Estimated reading time: 8 minutes

DIAGNOSIS OF MULTIPLE SCLEROSIS

Multiple sclerosis is diagnosed by a neurologist who is a specialist in nervous system disorders. The doctor will ask you questions about your medical history and symptoms, then will perform a physical examination. It is quite difficult for a doctor to diagnose multiple sclerosis because many conditions can have similar symptoms.

The doctor will also perform some tests to see if the brain and spinal cord are working properly. These include:

  • Neurological examination: The neurologist will look for abnormalities, changes or weakness in vision, eye movements, resistance in the hands and feet, balance and coordination, speech, and reflexes.
  • Blood tests: They cannot diagnose multiple sclerosis and are usually performed to rule out other diseases with similar symptoms, such as neuromyelitis optica, a very rare disease.
  • Lumbar puncture: Lumbar puncture is a procedure by which a sample of cerebrospinal fluid is collected by inserting a needle into the lumbar region. Cerebrospinal fluid surrounds the brain and spinal cord, and any changes in it may suggest nervous system problems. The procedure is done with local anesthesia, which means that you will be awake during the procedure, but the area where the needle enters will be numb. The sample is then tested for immune cells and antibodies. It can also help rule out infections and other conditions with similar symptoms. Lumbar puncture is a safe procedure, but it can cause headaches that occasionally last up to a few days.
  • MRI: MRI is a painless scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. An intravenous injection of a contrast agent may be given to highlight lesions indicating that the disease is in an active phase. Also, an MRI result that says things are normal does not rule out multiple sclerosis. You may have lesions in places that the scan cannot display.
  • Evoked potential tests: These record the electrical signals produced by the nervous system in response to stimuli. It is a painless test, the electrodes measure how fast the information moves on the nerve pathways.

TREATMENT FOR MULTIPLE SCLEROSIS

Currently, multiple sclerosis cannot be cured, but there are medicines and other treatments that promote recovery from attacks, slow the progression of the disease, and manage symptoms. Some people have mild symptoms and no treatment is needed.

1. Treatments for multiple sclerosis attacks

  • Steroids: Your doctor may recommend an intravenous dose of steroids, such as methylprednisolone or oral prednisone, to reduce nerve inflammation and relieve symptoms quickly. However, these drugs will not slow down the course of the disease. Side effects may include insomnia, high blood pressure, high blood sugar, mood swings, and fluid retention.
  • Plasma exchange (plasmapheresis): The liquid portion of the blood (plasma) is removed and separated from the blood cells. Blood cells are mixed with a protein solution (albumin) and then reintroduced into the body. Plasma exchange can be used if the symptoms are new, severe, and there has been no favorable response to steroid treatment. During the plasma exchange, blood pressure is lower than usual. This can lead to weakness, dizziness, or nausea. Fatigue may occur after plasma exchange.

2. Treatments to change the progression

  • For primary progressive multiple sclerosis (PPMS): Ocrelizumab helps to slow down nerve damage, reduce the number of recurrences, and delay the disability. This medicine is given by intravenous infusion. The starting dose is given as two separate intravenous infusions; the first infusion is followed two weeks by the second infusion. Subsequent doses are given as a single intravenous infusion every six months. The first subsequent dose should be given six months after the first infusion of the initial dose. Ocrelizumab can cause very serious (rarely fatal) side effects such as rash, itching, shortness of breath, swelling/sore throat, fatigue, fever, fainting, redness of the face, nausea, headache, dizziness, rapid heartbeat.
  • There are several types of treatment available for relapsing remitting multiple sclerosis (RRMS).

Injectable treatments include:

– Interferon beta medicines: They are given by injection under the skin or in the muscles and can reduce the frequency and severity of recurrences, helping people to have a lesser physical disability over time. Side effects of interferon may include flu-like symptoms (injection before bedtime is recommended), injection site reactions (swelling, redness, and pain), mood problems (sadness, anxiety, irritability, guilt, concentration problems, confusion). Blood tests are needed to monitor liver enzymes, as liver damage is a possible side effect of interferon use.
– Glatiramer acetate: This medicine prevents the immune system from attacking the nerves in the brain and spinal cord. This effect can decrease the number of recurrences and can prevent or delay physical disability. It is given by injection under the skin three times a week for at least 48 hours. Side effects may include irritation of the skin at the injection site.

