From the Guidelines
Multiple sclerosis (MS) manifests through a wide range of neurological symptoms that vary greatly between individuals, including fatigue, vision problems, muscle weakness, numbness, balance difficulties, cognitive impairments, and emotional changes. These symptoms can be attributed to the demyelination and inflammation in the central nervous system, which disrupts normal nerve signal transmission 1. The specific symptoms experienced depend on which areas of the brain and spinal cord are affected by the demyelinating lesions. Some common manifestations of MS include:
- Fatigue, which affects about 80% of patients
- Vision problems such as blurred vision, double vision, or partial vision loss due to optic neuritis
- Muscle weakness or spasticity that can affect mobility
- Numbness or tingling sensations in limbs
- Balance and coordination difficulties
- Cognitive impairments including memory problems and difficulty concentrating
- Bladder and bowel dysfunction
- Sexual dysfunction
- Pain
- Emotional changes like depression or mood swings These symptoms typically appear in episodes called relapses or exacerbations, followed by periods of remission, especially in relapsing-remitting MS 1. However, in progressive forms of MS, symptoms may steadily worsen over time without distinct relapses. The diagnosis of MS is based on the detection of lesions within the CNS that demonstrate dissemination in space (DIS) and dissemination in time (DIT), and the exclusion of alternative diagnoses that can mimic MS either clinically or radiologically 1. MRI findings can replace certain clinical criteria in a substantial proportion of patients, and the 2010 McDonald criteria have substantially improved the diagnostic process in relapsing–remitting MS (RRMS) 1. However, the diagnosis of primary progressive MS (PPMS) can be challenging, particularly in patients with normal brain MRI and inconclusive spinal cord findings 1. The use of MRI in MS diagnosis and monitoring is crucial, and changes in total brain, grey matter and/or white matter volumes can predict disability, but these measures are difficult to obtain and interpret in the routine clinical setting 1. Therefore, a comprehensive diagnostic approach, including clinical evaluation, MRI, and laboratory tests, is necessary to accurately diagnose and manage MS.
From the Research
Manifestations of Multiple Sclerosis
The manifestations of multiple sclerosis (MS) can vary widely among individuals, but research has identified several key aspects of the disease.
- Relapsing-remitting MS (RRMS) is characterized by relapses or exacerbations of the disease, followed by periods of remission 2, 3, 4.
- Secondary progressive MS (SPMS) is marked by a progressive worsening of the disease, with or without relapses 2, 4.
- The disease can cause a range of symptoms, including relapses, disability progression, and disease activity assessed by magnetic resonance imaging (MRI) 2, 5, 4.
- MRI outcomes, such as new or enlarging T2- or new contrast-enhancing T1 lesions, can be used to assess disease activity 5.
Treatment and Management
Treatment with interferon-beta-1b (IFN-beta-1b) has been shown to reduce the frequency and severity of relapses, as well as slow disease progression in some patients 2, 3, 4.
- IFN-beta-1b is generally well tolerated, with common adverse events including injection site reactions, asthenia, and an influenza-like symptom complex 2, 4, 6.
- The efficacy and safety of IFN-beta-1b have been compared to other disease-modifying therapies, such as glatiramer acetate, in several studies 5, 4.
- High-dose/frequency regimens of IFN-beta-1b may provide better long-term outcomes, although the overall severity of adverse events does not appear to be affected by different IFN-beta exposures 6.