Multiple Sclerosis

Multiple sclerosis is an autoimmune disorder that affects the brain and spinal cord (central nervous system).

Causes
Women are more prone to this disorder. It affects are seen more commonly in 20 – 40 years age group.
It affects the myelin sheath of the nerve. Usually these protective sheath around the nerve are damaged and the conduction of signal through it is slowered and at times stopped.
Usually inflammation results in the nerve damage. Body's own immune cells attack the nervous system and cause inflamation. This can occur along any area of the brain, optic nerve, and spinal cord.
It is unknown what exactly causes this to happen.

Symptoms
Depending upon the area brain affected the symptoms may vary.
It is an intermittent disorder which would have its episode of remission at regular intervals.
Since nerves in any part of the brain or spinal cord may be damaged, patients would have symptoms in many parts of the body.

Muscle symptoms:
  • Numbness
  • Loss of balance
  • Muscle spasms
  • Numbness or abnormal sensation in any area
  • Difficulty in moving arms or legs
  • Difficulty in walking
  • Difficult coordination thus poor fine movements.
  • Tremor in one or more arms or legs
  • Decreased attention span, poor judgment, and memory loss
  • Difficulty reasoning and solving problems
  • Depression or feelings of sadness

Eye symptoms:
  • Diplopia (Double vision)
  • Irritation in the eyes Eye discomfort
  • Nystagmus (Uncontrollable rapid eye movements)
  • Vision loss (usually affects one eye at a time)

Numbness, tingling, or pain
  • Unbearable Facial pain
  • Tingling, crawling, or burning feeling in the arms and legs

Bowel and bladder symptoms:
  • Constipation or poor stool control
  • Difficulty beginning to urinate
  • Increased frequency of urination
  • Strong urge to urinate
  • Urine leakage (incontinence)

Sexual symptoms:
  • Difficult erections
  • Problems with vaginal lubrication

Throat Symptoms (Speech and swallowing):
  • Slurred or difficult-to-understand speech
  • Trouble chewing and swallowing

Signs and tests
Most of the disorders affecting the nervous system would produce similar kind of symptoms. The best way in CNS disorder to make any diagnosis is to rule out the rest of neurological conditions.

MS in the given case can be suspected if there are decreases in the function of two or more different parts of the central nervous system (such as abnormal reflexes) at two different times.

A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. This may include:
  • Decreased or abnormal sensation
  • Other loss of nervous system functions
  • Abnormal nerve reflexes
  • Decreased ability to move a part of the body

An eye examination may show:
  • Abnormal pupil responses
  • Changes in the visual fields or eye movements
  • Decreased visual acuity
  • Nystagmus (Rapid eye movements triggered when the eye moves)

Tests to diagnose multiple sclerosis include:
  • Invasive → Lumbar puncture
  • Imaging → MRI scan
  • Nerve function study (evoked potential test)