Multiple Sclerosis: What it is, Causes, Treatment & More

What is Multiple Sclerosis?

Each nerve in the human brain and spinal cord is wrapped in a protective layer called myelin. It keeps signals moving efficiently between the brain and the rest of the body, enabling basic functions such as movement, sensation, and vision. In multiple sclerosis or 'MS', the immune system turns against this protective layer, mistakenly treating myelin as a threat and attacking it. Over time, this damage can cause scarring or sclerosis. These scars develop in multiple locations within the central nervous system.

How the condition affects a person varies considerably. Some people experience episodes of symptoms followed by periods of remission, during which no new symptoms appear. In more severe cases, damage to nerve fibres can be permanent, affecting a person's ability to walk or move independently.

What are the Types of Multiple Sclerosis?

MS is currently recognised as having four distinct disease courses, each differing in how symptoms appear, progress, and resolve over time. Here is an overview of each:

How Common is Multiple Sclerosis in India?

The true burden of multiple sclerosis in India remains difficult to quantify, largely due to limited research. Current estimates of the National MS Registry place the prevalence anywhere between 20 and 40 per 1,00,000 people, while India-focused analyses using age-standardised data suggest a figure of approximately 7.8 per 1,00,000, translating to around 110,000 patients. Global Burden of Disease data places the number at approximately 106,600 cases. States such as Maharashtra, Tamil Nadu, and Karnataka report a higher prevalence of MS compared to other parts of the country.

Perhaps the most alarming aspect of MS in India is not the number of known cases, but the number of unknown ones. Research suggests that only around 35% of MS cases in India are formally reported, meaning an estimated 65% of people living with the condition have never received a proper diagnosis.

What are the Symptoms of Multiple Sclerosis?

Symptoms of MS can be different for each person, depending on the type and the location of nerve damage. General symptoms of multiple sclerosis include:

• Fatigue

• Feeling numb or a tingling sensation in the face, arms, or legs

• Muscle weakness or stiffness

• Bladder and bowel problems

• Vision problems

• Difficulty walking

• Cognitive issues including memory problems, brain fog, or difficulty concentrating.

What Causes Multiple Sclerosis?

In people with MS, the immune system targets myelin, a fatty protective layer that surrounds nerve fibres in the brain and spinal cord. Hence, it is classified as an autoimmune disorder. Myelin helps electrical signals travel smoothly between the brain and the rest of the body. When this protective covering becomes damaged, communication between nerve cells is disrupted, causing messages to slow down, become distorted, or fail to reach their destination altogether.

The exact cause of the myelin damage is not yet known. However, current evidence suggests that MS is caused by genetic and environmental factors.

Risk Factors of Multiple Sclerosis

Research has identified several factors that can increase a person's chances of developing multiple sclerosis. Here are some prominent ones:

• Age and Gender: MS is most frequently diagnosed in teenagers and adults who are between 20 and 40 years old. However, it can be diagnosed at any age. Women are more likely to have it than men.

• Genetics: If any of your parents or your siblings have multiple sclerosis, the chances of you having the condition are high. Certain inherited genetic traits may make some individuals more susceptible to developing the condition when combined with environmental influences.

• Low Vitamin D Levels: Limited sunlight exposure and reduced vitamin D can be related to an increased likelihood of developing multiple sclerosis.

• Previous Viral Infections: Certain viral infections have been associated with a higher risk of MS. One of the most commonly studied is the Epstein-Barr virus, which causes infectious mononucleosis.

• Other Autoimmune Conditions: If you are diagnosed with other autoimmune disorders, you may have a slightly higher risk of MS.

• Being Overweight: Obesity, particularly during childhood or teenage years, has been linked to a greater risk of developing MS later in life.

• Geographical Location and Climate: MS tends to occur more frequently in regions with temperate climates and is less common in areas closer to the equator.

What are the Complications of Multiple Sclerosis?

If the disease progresses over time, it can lead to several physical, cognitive, and emotional challenges. Here are some of the most commonly seen complications:

• Difficulty Walking and Balance Problems: Muscle weakness, stiffness, vision changes, and poor coordination can make walking difficult. Some people may eventually require walking aids such as walkers, or wheelchairs.

• Bladder and Bowel Dysfunction: Damage to nerve pathways can interfere with normal bladder and bowel control, leading to urgency, constipation, difficulty urinating, or loss of control.

• Memory and Thinking Issues: Some people experience problems with concentration, memory, information processing, and decision-making, which can affect daily activities and work.

• Depression, Anxiety, and Mood Changes: Living with a long-term neurological condition can have a significant emotional impact. Depression, anxiety, and mood swings are common among people with MS.

• Sexual Dysfunction: MS can disrupt nerve signals involved in sexual function, affecting sexual desire, arousal, erections, orgasm, or sexual comfort.

• Muscle Stiffness and Spasms: Tight, painful muscles and involuntary spasms can develop, particularly in the legs, making movement and daily tasks more challenging.

