Written by Dr. Matthew (Max) Carraro, MD
MS Fellowship Trained, Board Certified Neurologist
The Charlotte Center for MS, Lake Norman Neurology
What is Multiple Sclerosis?
MS is thought to be an autoimmune condition that impacts the body’s central nervous system (CNS) comprised of the brain and spinal cord. The immune system (which typically defends us from viruses and bacteria) mistakenly identifies the CNS as a target for attack, and begins to damage the outer coating of nerves, called myelin. Once this has occurred, additional damage can develop leading to symptoms from fatigue and cognitive difficulty, to weakness or pain.
Who gets Multiple Sclerosis?
MS is typically diagnosed between the ages of 20 and 40. It is 2-3 times more common in women than men. Historically, it has been considered to primarily affect Caucasian individuals of Northern European descent. However, MS can occur in pediatric patients, people aged 65 and older, males, and people of most any racial and ethnic background.
How do you diagnosis Multiple Sclerosis?
Diagnosis begins with the symptoms and history reported by the patient. If these features are suspicious for MS, they often lead to having MRIs of the brain, or sometimes the orbits (optic nerves), cervical spine, and or thoracic spine. In multiple sclerosis, MRIs will reveal “lesions” that are typical in appearance for MS. It is important to note that other diseases can cause lesions, some of these can mimic the appearance of MS while others may be more in keeping with small vessel disease (damage caused by conditions such as high blood pressure or diabetes). It is always important to order lab work that looks for conditions considered to be possible “mimics” of MS. In some cases, your doctor may recommend having a lumbar puncture (“spinal tap”) to look for signs of inflammation in the spinal fluid.
How do you treat Multiple Sclerosis?
The focus is on early diagnosis, early treatment, and in many cases the early implementation of highly effective therapy. The 1st treatment for multiple sclerosis was approved in 1993. Its impact on the disease was modest, especially in the long-term. There are now more than 20 FDA approved disease modifying therapies (DMTs). Some of these are injections (shots), some are oral pills, some are intravenous infusions. While there is no cure for MS, many of these treatments can shut down disease activity for years or even decades. The better MS is controlled early on, the better patients are protected from long-term disability.
In addition to controlling MS with DMTs, wellness work is extremely important! By coupling this with appropriate DMT, patients will optimize their care. Fitness, nutrition, sleep, stress management, in some cases supplements, are all aspects of wellness and go a long way towards protecting all of us, but especially people living with MS.
Are there different types of Multiple Sclerosis?
We have historically referred to different classifications or types of multiple sclerosis. These include radiographically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing forms of MS, secondary progressive MS (SPMS) which can occur “with” or “without” activity, and primary progressive MS (PPMS). However, it is more important to understand whether there is a predominance of inflammatory disease, degenerative disease, or combination of both.