Oral treatments include:

– Fingolimod: This medicine helps to reduce the number of worsening episodes and can prevent or delay physical disability. The dose is adjusted according to the patient’s body weight. This medicine is given orally with or without food, usually once a day. Heart rate and blood pressure will be monitored for six hours after the first dose, as the heartbeat may be slowed. Other side effects include rare serious infections, headaches, high blood pressure, and blurred vision.
– Dimethyl fumarate: This medicine reduces the number of recurrences. This medicine is given orally with or without food, usually twice a day. Side effects may include redness, diarrhea, nausea, and decreased white blood cell counts.
– Diroximel fumarate: It is similar to dimethyl fumarate, but usually has fewer side effects. This medicine reduces the number of recurrences. This medicine is given orally with or without food, usually twice a day.
– Teriflunomide: This medicine reduces the number of recurrences and can help slow down physical problems. This medicine is given orally with or without food, usually once a day. The dose is adjusted according to medical condition and response to treatment. Side effects may include liver damage and hair loss. This medicine is associated with birth defects. Therefore, it is recommended to use contraception during treatment and for two years after stopping it.
– Siponimod: This medicine reduces the number of recurrences and helps to slow the progression of the disease. It is also approved for secondary progressive multiple sclerosis (SPMS). This medicine is given orally once a day. Side effects include viral infections, liver problems, low white blood cell counts, changes in heart rate, headaches, and vision problems. This medicine is associated with birth defects. Therefore, it is recommended to use contraception during treatment and for 10 days after stopping it.
– Cladribine: This medicine is used to treat a certain type of cancer (hairy cell leukemia), it stops the growth of cancer cells. It is also approved for SPMS. It is administered in two cycles of treatment. Each treatment cycle consists of two weeks of treatment, one at the beginning of the first month and one at the beginning of the second month of that treatment year. Each week of treatment consists of four or five days in which the patient is given the medicine. Side effects include upper respiratory infections, headaches, tumors, severe infections, and low white blood cell counts. This medicine is associated with birth defects. Therefore, it is recommended to use contraception during treatment and for six months after stopping it.

Infusion treatments include:

– Natalizumab: It helps by preventing the immune system from attacking the nerves in the brain and spinal cord, decreases the number of worsening episodes, and can prevent or delay physical disability. This medicine is given by intravenous infusion every four weeks. This medicine is mixed into a solution and slowly injected into a vein, usually within an hour.
– Alemtuzumab: This medicine reduces the number of recurrences. It is administered in two cycles of treatment. The initial treatment cycle lasts five consecutive days. The second treatment cycle lasts three consecutive days, being administered 12 months after the initial treatment cycle. Side effects include the risk of infections, thyroid autoimmune diseases, and kidney disease.

3. Lifestyle and home remedies

  • Get plenty of rest: Maintain a regular sleep schedule. The bedroom should be cool, dark and without screens around.
  • Exercise: If you suffer from mild to moderate multiple sclerosis, regular exercise can help you improve your muscle tone, balance, and coordination. Swimming or other exercises in the water are good options. Other recommended types of exercise include walking, low-impact aerobics, stationary bikes, yoga, and tai chi.
  • Stay away from heat: An increase in your body temperature can make your symptoms worse. Avoid exposure to heat and wear light, breathable clothing.
  • Eat healthy foods: There is no diet for multiple sclerosis, but experts recommend foods low in saturated fat and high in fiber. Make sure you take your dose of vitamin D, as it can have potential benefits for multiple sclerosis.
  • Manage your stress: Stress can trigger or worsen your symptoms. Find activities to relax such as yoga, massage, meditation, reading, talking with friends.

If you want to find out about diabetes, check out our article on this topic: Diabetes: diagnosis, treatment, complications, and prevention.

[Photo from Unsplash]