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 By: Lauren McRae

Multiple sclerosis (MS) is one of the most common neurological disorders in America, but many do not know how to recognize the symptoms, what causes it, or that it can appear alongside other conditions. Dr. Susan Rubin, NorthShore Neurologist, shares some need-to-know information about MS, and what NorthShore is doing to better the treatment process.

What is multiple sclerosis? 
Multiple Sclerosis is an inflammatory and degenerative disease of the central nervous system (brain and spinal cord) leading to loss of the myelin covering of nerves and eventually damage to the nerves themselves.

Are there different types of MS?
Yes, there are both relapsing and progressive forms of the disease that often overlap. Relapsing forms can transition to a more progressive course over time. A primarily progressive form of the disease can have occasional relapses. We previously defined patients by their primary type: relapsing-remitting MS (RRMS), primary-progressive MS (PPMS), secondary-progressive MS (SPMS), and progressive-relapsing MS but now recognize that this can vary over time. Within each person there are varying degrees of severity in which one person may be high functioning with no deficits while another person could be considered.

 What are some of the recognizable symptoms of MS? 

Multiple sclerosis can affect any part of the central nervous system and the symptoms relate to where the inflammation is occurring. Some of the most common symptoms of Multiple Sclerosis include inflammation of the optic nerve leading to vision loss (optic neuritis), inflammation in the spinal cord or brain leading to numbness, weakness, incoordination, bowel and bladder control issues and excessive fatigue.

Can MS symptoms come and go over a lifetime?
Most patients with multiple sclerosis have a relapsing-remitting course which means they will have periods where they develop new symptoms and then periods where they have recovered from those new symptoms and are stable. Unfortunately, over time the ability of the nervous system to recover from new symptoms becomes less effective and patients are left with residual symptoms. Disability builds as the number of residual symptoms builds. Rarely patients have a progressive course from the beginning and develop a progressive disability over time without a distinct onset of new symptoms.

Is MS curable? 
Unfortunately, we do not have a cure for multiple sclerosis yet but we can reduce the effects of the disease by reducing the frequency of new symptoms. With early diagnosis and personalized treatment plans we can significantly reduce relapse rates and disability accumulation, with the goal of preventing or delaying progressive disease. 

What does the current treatment process involve? 
Treatment is divided into two main paths which are often used together to manage the patients. The first is symptom management and we can prescribe many different medications or therapies to help alleviate acute symptoms (often by prescribing anti-inflammatory medications like steroids) as well as control residual symptoms (with medications, physical therapy, lifestyle modification, etc).

The other path is disease modification by prescribing a medication to alter the course of the disease and reduce the likelihood of new symptoms. We are fortunate to now have over 20 disease-modifying medications on the market plus some generic medications so we can tailor the treatment to the patients’ needs and preferences. All of these treatment options are available through NorthShore and all of our MS specialists are comfortable with providing these treatments. 

Some women are diagnosed with MS after pregnancy – is there a reason it appears at this time? 
Sex hormones do have an impact on multiple sclerosis and pregnancy is often a time of reduced disease activity as estrogen and progesterone levels rise. However, in the postpartum period after delivery patients often have an increased risk of disease activity as the hormone levels shift down again. Furthermore, stress can impact disease activity as well making the postpartum period the common time for a first symptom or a new event in an already diagnosed patient.

How does patient care for MS patients differ for those who have had recently had a baby? 
As mentioned above, pregnancy is often a time where there is little activity so patients often come off their disease-modifying medications during pregnancy. The decision then needs to be made whether a patient should go back on medication during that riskier postpartum period. If the mother wants to breastfeed, we don’t recommend being on their disease-modifying medication so we need to provide other methods of decreasing risk like intermittent doses of steroid medications or IVIG to help prevent new symptoms while they are breastfeeding.

Are there any signs pregnant women should look out for that might indicate MS? 
There are no signs that someone might develop MS after their pregnancy. In fact, they often feel great during pregnancy even if they have been diagnosed with the disease previously.

Is there any research/clinical trials being done focusing on MS? Any new treatment options/medications that are being integrated at NorthShore? 
Fortunately, there is a lot of research being done focusing on MS looking for better medications to manage the disease, alternative or lifestyle modifications that could more naturally help treat or prevent the disease and research into possible causes that might lead to a cure. At NorthShore, we are involved in new drug trials as well as our own research to look for genes that might be involved in the disease. A majority of our patients are entered (anonymously) into a database that helps us better understand the disease course, treatment effectiveness and factors that impact management. Blood samples are also collected and sent for genetic analysis to hopefully identify possible causes of this disease.