Dr. Sharlin: Understanding the Symptoms of Multiple Sclerosis
I’m Dr. Ken Sharlin, a practicing functional medicine board-certified neurologist. When my nurse says the next patient waiting to see me is a 34-year-old woman with numbness and tingling whose doctor referred her because he cannot explain her symptoms and she has a spot on her MRI (Magnetic Resonance Imaging) I jump into action. The patient is worried she might have MS. Unfortunately, she might be right. This is a very common reason patients come to see me, so I’d like to help set the record straight when it comes to understanding the symptoms of multiple sclerosis.
What Is Multiple Sclerosis?
First, a little bit about what multiple sclerosis actually is. Multiple sclerosis, or MS, is a condition in which the immune system attacks the nerves of the brain and spinal cord. It’s a coordinated attack by the patient’s own white blood cells — both T-cells and B-cells (more on this later).
These white blood cells target the nerve cells, called neurons, and damage their fatty conduction-enhancing coat and the nerve cell fascicle itself – called the nerve axon. Commonly, the destruction of myelin and nerve cells occurs (called relapses or exacerbations). The immune system attack eventually kills the nerve.
Sometimes a person is aware of these attacks, and other times they are not — in other words, they can occur without causing symptoms. Attacks which do produce symptoms typically come on gradually, but unexpectedly, and can last for hours to days or even weeks. Sometimes the attacks resolve on their own, other times not. Immune-calming medication may be required, but it doesn’t always work. The attacks can leave in their wake permanent loss of function in the part of the brain or spinal cord affected. (By the way, MS only affects the brain and spinal cord, the central nervous system.) This could mean loss of vision, weakness of an arm or leg, slurred speech, difficulty swallowing, or trouble walking. The fact that the symptoms and changes on the MRI occur in different parts of the central nervous system and throughout the life of the patient provides the defining feature of MS which is the range of the disease over space and time.
How Is MS Diagnosed and What Causes It?
Currently, neurologists use the 2017 Revised McDonald Criteria to evaluate patients like the young woman in the beginning of this blog for Multiple Sclerosis. There are probably many causes of multiple sclerosis.
It turns out that genes which control the immune response contribute only about 25% of the risk. The remainder of causes come from the environment and lifestyle. This includes infection with the Epstein Barr Virus (the virus that causes mononucleosis), cigarette smoking, obesity, solvent exposure, nutritional imbalances, and stress, to name a few.
It has been known for many years that the further a person lives from the equator the greater their risk of MS. But in the 21st century we are a population on the move, so geography becomes a difficult factor to consider when evaluating the likelihood of the diagnosis.
Why Does MS Cause So Many Different Symptoms?
Another idea I frequently discuss with my patients who are worried about multiple sclerosis is that it’s important to remember the symptoms are brain and spinal cord location-specific, not disease-specific.
To illustrate this point, consider the heart and heart disease. The heart is a pump that receives blood and sends blood around the body. Its job is to make sure that blood which has been “recharged” with oxygen by the lungs is distributed to all the tissues in proportion with the demand we put on it. For example, it has to work harder if we climb a set of steps or go for a jog. In the sac that surrounds the heart called the pericardium there are pain-sensitive nerve endings which, when irritated, tell us something is going on with our old tick-tock.
What this boils down to is the fact that when disease affects the heart there are only a few symptoms that we experience – chest pain, shortness of breath (especially with increased exertion), or a backup of fluid when the heart is failing. Notice that none of these symptoms tell us the cause of the heart disease, and the causes are many: blockage of the arteries of the heart, infections, inflammation, things a person is born with, trauma to the heart, and even tumors of the heart, to name a few.
Brain and spinal cord problems follow the same logic, but since the nervous system is much more complicated and diverse, so are the symptoms of brain and spinal cord disease. If, for example, a person has a problem in the part of the brain responsible for vision, then there will be vision-related symptoms. If, on the other hand, a person has a problem in the part of the brain responsible for swallowing, then there will be swallowing problems. The part responsible for balance leads to balance problems; the part responsible for activating muscles leads to weakness.
