What is Multiple Sclerosis?
Multiple Sclerosis
Multiple sclerosis (MS) is a disease in which the immune system attacks the brain and spinal cord, damaging nerve fibers over time. People with MS often live with uncertainty and worry, because symptoms can flare without warning and affect many different functions. MS can affect balance, vision, strength, sensation and even thinking. It can be very challenging to live with.
How Common Is MS?
Nearly 1 million Americans are living with multiple sclerosis. MS occurs in most ethnic groups but appears to be more common in people of northern European descent. It is about three times more common in women than in men, which suggests hormones may play a role. MS usually begins between ages 20 and 50, though it can start at any age. It is also more common in people who live farther from the equator, for reasons that are still debated (1).
What Causes MS?
MS is an autoimmune disease in which the immune system attacks myelin, the protective coating around nerve fibers in the brain and spinal cord. Myelin protects nerve fibers and helps signals travel quickly and efficiently between nerve cells.
Myelin-coated nerve fibers make up the white matter of the brain and spinal cord. When an MS attack damages myelin, signals slow down or break down, and the underlying nerve fibers become more vulnerable to damage. Inflammation from MS attacks can leave behind areas of scarring, and over time it can lead to the loss of nerve fibers and nerve cells (2).
Research also suggests that MS may damage synapses, the connections between nerve cells, which can further affect how nerve cells communicate (3).
What Are the Symptoms of MS?
MS can cause many different symptoms. Common ones include numbness or other changes in sensation, bladder problems, thinking and memory problems, and vision loss in one eye, often with pain when moving the eye. Double vision, limb weakness, balance and coordination problems, fatigue and bowel problems are also common. Because MS can affect almost any part of the nervous system, it can show up in many different ways, and no two cases are exactly alike (4).
If you have MS and notice new symptoms or a sudden worsening of existing symptoms, contact your neurologist promptly, since this may be a relapse that needs treatment.
How Does MS Affect the Brain?
The symptoms of MS depend largely on where damage occurs in the brain and spinal cord. MS can affect different areas at different times, and attacks can range from mild to severe. After milder attacks, not all function is lost, and the nervous system may be able to repair itself or reroute around the damage. Not all of the damage from MS is permanent. The brain constantly works to adapt and reorganize to keep its systems working.
There are limits to how much the brain can adapt. With enough damage, the brain can no longer fully compensate, and symptoms can become permanent (5).
How Is MS Diagnosed?
MS is diagnosed by a neurologist. No single symptom or test can diagnose it on its own. Diagnosis is based mainly on symptoms and findings that point to damage in the brain and spinal cord, and MRI and spinal fluid testing can help confirm it (6). Diagnostic criteria look for evidence of damage in more than one area of the nervous system and at more than one point in time (7).
MS is often grouped into types based on how it behaves over time. The main types are clinically isolated syndrome (CIS), relapsing-remitting MS, secondary progressive MS and primary progressive MS (8).
How Is MS Usually Treated?
There is no cure for MS. Treatment focuses on speeding recovery from attacks and slowing the disease by calming the immune system.
MS relapses are often treated with corticosteroids, and sometimes with plasma exchange.
Many disease-modifying medications are available to slow MS. Starting effective treatment early can lower the relapse rate, slow the formation of new lesions and reduce long-term damage. Some of these medications can have serious side effects, so your neurologist will help weigh the benefits and risks (9).
Other treatments focus on managing symptoms. Physical therapy, counseling and other supportive therapies are often helpful.
Diet may also play a role. A review by Esposito and colleagues looked at many diets people with MS try. While large, well-designed studies are still limited, the authors recommended an overall healthy lifestyle with balanced nutrition, including healthy unsaturated fats, unrefined carbohydrates, fiber and antioxidants, and correcting any vitamin deficiencies. Because diet-related conditions like malnutrition, metabolic syndrome and heart disease are linked to worse physical function and quality of life in MS, the authors recommended nutritional counseling for everyone with MS (10).
