With No Consistent Symptoms or Single Test to Identify It, How Do Specialists Diagnose & Treat MS?

With No Consistent Symptoms or Single Test to Identify It, How Do Specialists Diagnose & Treat MS?

Content derived from DocTalk with Sargon Bet Shlimon, MD – Neuroscience Institute

0:17 | What is multiple sclerosis (MS)?
MS is a disease in which the immune system, which normally fights infection, attacks the nervous system instead. Specifically, it attacks the central nervous system, which includes the brain, spinal cord, and the optic nerves. Even more specifically, it attacks a substance called myelin, which is an electrical sheathing around your nerve cells that helps your nerve cells conduct signals. That is why MS is sometimes called a demyelinating disease.

1:01 | What causes MS?
Unfortunately, we don’t know. We do know that both genetic and environmental factors play a role, and there is a lot of research about different things that can increase a patient’s risk for MS, but we don’t have an exact cause pinned down.

1:20 | What are the signs and symptoms of MS?
A lot of the symptoms in MS come from specific areas of the nervous system that are being damaged, so the signs and symptoms can really vary. If there is one specific area being damaged, then a person may only have one symptom, but if a different part of the nervous system is being damaged, they might have a completely different symptom. Different people may also show symptoms differently.

Oftentimes, symptoms begin to improve after a while, especially when someone is early in the disease; this is one of the reasons it can be so difficult to diagnose. Sometimes it can take the symptoms coming back several times before someone puts together that they’re dealing with a neurologic disease.

More broadly, people may experience symptoms that range from vision changes, to changes in their sensation, changes in their balance or how they walk, or even changes in bladder or bowel function.

2:37 | How do you diagnose MS?
There is no test to diagnose MS, so we use a set of diagnostic criteria to evaluate someone’s symptoms, including neurologic examination findings, imaging findings from MRI, and laboratory findings. If someone meets those criteria and has no other explanation for their symptoms, they could be diagnosed with MS. This means that we are often looking for other things to rule out, that may be causing their symptoms, before making a diagnosis of MS.

3:22 | How is MS treated? Is there a cure?
Unfortunately, there is no cure. MS is a chronic illness that people carry with them throughout their lives. However, there are treatments, and a lot of the treatment focuses on prevention and reducing the risk of damage to the nervous system, and of developing disability in the future.

3:55 | I’ve heard MS is more prevalent in the Pacific Northwest, why is that?
Yes, it has been noticed that MS is more prevalent, not just in the Pacific Northwest, but also in other areas at high latitudes, and there are some theories about this:

  1. Sunlight exposure and vitamin D levels | There is some evidence that connects low vitamin D levels and a risk of developing MS, or risk of worsening MS.
  2. Genetics | MS tends to be more prevalent in people of northern European descent, of which we have a high population in the northwest.

4:43 | If someone has MS, how will it impact their life?
This can be really difficult to answer because it varies a lot from person to person. Some patients may go their entire lives with very few symptoms, and some patients might be more severely impacted. We do know that being on preventive medications for MS will reduce the risk of disability later on and improve the chances that people will have less impact as they go on in their life.

5:23 | What is an MS flare? How long does it last?
An MS flare (also known as an exacerbation, relapse, or attack) is when the immune system attacks a particular part of the nervous system and produces symptoms that are related to that part of the nervous system.

For example: if someone has an attack that involves the nerve behind the right eye, they might have blurriness and pain when they move that eye. That would be an attack in the eye. However, if they had an attack in the spinal cord, they might have changes in sensation from some part of their body downward.

Essentially, the attack reflects an area of damage that is happening in a part of the nervous system and is causing symptoms. By strict definition, symptoms must last at least 24 hours to be considered a flare or an attack, but commonly these attacks last much longer. Normally, symptoms begin over a day or two and last for days to weeks at a time, before slowly improving, depending on the attack, and depending on the person.

6:55 | What lifestyle changes should you make if you’re diagnosed with MS?
People often ask about lifestyle changes in MS and there are a few things we know, but there’s a lot of things we don’t know.

  • Stop Smoking | One thing that is very clear is that if you are a smoker, you should stop smoking. Not just for your general health, but because we know that people who smoke are more likely to have worse MS over time, compared to people who don’t.
  • Diet & Exercise | There have been a lot of diets that have been tested or proposed in MS, but no single diet has been proven to be more helpful than another. Instead, what I often recommend to my patients is eating a diet that is heart healthy. One of the diets that has been best studied in that context is the Mediterranean diet. It’s high in polyunsaturated fats, low in saturated fats, high in fibers, and includes lean proteins. I recommend this diet because we know that people who have uncontrolled cardiovascular disease also tend to have worse MS with time. Keeping up a regular exercise schedule is also a good idea.
  • Vitamin Supplementation | People often have low or low-normal vitamin D levels with MS, so I highly recommend consulting with your doctor about whether you would benefit from vitamin D supplementation.

8:34 | If your friend or family member has MS, how can you support them?
Because MS is a chronic illness, people with this diagnosis are going to have a lot of ups and downs. This means that some of the best things you can do for a friend or family member with MS are to be aware that there will be times when they’re going to be more affected or impacted than others, and to be there for them emotionally, and be supportive.

To learn more, visit valleymed.org/neuroscience

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