Understanding Multiple Sclerosis: Symptoms, Causes, Treatments, and Natural Approaches

Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system, including the brain and spinal cord. It results from the immune system mistakenly attacking the protective myelin sheath around nerves. This condition, common among young adults aged 20 to 40, can lead to issues in muscle coordination, vision, balance, sensation, and cognitive function. Currently, nearly 1 million people in the United States are living with MS.

Types of multiple sclerosis

Relapsing-Remitting Multiple Sclerosis (RRMS): This common form (85% of cases) involves episodes of active disease followed by recovery. Relapses cause abrupt symptom worsening lasting at least 24 hours, with potential improvements during remission.

Primary Progressive Multiple Sclerosis (PPMS): Representing 10-15% of cases, PPMS is marked by a continuous, worsening course from the start, lacking distinct remission periods or acute attacks.

Secondary Progressive Multiple Sclerosis (SPMS): Developing after an initial RRMS phase, SPMS entails a steady disease worsening without distinct relapse-recovery cycles. The transition period varies and may take years.

Progressive Relapsing Multiple Sclerosis (PRMS): A rare form, PRMS involves continuous nerve damage, leading to symptom deterioration. Relapses may occur, but symptoms progressively worsen throughout the disease course.

What Are the Symptoms and Early Signs of Multiple Sclerosis?

MS symptoms can vary widely from person to person due to the affected nerve fibers’ location, and there’s no one-size-fits-all pattern. Many MS early signs can affect both women and men. However, it’s important not to jump to conclusions, as MS shares similar symptoms with many other conditions.

Vision problems are among the first signs. Commonly seen early problems with vision may include the following problems:

• Optic neuritis: Optic neuritis is the inflammation of the optic nerve and the first noticeable symptom in 25 percent of MS cases. Individuals with this condition may experience partial loss of vision, loss of central vision, eye pain (especially when the affected eye moves), temporary loss of vision for days or weeks, color blindness or red-green color distortion, and brief flashes of light when moving the eye. Optic neuritis may affect one eye or both eyes.
• Internuclear ophthalmoplegia: With internuclear ophthalmoplegia, damage to nerve fibers coordinating horizontal eye movement results in one eye’s inability to turn inward, causing double vision in the opposite direction. The unaffected eye may show involuntary movement, including rapid, repetitive motion in one direction followed by a slow drift back, a condition known as nystagmus.

The following are some of the other more common and early symptoms of MS:

• Paresthesia (abnormal sensations): Unusual sensations such as tingling, numbness, pain, burning, or itching can occur in the arms, legs, trunk, or face, often accompanied by a decreased sense of touch.
• Loss of strength or dexterity in a leg or hand: This can lead to stiffness in the affected leg or hand.
• Muscle problems: Muscle issues are common in MS, resulting in weakness, stiffness, and a heavy feeling in one’s limbs. This can lead to leg dragging while walking, muscle weakness, stiffness and resistance to muscle movement, and muscle spasms.
• Balance problems: Individuals with MS may feel lightheaded or dizzy or experience vertigo. This may be the result of damage to the brain’s cerebellum.
• Bladder problems: Bladder dysfunction is prevalent in MS, and its symptoms may include increased urination frequency, incontinence, urinary retention, and nocturia (nighttime awakening to urinate).
• Fatigue: MS can cause extreme fatigue, making even simple tasks challenging. Fatigue typically worsens at day’s end, in hot weather, after physical activity, and during illness.

The following symptoms may develop more slowly:

• Paralysis: Individuals with MS may experience partial or total paralysis.
• Tremor: MS patients may experience the shaking of limbs.
• Bowel problems: Bowel issues may result from the condition or be linked to the medications treating it. Constipation is the most common bowel issue in MS; bowel incontinence is less common. If stool becomes impacted, which is often a result of constipation, it can irritate the bowel wall, leading to increased fluid and mucus production, which can leak from the rectum.
• Cognitive problems: Approximately 50 percent of people with MS experience cognitive issues. Symptoms of cognitive dysfunction may include brain fog, problems acquiring and retaining new knowledge, slowness in processing large amounts of information, difficulty multitasking, shortened attention span, poor judgment, problems processing visual information (e.g., reading maps), difficulty with planning and problem-solving, and reasoning problems (e.g., solving puzzles).
• Disability: Frequent relapses can lead to a progressive and potentially permanent increase in disability.
• Neuropathic pain: MS-related pain arises from nervous system damage and includes many symptoms, including stabbing pain in the face, torso, and limbs, burning sensations, pins and needles (a feeling of unpleasant tingling or prickling), and feelings of being hugged or squeezed.
• Dysphagia: Dysphagia refers to difficulty swallowing. It can range from challenges with specific foods or liquids to a complete inability to swallow.
• Dysarthria: Dysarthria is a speech disorder resulting from muscle weakness, leading to slurred or unclear speech. Thus, it may be challenging for individuals with dysarthria to pronounce words and articulate effectively.
• Pseudobulbar affect (PBA): Pseudobulbar affect is a neurological condition marked by involuntary and abrupt episodes of laughter or crying, which can be challenging to manage.
• Sexual dysfunction: Individuals may lose their libido. Men may have difficulty maintaining erections (erectile dysfunction), while women may have decreased vaginal lubrication or have difficulty reaching orgasm.

