Multiple Sclerosis is a disease affecting the central nervous system (the brain and spinal cord). The immune system attacks the protective sheath covering the nerve fibers causing a disruption the flow of communication within the brain and between the brain and the rest of the body. Symptoms of Multiple Sclerosis develop as a result to the damage and deterioration to the nerves affected by the interrupting in communication.
Four disease courses have been identified in Multiple Sclerosis. Patients will generally follow one of the four disease courses with symptoms varying in severity. The four courses of Multiple Sclerosis are:
Clinically Isolated Syndrome: Considered the first episode of neurological symptoms, lasting at least 24 hours, caused by nerve damage in the central nervous system. While clinically isolated syndrome is a characteristic of Multiple Sclerosis, not all patients who experience CIS may develop Multiple Sclerosis. Early diagnosis and treatment of clinically isolated syndrome can potentially delay the onset of Multiple Sclerosis.
Relapsing Remitting Multiple Sclerosis: The most common disease course, characterized by clearly defined attacks of new or worsening neurological symptoms and radiological changes followed by periods of remission. Exacerbations, also referred to as relapses, are followed by periods of remission in which symptoms appear to stabilize and no signs of disease progression are evident. Development of new lesions on the central nervous system, seen on radiological scans, occur as part of a relapse but do not always occur with new or worsening symptoms.
Secondary Progressive Multiple Sclerosis: Occurs when neurological symptoms worsen and increasing disability develops over time. Patients experience a gradual increase in symptoms with or without evidence of disease activity, occasionally experiencing relapse with periods of stability.
Primary Progressive Multiple Sclerosis: Characterized by worsening neurological functioning and increased disability without early stages of relapse or remission. Patients may experience brief periods of stability or periods of increasing disability with or without new relapses or radiological changes.
Symptoms can include but are not limited to:
Diagnosing Multiple Sclerosis requires a neurological evaluation, complete with a medical and family history. Radiological images such as an MRI are also essential in diagnosing Multiple Sclerosis. MRI scans can aid in a quicker diagnosis as they can show the presence of lesions on the central nervous system.
In some cases, providers may need to order a lumbar puncture to confirm a diagnosis of Multiple Sclerosis. A lumbar puncture will allow testing of cerebral spinal fluid (the fluid surrounding the brain and spinal cord) to evaluate for cellular or chemical abnormalities indicative of Multiple Sclerosis. Lumbar punctures often help support findings on radiological scans though are not always necessary.