Multiple Sclerosis (MS)

Following are the types of multiple sclerosis:

1. Relapsing-Remitting (RRMS): Patients have occurrences of multiple sclerosis symptoms, with or without recovery, but between attacks, there is no interval worsening.
   
2. Secondary-Progressive (SPMS): This stage comes a few years after RRMS and the pattern changes from a relapsing one to a progressive one in between the attacks.
   
3. Primary-Progressive (PPMS): Gradual onset from the beginning with no attacks.
   
4. Progressive-Relapsing (PRMS): One of the rare forms of multiple sclerosis, it begins with a progressive course which later transforms into developing attacks.
   
5. Fulminant: A rare yet extremely severe and rapidly progressive multiple sclerosis.

The causes of multiple sclerosis are still not known. However, there is an interaction of several factors. Extensive research is being carried out in genetics, immunology, and epidemiology, according to which, multiple sclerosis causes can be classified into the following categories:

• Immunologic Factors: Multiple sclerosis occurs when the immune system attacks the nervous system. Recently, researchers have identified the immune cells that initiate the attack and factors that cause the immune cells to attack.
  
• Environmental Factors: The disease is more prevalent in regions that are farther from the equator. Enough evidence shows that Vitamin D plays a significant role in strengthening the immune system. People who are exposed to more sunlight throughout the year have lesser chances of developing multiple sclerosis symptoms.
  
• Genetic Factors: The disease is not genetic. However, having a first-degree relative such as a parent or sibling with multiple sclerosis increases the chance of developing the disease.
  
• Infectious Factors: Any initial exposure to certain viruses, bacteria, and other microbes during childhood can cause multiple sclerosis in the future. Since viruses are well-recognized as triggers of demyelination, the removal of the myelin sheath from a nerve fibre can lead to multiple sclerosis.
  
  Attacks of neurological symptoms having a tendency to improve if appropriately treated. However, depending on the severity of the disease and the frequency of such attacks, patients can develop permanent disabilities including getting wheelchair-bound or even going into a bedridden state, more so if timely diagnosis and management is not done.
  

• Loss of balance
• Muscle spasms
• Numbness or abnormal sensation in any area
• Problem walking or moving arms or legs
• Problems with coordination and making small movements
• Tremor/weakness in one or more arms or legs

Sclerosis is characterized by ‘attacks’ of neurological symptoms lasting for at least 24 hours, depending on the area of involvement of the brain or spinal cord. More common multiple sclerosis symptoms include:

• Diminution of vision in one or both eyes
• Tingling or numbness with/ without reduction of strength, or coordination of limbs of same side
• Weakness of lower limbs or all four limbs with retention of urine and/or stool along with a sensory loss over back or trunk
• Imbalance on walking
• Difficulty in speaking or swallowing

At Max Institute of Neurosciences (MINS), we have an exclusive Multiple Sclerosis Clinic that offers consultation, comprehensive diagnosis and therapies for the condition. Here we offer the following tests to diagnose multiple sclerosis:

• Neurological examination: This may suggest problems with the spinal cord or brain.
• Imaging studies: MRI is the most common test that helps diagnose the disease.
• Spinal tap or lumbar puncture: It is conducted to collect a small amount of cerebrospinal fluid which is used to confirm the presence of proteins, inflammatory markers or other substances. Generally, a spinal tap is not required if one’s MRI scans are normal.

Once multiple sclerosis is confirmed in a patient, modifying therapy is recommended. This treatment controls the occurrence of symptoms. It includes drugs for controlling symptoms to prevent attacks in the future.

Max Institute of Neurosciences (MINS) provides world-class super speciality tertiary care for all kinds of neurological disorders. Apart from an array of services like Advanced Brain Tumour Centre,  Minimally Invasive Spine Surgery Centre and  Stroke Centre, the institute boasts of having India's first BrainSUITE - the most advanced Neuro Operation Theatre.  

We have leading and experienced neurologists with highly recognised clinical and research work in multiple sclerosis helping in treating patients with the highest level of expertise. We have special clinics, with a dedicated team of clinicians working for such patients. Most of the management in the early stages of the disease is done through medication, but it becomes more challenging when it comes to management of patients in advanced stages.

In advanced stages, many other therapies including the latest monoclonal antibody therapy, intravenous immunoglobulin therapy, plasma exchange and bone marrow transplant etc might be required. Max Institute of Neurosciences, with its state-of-the-art infrastructure and cutting-edge technology, can provide all mentioned therapies under one roof if required.

Sclerosis is considered to be an auto-immune disease, where one’s own immune system starts creating antibodies directed against certain tissues in the brain and spinal cord. This produces a focal inflammation (known as the demyelinating plaque) in the early stages, which can cause irreversible damage and degeneration if left untreated.

Multiple sclerosis is often difficult to diagnose because there is no single diagnosis or test for finding out if the person suffers from it or not. The neurological symptoms in the initial stage typically improve even without treatment. But, if not diagnosed and treated early, these deficits continue to accumulate over a period of time leading to progressive and permanent physical disability. Since symptoms vary from person to person, our neurologists have to take the history of neurological symptoms into account.

• How to Find a Neurologist When Suffering from Multiple Sclerosis
• Is Your Headache a Symptom of Multiple Sclerosis?
• Autologous Stem Cell Transplant for Multiple Sclerosis