You see, when playing medical detective, symptoms alone do not necessarily tell us the cause. The same list of disease categories that applies to the heart also applies to the brain, including artery blockage, infection, inflammation, things a person is born with, trauma, tumors, and others, including so-called “de-myelin-ating” diseases (remember the fatty conductive coating around the nerve cells called myelin) like multiple sclerosis.
When the diagnosis of MS is made by a neurologist like me, it is after a careful history, a thorough neurological examination, review of the MRI, and sometimes a spinal fluid test or electrical tests called “evoked potentials.” Also, it is important to consider whether other conditions might be the culprit, and my choice of testing helps me to make the diagnosis of MS while excluding other causes.
Not Everything That Looks Like MS Is Actually MS
Got it? This was a really important point. Not everything that looks like MS is actually MS. It is my personal experience that many people go to the doctor with unexplained symptoms and, particularly if they are young and more often if they are women, they are told they might have MS and to go see a neurologist, like me — the average age of onset for multiple sclerosis is 34, and women are two to three times more likely to develop MS compared to men.
This is a scary journey, but know that you are not alone. MS is a growing problem in the United States, and the estimate of the number of people affected by the condition has grown from 300,000 in the mid-1970s to 750,000 in 2010, to nearly 1 million individuals affected today.
Understanding Common Symptoms of Multiple Sclerosis
You’ve got a little more expertise under your belt, so now we can consider the more common symptoms of multiple sclerosis. These include a painful loss of vision in one eye, double vision due to a lack of eye muscle coordination when both eyes are moved together, numbness or tingling in one part or many parts of the body, weakness of one or more limbs, balance problems, bowel or bladder problems, depression, severe fatigue, and pain.
A particularly classic pattern of MS-related pain is an electrical sensation that goes down the spine when bending or flexing the head toward the chest. This is called “Lhermitte’s sign.” You can see that none of these symptoms are specific for multiple sclerosis because all of them can occur in one situation or another when the brain or spinal cord is affected by disease. Sorting out the diagnosis is work that is best left to an expert, but know that, for people like the 34-year-old woman we met in the beginning, there is hope.
Multiple Sclerosis Treatment has come a long way since the introduction of the earliest disease-modifying therapies in the 1990s. The medications currently available target those T- and B- white blood cells and can have a powerful effect on multiple sclerosis treatment. Research has shown that these medications put a major dent on disease and symptom progression, and those changes can occur on MRI, even when the person affected is unaware. When to choose medication and which one to choose should be considered on an individualized basis and is between you and your neurologist.
Environment, Diet, and Lifestyle Make a Difference
Furthermore, it is increasingly obvious that diet and lifestyle, and the identification of treatable environmental factors can be game-changers when it comes to altering the trajectory of multiple sclerosis treatment. If you haven’t seen them, yet I recorded a series of videos in 2017 with my friend, Dr. Terry Wahls, whose story of MS reversal has inspired thousands of people to make changes in their lives, many with similar success in beating their condition as Dr. Wahls herself.
Dr. Wahls has an annual seminar in Cedar Rapids, Iowa, where she meets people who suffer from a variety of brain conditions, teaches her approach, while also certifying practitioners to go out into their communities and share the same message.
At Sharlin Health and Neurology, there are three Wahls Certified Health Professionals on staff (including myself) who are eager to guide you through the most comprehensive, turn-key approach to battling MS you can find anywhere. Our Unique 5 Pillars Approach will help you Identify the reason for your symptoms, Investigate the root causes, Integrate this information into one patient-centered strategy, and help you Restore your brain using all the available tools in The Healthy Brain Toolbox – medication when appropriate, but also diet, lifestyle, environment modification, genomics, and 21st century Regenerative medicine strategies.