Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. It occurs when a person’s immune system mistakenly starts attacking healthy cells. The immune system attacks the myelin sheath, a protective fatty tissue surrounding the nerves and spinal cord. 

When the myelin sheath protects the nerves, they can send signals quickly, but if the myelin sheath is destroyed by multiple sclerosis, the nerves become exposed and scarred. They may no longer send signals around the body, which can lead to loss of function and certain disabilities.

The disease is very unpredictable and can be different for each person. Some people may experience mild symptoms, while others may become disabled; they may lose their ability to see, walk, or talk. 

Types of Multiple Sclerosis

Clinically Isolated Syndrome

When people have their first episode of multiple sclerosis symptoms, it is categorised as a clinically isolated syndrome because not everyone who has a first episode will progress to develop the disease fully. Some people may experience only one episode. 

Primary Progressive MS (PPMS)

The people in this category have symptoms of MS, but it slowly and gradually becomes worse over time without any period of remission or relapse.

Relapsing-remitting MS (RRMS)

This is the most common type of MS; it is characterised by recurring episodes of MS symptoms. People with RRMS have occasional flare-ups of new or worsening symptoms, and then a period of remission follows (a time when the symptoms go away or stabilise). 

Secondary Progressive MS (SPMS)

In this case, people who were diagnosed with RRMS progress into SPMS. With SPMS, the symptoms worsen progressively with some relapses or flare-ups, but there won’t be any period of remission afterwards, so it just keeps getting worse with no time for symptoms to stabilise or go away. 

Causes

The exact cause of MS is still unknown. Experts do not know what triggers the immune system to attack itself, but some factors are more likely to contribute, including:

• Living further away from the equator which may cause low levels of vitamin D.
• Genetic factors.
• Environmental factors.
• Smoking.
• Obesity.
• Autoimmune disorders.
• Glandular fever (Epstein-Barr virus).
• Infectious agents such as viruses.

Symptoms 

One of the most common and first signs of multiple sclerosis is vision problems such as optic neuritis (pain in one eye and blurry vision). The other early signs of MS include:

• Tingling or numbness, especially in the arms and legs.
• Fatigue.
• Trouble walking.
• Red-green colour distortion in the eyes.
• Changes in gait.
• Loss of balance and coordination.

Some more severe symptoms of multiple sclerosis may begin to occur later, including: 

• Muscle spasms.
• Muscle weakness.
• Trouble with coordination; you may not be able to stand or walk.
• Partial or complete paralysis.
• Constant tiredness.
• Tremor.
• Hearing loss.
• Dizziness.
• Speech problems.
• Depression.
• Bowel and bladder problems.
• Changes in sexual function.
• Cognitive problems: you may have poor memory, problems focusing or paying attention to anything, or poor judgement.

Treatment

There is no cure yet for multiple sclerosis, but some things can be done to help you manage symptoms, treat flare-ups and significantly improve your function and mobility. The treatment options include:

• Disease modifying therapy, which involves using drugs to slow the disease progression, reduce flare-ups and prevent lesions on the spinal cord and the brain.
• Relapse management medications such as corticosteroids.
• Equipment for support like braces, canes or walkers.
• Rehabilitation to restore function and mobility, to make you as independent as possible, to help you understand your condition better, and to teach you how to care for yourself. 
• Mental health counselling.