Causes of Multiple Sclerosis

The exact cause of multiple sclerosis (MS) is unknown, but a combination of genetic and environmental factors is believed to play a role. Factors such as sunlight exposure, vitamin D levels, habits, and diet are under investigation. Immune cells like B and T cells are implicated in MS, attacking myelin and nerve fibers, leading to inflammation and damage.

Risk Factors for Developing MS

MS commonly affects those aged 15 to 50, with women being three times more likely than men to develop it. Genetics play a role, with a 2-3% risk for siblings or children of MS patients. Ethnicity and race influence susceptibility, with whites having a higher risk. Geographical location, vitamin D levels, smoking, previous viral infections, diet, childhood obesity, and head trauma in adolescence are also linked to MS risk. Early diagnosis and personalized strategies are essential for managing symptoms effectively.

Vaccines and Multiple Sclerosis

Concerns have been raised about potential links between certain vaccines, including those for COVID-19, and the development of multiple sclerosis (MS). While early documentation explored a connection between the hepatitis B virus (HBV) vaccine and MS, no conclusive evidence supports a causal relationship. Reports of MS onset, relapse, or exacerbation post-vaccination for COVID-19 have surfaced, but case studies do not establish causation. Research exploring potential links between COVID-19 vaccination and MS remains inconclusive, with other studies suggesting the virus itself as a factor. More focused research is needed to determine associative findings.

Diagnosis of Multiple Sclerosis

Early diagnosis is crucial for better MS outcomes, although no definitive test exists. Medical history and neurological examinations provide initial indications of nervous system issues. Diagnosis involves ruling out other potential causes, and criteria include experiencing at least two attacks with a one-month gap and demonstrating damage to myelin in multiple areas of the central nervous system. Diagnostic tests may include neurological exams, MRI scans, lumbar punctures, evoked potential tests, blood tests, eye examinations, and inner ear tests.

Complications of Multiple Sclerosis

Complications of MS include both secondary complications from disease symptoms and tertiary symptoms arising from social, employment, or emotional challenges. These may involve decreasing self-care capacity, indwelling urinary catheter requirements, medication side effects, bedsores, recurrent urinary tract infections, decreased bone density, pneumonia, mobility issues, musculoskeletal pain, depression, anxiety, job loss, mood swings, difficulty sleeping, and cognitive dysfunction. Comprehensive management is essential to address these challenges.

Multiple Sclerosis Treatments:

1. Disease-Modifying Therapies (DMTs):
   • DMTs aim to minimize damage and scarring to the myelin sheath associated with relapses.
   • Over 16 FDA-approved DMTs exist, effective in reducing relapses and neurologic disability.
   • Types include injectables (beta interferon drugs, glatiramer acetate), infusions (natalizumab, ocrelizumab, alemtuzumab, mitoxantrone), and oral medications (fingolimod, dimethyl fumarate, teriflunomide, cladribine, siponimod).
2. MS Relapse Treatment:
   • Infections, stress, and heat can trigger pseudo-relapses.
   • Steroids, taken over five days, can expedite recovery from a relapse but do not prevent future relapses or MS progression.
3. Symptom Treatment:
   • Fatigue:
     • Cognitive behavioral therapy, physical activity programs, occupational therapy, and medications (e.g., amantadine, modafinil) are recommended.
   • Vision Problems:
     • Intravenous steroids, specialized eyeglasses, and rest may be advised in severe cases.
   • Muscle Problems:
     • Physiotherapy, water therapy, yoga, and muscle relaxants (e.g., baclofen) may help.
   • Mobility Problems:
     • Exercise programs, mobility aids, home adaptations, dalfampridine, and physical therapy may be suggested.
   • Pain:
     • Transcutaneous electrical nerve stimulation (TENS), analgesics, muscle relaxants, and physical therapy are options.
   • Cognitive Impairment:
     • Drugs like donepezil may be helpful in certain situations.
   • Depression:
     • Antidepressants, cognitive behavioral therapy, and SSRIs may be recommended.
   • Bladder Problems:
     • Intermittent self-catheterization, catheters, stimulators, and medications (e.g., flavoxate) may help.
   • Bowel Dysfunction:
     • Dietary changes, medications, exercises, and stool softeners may be used.
   • Speech and Swallowing Problems:
     • Speech therapy and mouth muscle exercises may be recommended.
   • Tremor:
     • Assistive devices, weights, anticonvulsants (e.g., gabapentin), and deep brain stimulation are potential treatments.
   • Pseudobulbar Affect:
     • Combination treatments with dextromethorphan and quinidine, or other medications, may be effective.
   • Vertigo:
     • Anti-emetics like dimenhydrinate may be helpful.