Studies have also found that regular exercise, including resistance training, can improve fatigue, function and balance in people with MS (11). Some people with MS hesitate to exercise because of their symptoms, but a well-designed program can be safe and helpful.
How the NeuroRescue Program Can Help
Our care works alongside your neurologist and your disease-modifying treatment, never in place of them. Please don’t stop or change any MS medication without talking with your neurologist.
Lifestyle and nutrition. We look for diet, nutrition and lifestyle factors that may add to inflammation, such as nutrient deficiencies and gut health. These factors don’t cause MS, but some research suggests that diet and lifestyle approaches may help with inflammation and quality of life in people with MS (12, 13).
Eye movements. Much of our work involves targeted eye movement therapy. A research review by Gil-Casas and colleagues found that eye movement problems are common in MS, with nearly half of patients having problems with saccades, the quick jumps of the eyes between targets, or with pursuit, the ability to follow a moving target. The most common saccade problem was the eyes falling short of the target, and during pursuit the eyes often fell behind and had to catch up in small jumps. Other common findings included nystagmus, a repeated drifting and jerking of the eyes, and internuclear ophthalmoplegia (INO), in which the eyes don’t move together properly. These problems can contribute to dizziness, double vision and balance problems (14).
Other research found that people with MS were slower to start eye movements toward a target and had more difficulty with anti-saccades, in which a person must look away from a new target. On MRI, these eye movement measures were linked to the amount of gray matter in the brain, including in areas involved in attention (15).
We measure eye movements with infrared eye tracking, called videonystagmography (VNG). Studies suggest that subtle eye movement changes are common across all types of MS, even early on, and may sometimes appear before other signs (16). Our testing is used to guide rehabilitation, not to diagnose MS.
Balance. Many people with MS struggle with balance and walking. Because MS often affects brainstem pathways that connect the inner ear’s balance system with eye movements, many balance problems in MS involve the vestibular system. Studies have found that vestibular rehabilitation can improve balance, fatigue, daily activities and short-distance walking, even in people with more severe MS (17). Combining balance training with eye movement and gaze stabilization exercises has been shown to help people with MS who have balance problems and fatigue (18).
We focus on eye movements and on how eye movements, balance, movement and thinking work together, with the goal of improving balance, stability, fatigue and daily function.
Electrical stimulation. Your program may include electrical stimulation, applied through the skin. Bladder problems are common in MS, and stimulation of the tibial nerve in the leg has been studied as a treatment for bladder control problems in MS (19). Functional electrical stimulation of the nerves in the legs has also been studied for improving walking distance and balance, and reducing pain and fatigue (20).
Light therapy. One study found that low-level laser therapy increased levels of IL-10, an anti-inflammatory signaling molecule, in people with MS (21).
Cognitive training. Problems with thinking, memory and processing speed are common in MS. We use computerized cognitive training to exercise these skills. A review of studies found that computerized cognitive training led to small but meaningful improvements in overall thinking skills in people with MS (22).
Transcranial magnetic stimulation. TMS has been studied for reducing symptoms and improving function in MS (23), and one study found that combining TMS with laser therapy improved quality of life (24). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it’s appropriate for you.
Other therapies. Your program may also include mirror therapy, which has been studied for improving mobility and function (25), and exercises in a virtual reality environment, which have been studied for reducing fall risk (26) and improving walking, balance and thinking skills such as attention, memory and visual-spatial skills (27). Some programs also include mild hyperbaric therapy as a structured recovery option between more demanding therapy sessions.
Every NeuroRescue Program is different, with therapies chosen based on your testing and your specific situation. No two people with MS are alike, and no two programs are either.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function and endurance in the systems that need support. Our testing also helps us decide when to push and when to let you rest, which matters especially with MS fatigue.
We can’t bring back nerve cells that have been lost. What we can do is work with the pathways that remain, helping them work more efficiently and work better together. Our goal is to help you improve your balance, energy and daily function, and enjoy more of your life.
Your Next Step
Living with multiple sclerosis is challenging, but symptoms can often be managed and function can often improve. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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