Multiple Sclerosis Progression: An Overview

Multiple Sclerosis is an autoimmune disease that affects adults between 20 and 40 years of age. The signs and symptoms of Multiple Sclerosis vary widely from patient to patient, and even fluctuate throughout each patient’s life. While this can make it hard to predict exactly how the disease will progress, there are patterns that it follows that can help patients know what types of Multiple Sclerosis treatment to seek. Here’s a quick guide to what Multiple Sclerosis looks like and how it evolves over the years.

Understanding Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic inflammatory condition of the central nervous system. It is an autoimmune demyelinating disease, which means the immune system mistakenly attacks normal tissues — in this case, the myelin or protective covering around nerve fibers. This leaves scarred tissues or lesions in multiple areas, disrupting electrical impulses throughout the body. When the myelin sheath is damaged, nerve impulses slow or even stop, causing neurological problems. The exact cause of Multiple Sclerosis is unknown in most cases, with a combination of environmental and genetic factors usually held responsible.

Early Signs and Symptoms of Multiple Sclerosis

Multiple Sclerosis manifests in a number of ways, which can make it hard to receive an official diagnosis. Typically, a neurologist will conduct tests to detect Multiple Sclerosis, if a patient experiences some or all of the following symptoms:

• Unexplained weakness in the arms and/or legs
• Numbness and/or tingling in body parts
• Trouble walking
• Vision loss in a single eye, either partial or complete
• Double vision or an inability to see color
• Seeing flashing lights
• Slurred speech
• Electric shock sensations that occur with certain types of neck movements
• Fatigue and dizziness
• Bladder and/or bowel dysfunction
• Cognitive changes, like forgetfulness or shorter attention span

The neurologist will first try to rule out other causes that could be behind these symptoms, such as a tumor, a stroke, diabetes, or even other types of nervous system disorders. Subsequently, they will check for damage to the brain and spinal cord, usually with an MRI or a lumbar puncture. A final diagnosis of Multiple Sclerosis is typically given once the doctor confirms that the symptoms occurred at, at least two different points in time.

How Different Types of Multiple Sclerosis Progress

Multiple Sclerosis progression will look different for each patient, depending on the range of symptoms they display, the rate of degeneration in their CNS, and their test results at different points in time. In general, each of the four types of Multiple Sclerosis progresses in the following manner.

• Clinically Isolated Syndrome (CIS): This is an initial episode of neurological symptoms, brought on by inflammation of the nervous system. While technically not a "stage" of Multiple Sclerosis, CIS accompanied by the detection of brain lesions on an MRI increases the chance of a second episode, and thus a confirmed Multiple Sclerosis diagnosis. By definition, the episode of symptoms must last for at least 24 hours.
• Relapsing-remitting Multiple Sclerosis: Patients with this type of MS will experience relapses during which their symptoms will get worse. These can last anywhere between several days to several weeks. Afterwards, they will experience recovery, which could take up to weeks or months. Symptoms generally do not worsen during recovery periods, and may even improve slightly. This type of relapsing typically occurs around the time patients first get a Multiple Sclerosis diagnosis. About 85% of Multiple Sclerosis patients will experience relapsing-remitting MS.
• Primary-progressive Multiple Sclerosis: Patients with this type of MS will experience a gradual worsening of symptoms right from the onset of the disease, without any relapsing patterns. About 15% of Multiple Sclerosis cases take this form, especially in people first diagnosed after the age of 40.
• Secondary-progressive Multiple Sclerosis: Patients with this type of MS will initially experience relapses and remittances. Over time, however, the symptoms will start to steadily become worse. This will usually happen within 10 years of the initial diagnosis. About 50% of patients with relapsing-remitting MS will experience this type of Multiple Sclerosis progression.

What is a Multiple Sclerosis Relapse?

A Multiple Sclerosis relapse can occur from an inflammation or irritation of the nerves in the brain or spinal cord. When inflammation occurs, the nerves lose their myelin coating and a plaque develops on them instead. This plaque affects the electrical signals that travel through nerves, distorting them or causing them to stop altogether. This in turn leads to the manifestation of Multiple Sclerosis symptoms. These relapses are also known as flares, and tend to last between a few days to several weeks. Occasionally, they may linger for several months. Flares may range in intensity from mild to severe.

Another situation in which symptom flares may occur is known as a pseudo-relapse. This is when something external exaggerates the patient’s condition, such as a change in weather, an infection, or a period of stress.

Treatment for Multiple Sclerosis

Currently, there is no cure for Multiple Sclerosis. Treatment can slow the rate of disease progression and help patients lead a longer, more functional and independent life. Treatment is also invaluable for controlling the later complications of Multiple Sclerosis, such as epilepsy, cognitive disorder, or depression. A typical Multiple Sclerosis treatment plan will consist of Stem Cell Therapy, physiotherapy, occupational therapy, and speech and language therapy. If the patient’s gait and movement are severely affected, the doctor may recommend the use of assistive devices like walkers or wheelchairs. A nutritious diet and regular exercise are also key to managing Multiple Sclerosis symptoms.

In short, it is important to know what to broadly expect as one’s Multiple Sclerosis progresses, while keeping in mind that individual symptoms may differ widely. The patient should thus track their symptoms closely and consult the doctor the moment they notice any change or worsening. This way, patients can benefit from the right treatment and gain more control over their daily lives, allowing for happier and healthier choices.

A highly regarded neurologist and stem cell specialist, Dr Na’eem Sadiq studied neurology and clinical neurophysiology in London before working with some of England’s and the Middle East’s most prestigious medical institutions. He completed his MBBS