While there is no cure for MS, comprehensive management through these treatments aims to improve the quality of life for individuals with the condition. Treatment plans are tailored to each person’s specific symptoms and disease activity.

Natural Approaches to Multiple Sclerosis:

1. Herbal Therapies:
   • Black Seed (Nigella sativa): Shows positive effects in repairing myelin, reducing inflammation, and lowering specific molecules involved in MS.
   • Evening Primrose (Oenothera biennis): Contains omega-6 fatty acids, demonstrating anti-inflammatory and immune-modulating properties.
   • Ginkgo (Ginkgo biloba): EGB761 extract has anti-inflammatory properties, potentially effective in treating MS. Also shows promise in alleviating fatigue.
   • Valerian (Valeriana officinalis): May improve sleep issues and alleviate fatigue.
   • Ginger (Zingiber officinale): Known for anti-inflammatory capabilities; active compounds show neuroprotective effects in animal models.
   • Saffron (Crocus sativus): Antidepressant properties can be beneficial for managing depression in individuals with MS.
   • Asian Ginseng (Panax ginseng): May help reduce inflammation and fatigue in MS.
   • Boswellia papyrifera: Known for anti-inflammatory and neuroprotective properties; may improve cognitive function in MS patients.
   • Common Grape Vine (Vitis vinifera): Resveratrol in grapes shows neuroprotective and anti-inflammatory properties.
2. Nutritional Supplements:
   • Antioxidant Vitamins (A, C, E): Combat free radicals, helping prevent myelin damage.
   • Vitamin D: Associated with MS prevalence; deficiency linked to faster MS progression.
   • Vitamin B12: Deficiency can harm the spinal cord and optic nerve.
   • Polyunsaturated Fatty Acids (Omega-3): Regulate the immune system, reducing inflammatory cytokine levels.
   • Linoleic Acid: May regulate cell-mediated immunity, helping manage MS.
3. Special Diets:
   • Low-Fat Diet: Reduces severity and frequency of relapse episodes.
   • Modified Mediterranean Diet: Anti-inflammatory; reduces fatigue, impact of MS symptoms, and disability.
   • Ketogenic Diet: Low-carbohydrate; may result in weight loss, reduced fatigue, depression, and improved quality of life.
   • Swank Diet: Low-fat diet; associated with decreased risk of premature death and disability in MS patients.
4. Homeopathy:
   • Certain homeopathic remedies used for MS symptoms; research evidence for effectiveness is lacking.
5. Aromatherapy:
   • Utilizes essential oils to offer relief from symptoms, including pain, and enhance overall well-being.
6. Acupuncture and Reflexology:
   • Acupuncture: Alleviates various MS-related symptoms such as pain, spasticity, and depression.
   • Reflexology: May improve symptoms such as paresthesia, muscle strength, spasticity, and reduce pain and spasms.
7. Mind-Body Practices and CAM:
   • Yoga: Improves overall well-being, mobility, muscle strength, mental function, and reduces fatigue and spasticity.
   • Exercise: Manages various MS symptoms, improving cardiovascular fitness, strength, mood, cognitive function, and flexibility.
   • Meditation: Assists in pain reduction and enhances quality of life scores in individuals with MS.

Prevention:

• Disease-modifying therapies reduce relapses; healthy lifestyle aids in prevention.
• Nutritious diet, regular exercise, stress management, and tobacco avoidance contribute to overall well-being.