to fight against losing muscle, and to stay strong. The whole treatment plan will be aimed at maximizing daily function, keeping and improving all that you can do. You have to keep moving and keep thinking.
What About “Alternative Medicine”? Are there Alternative Medicines That Work?
We need to say something first. We of the Neuroscience Research and Development Consultancy love new things. New ideas and new medications are great. It’s what we do. New treatment approaches. We felt the need to explain ourselves first because of what we’re about to say. For MS, walking down the path of “alternative medicine” is a really bad idea. We wish it weren’t true, but alternative medicine for MS is a trap. There are many, many “alternate” treatments promoted for MS and none of them work. We understand that desperate people will try just about anything. But don’t go this direction. Really, none of these work. If you happen to like one that is harmless, that’s fine, go ahead with it. But it won’t treat the MS, so don’t stray from your real medical treatment plan.
Three (or Four) Types of MS
As we said above, there are different types of MS. MS can appear in a person’s life in several different ways. And MS can move forward, get worse, or get better, seemingly always going in different directions. These different patterns of starting and moving forward can be divided into three or four main types. (Type four below might not be MS at all.) Which type a person has is important because it will determine which disease-modifying therapy will work the best.
The First Type of MS – Relapsing-Remitting MS
This is the most common type of MS. About 85% of people with MS have this type. It’s called relapsing-remitting MS, or RRMS. The symptoms start, get worse over a few days or weeks, and then get better over the next weeks or months. The MS then might “stay better”, that is, be in recovery, for months or years. But “better” does not always mean well. Sometimes there are symptoms that hang around, residual symptoms, little losses that don’t fully recover. Over several years, or maybe many years, these small bits of “not all the way better” can add up to a real disability. After 10, or 15, or 20 years the relapses no longer occur but neurologic deficits have accumulated and continue to slowly progress. This stage of the condition is the next MS type, secondary progressive MS.
A Second Type – Secondary Progressive MS
All those 85% of people who start with the first type above, RRMS, at some point get to this much later second type called secondary progressive MS, or SPMS. Those small leftover symptoms from the RRMS add up over time to become a bigger number of symptoms, often enough to cause problematic disability. At times there can be a small, brief lessening of symptoms but overall the disease course is downhill.
A Third MS Type – Primary Progressive MS
So the 85% of people with MS start with the RRMS. What about the other 15%? About 10% or 15%, that is, about one out of ten, people with MS have this primary progressive MS, or PPMS. This type usually starts later in life, during one’s 40s or 50s. With PPMS, unfortunately, once the symptoms start they never go away. Unlike RRMS that waxes and wanes and might go away, PPMS starts and never stops. The accumulation of symptoms can progress quickly to disability.
Finally, A Fourth Type – CIS
After the two troubling types above, SPMS and PPMS, this 4th type is a relief and might not be MS at all. It’s called Clinically Isolated Syndrome (CIS). With CIS one gets symptoms of MS for a day or more, then they go away. The symptoms might never come back. But it’s also possible that after an interval the symptoms might return. If the symptoms do come back later this first evidence of symptoms is no longer called CIS. It has become the first of repeated relapses, so the diagnosis is RRMS. Most of the time a doctor in a well-equipped medical center can have brain imaging done. Brain imaging will probably be able to predict who with CIS will have another attack and who will not.
Early and Accurate Diagnosis: The McDonald Criteria
Since the earliest accurate diagnosis is vitally important to start the best disease-modifying treatment right away, criteria to affirm what is and what is not MS are critical for success. Since the first signs for what later could be full MS is the Clinically Isolated Syndrome, the criteria are used when a person presents with a typical CIS. The McDonald criteria are used after the completion of a full assessment. A full assessments means a review of all symptoms, a physical examination, testing, and careful and full consideration of all other diagnoses that might cause the symptoms. If the full assessment supports that this CIS might be MS, the criteria are applied. The criteria apply to the timing and physical location of brain and spinal cord lesions on MRI scans. The initial 2010 McDonald criteria were revised in 2017.
So What Eventually Happens with MS? Multiple Sclerosis and Optimism
As laid out above, what eventually happens to a person with MS depends. One thing it depends upon is an early and accurate diagnosis. That’s why getting a good diagnosis of MS as early as possible is so important. There are at least sixteen disease-modifying medications available to treat MS. If MS is found early and the person works hard with a skilled and experienced neurologist and the whole treatment team, modern medicine can help most people live almost a full lifespan, and perhaps a full lifespan. However, that changes if the individual has had MS for a long time before a diagnosis is finally confirmed and treatment started. In this situation there might be more symptoms present long-term and lifespan might be shorter than wanted. This same unfortunate situation can occur if the individual does not or cannot work hard with the doctor and the treatment team to stay with the treatment plan.
Helpful links:
NIH National Institute of Neurological Disease and Stroke on Multiple Sclerosis: Hope Through Research
National Library of Medicine Medline Plus on Multiple Sclerosis
National Multiple Sclerosis Society answering the question: What is MS?
The Mayo Clinic on Multiple Sclerosis
Michael J. Olek DO. In the Clinic: Multiple Sclerosis. Annals of Internal Medicine, June 2021, Vol. 174, No. 6, pp. ITC81-ITC96.
The 2017 McDonald Criteria for diagnosing MS