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Multiple Sclerosis Diagnosis: What Does It Mean?

Multiple sclerosis is an autoimmune neurological disease affecting the central nervous system (CNS – brain, spinal cord, optic nerves).  The central pathology (cause of problem) involves the long arms of nerve cells (axons) losing their outside wrapping (myelin sheath), which greatly affects conduction of nerve impulses.

As a result, patients often, though not always, experience a relapsing-remitting course of neurological problems – from mild to severe – including numbness, visual deficits, muscle weakness and decreased control of bodily functions.  It is most often diagnosed between the ages of 20 – 40 (though it can affect persons of any age), and women are twice as likely to develop the disease.  Below, we discuss some important issues regarding progression, treatment and prognosis.

What is the prognosis for quality of life with MS?

This is a difficult question to answer because it really depends on the details of the disease, which tends to vary greatly from person to person.  Some patients experience very limited symptoms and therefore are able to function relatively normally while dealing with multiple sclerosis; others may become quite debilitated, with major adverse effects such as blindness and paralysis.  Thus, it is something that your doctor, knowing you personally, can shed much more light on than we can here.  However, according to PubMed there are several factors that predict a possibly milder course, including being young (under 30 years old) and female, and showing limited disease on imaging studies.

As for life expectancy: while it is also variable and dependent on various factors, multiple sclerosis patients can often live a normal or near normal lifespan, and many retain function, to a greater or lesser degree, throughout this period.  Again, this is contingent on individual disease course and symptoms, areas of the body affected, and specific disease progression.

How does the disease progress over time?

Unfortunately there is no one good answer to this question either.  The course of disease varies quite a bit depending on the sufferer’s particular situation.  Some patients will see little progression and only mild to moderate symptoms; others may experience any number of serious developments over time, accompanied by more serious signs and symptoms.  Fortunately, the majority of people affected tend to exhibit mild to moderate symptoms, though MS can sometimes affect one’s ability to talk, eat, see or perform certain bodily functions.  Trouble ambulating is a very common difficulty with MS, and a decent proportion of patients will require some form of walking aid after years of battling multiple sclerosis.

The answer to this question also depends on which subtype you are diagnosed with.  Those with “relapsing-remitting” tend to fare better than those who have been diagnosed with the “progressive” form of the disease.

Do the treatments stop the progression, or just mask the symptoms?

There are two types of treatments offered to multiple sclerosis sufferers: those aimed at slowing/stopping multiple sclerosis disease progression, and those meant to control symptoms and flares during relapses.  Though they are used for different purposes, none of these medications simply mask the symptoms.

The meds that are used to slow or stop progression of the disease are generally those that affect the immune system, including beta interferon (first-line treatment) and other immunomodulators meant to decrease the immune response causing the illness.  These tend to have decent efficacy, but can also be effective or ineffective on an individual basis.  The latter types of medication, focused on reducing acute flare symptoms, include such drugs as injectable steroids and muscle relaxants, prescribed with the goal of mitigating the effects of an acute episode, such as inflammation and muscular problems.  In addition, there are several experimental drugs, such as Aubagio, which was just recently approved, that show some promise in advancing treatment of this disease, with the ultimate goal being reversal of the progression.  To date though, there is no cure or reversal therapy available.

Will I just have one treatment plan, or will I have to change medications as the condition progresses?

After reading the answers to the previous questions, it will probably come as no surprise that the treatment plan and medications used will vary on a case-by-case basis.  Virtually everyone starts with some form of beta interferon, and medications are added or changed as the situation dictates.  If this regimen (in conjunction with steroids) works well, there is usually no reason to try anything else.  On the other hand, if symptoms are getting worse or new symptoms develop, most doctors will move on to second and third line drugs.  Various medications are also used to control the specific effects of multiple sclerosis, such as muscle weakness/stiffness, loss of bladder control, and depression.  The National MS Society provides an excellent table covering many of the drugs used for these different purposes.

There are also several non-medication therapies that are applied based on patient specifics.  Some of these include physical therapy, occupational therapy, speech therapy, meditation and calisthenics, in addition to several forms of complementary therapy, such as massage and acupuncture.

Questions for your doctor:

  • What type of multiple sclerosis do I have, and what does it mean in terms of progression and treatment?
  • Are there any new drugs available that might help my condition?  Can I participate in clinical trials?
  • Can I use over-the-counter or natural remedies to treat my MS?  If so, which are proven safe to use?
  • Is there anything I can do physically to prevent or reduce the onset of multiple sclerosis if it runs in my family?  Exercise, yoga, etc.?
  • Can you recommend a good source of information about MS and its treatments?  Are there any sources from which I should stay away or not take advice?

 

About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians.  After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time.  He may be reached at [email protected].

 

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