• Vision Problems: Damage to nerves involved in vision may cause blurred vision, double vision, eye pain, uncontrolled eye movements, or temporary vision loss.

• Weak Muscles or Paralysis: More advanced cases may cause extreme muscle weakness or paralysis, especially in the arms or legs, affecting independence and mobility.

• Seizures: Although uncommon, some people with MS may develop seizures due to changes affecting the brain's normal electrical activity.

When Should I See My Healthcare Provider?

You should consult a doctor if you notice symptoms that could be associated with multiple sclerosis, especially if they persist, worsen over time, or occur without an obvious cause. These symptoms may include unexplained weakness, muscle stiffness, numbness, vision problems, etc.

As many MS symptoms can resemble those of other neurological or medical conditions, a proper diagnosis from a doctor is essential before starting any line of treatment.

How is Multiple Sclerosis Diagnosed?

Identifying multiple sclerosis can be challenging because there is no single test that can definitively confirm the diagnosis. A series of medical and blood tests is required to confirm the suspicion of MS.

How is Multiple Sclerosis Treated?

Multiple sclerosis does not have a complete cure yet. Treatment options are available for slowing the progression, relieving symptoms, and reducing the frequency of relapses.

• Disease-Modifying Therapies (DMTs): These medicines help reduce the number of relapses, slow the progression of the disease, and decrease the formation of new lesions in the brain and spinal cord.

• Medicines for Relapses: During severe flare-ups, corticosteroids may be prescribed to reduce inflammation and speed up recovery. These medicines can be given as tablets, injections, or intravenous (IV) infusions.

• Plasma Exchange (Plasmapheresis): If symptoms do not improve with steroid treatment, plasma exchange may be used to help reduce damage from a severe ongoing relapse.

• Symptom-Specific Medications: Doctors may prescribe medicines to manage particular symptoms such as pain, muscle spasms, tremors, seizures, vision problems, or cognitive difficulties.

• Mobility Aids and Supportive Devices: Canes, walkers, wheelchairs, and other assistive devices can help people maintain independence and move around more safely.

• Mental Health Support: Counselling, therapy, and medications may be recommended to help manage depression, anxiety, mood changes, and the emotional challenges associated with living with MS.

• Fixing Your Lifestyle: Engaging in regular physical activity, eating a nutritious diet, getting enough sleep, managing stress, and adhering to the prescribed treatment plan can help improve your daily life.

Can Multiple Sclerosis be Prevented?

There is no known way to completely prevent multiple sclerosis because its exact cause has not yet been identified. However, certain measures may help reduce the risk of disease progression or support long-term health.

• Follow Prescribed Treatment Plans: Disease-modifying therapies (DMTs) are currently the most effective way to reduce relapses and slow the progression of multiple sclerosis in people who have been diagnosed.

• Keep a Healthy Lifestyle: Eating a nutrient-rich diet, getting proper sleep, and exercising regularly can support overall well-being and may help better manage the condition.

• Avoid Tobacco Products: Smoking is connected to an increased risk of MS and may contribute to faster disease progression, making tobacco avoidance particularly important.

• Monitor High-Risk Individuals: People with a parent, sibling, or child who has MS may have a higher risk of developing the condition. Researchers are exploring ways to identify MS earlier in these individuals so treatment can begin before significant damage occurs.

• Look After Mental Well-Being: Living with a chronic neurological condition can affect mood, memory, and emotional health. You must ask for support from mental health professionals when needed. It is an important part of long-term disease management.

What is the Prognosis of Multiple Sclerosis?

If you have this condition, you will need to manage it for life, as there is no definitive cure. Managing MS requires regular medical care, symptom management, and monitoring of disease progression. The course of the condition can vary from person to person, with some experiencing mild symptoms for many years and others facing more significant challenges.

The good news is that most people with MS can expect to have a near-normal life expectancy. The condition itself is only rarely fatal. Taking proper treatment, staying active, avoiding smoking, and paying attention to mental well-being can all help improve quality of life.

Does Health Insurance Cover Multiple Sclerosis?

Yes, most health insurance companies in India provide coverage for multiple sclerosis. Since MS is a serious condition that requires long-term treatment, most health insurance companies cover it under their critical illness plans.

Critical illness plans generally provide a lump-sum payout upon diagnosis of the condition, subject to the policy terms and conditions. This amount can be used for medical treatment, rehabilitation, OPD charges, tests, etc.

It is worth noting that most critical illness plans include a waiting period, typically 30 to 180 days from the policy commencement date. Also, insurers generally require a survival period of 7 to 30 days. As coverage terms, waiting periods, survival periods, and eligibility criteria differ across insurers, it is advisable to carefully review the policy wording before purchasing a plan.

How Much Health Insurance is Required for Multiple Sclerosis?

Multiple sclerosis is a long-term condition that often requires lifelong medical management, including consultations, tests, medications, therapies, and occasional hospitalisation. Treatment costs can accumulate significantly over the years.

Critical illness insurance plans typically offer sum insured options starting from around ₹1 lakh and can extend up to ₹1 crore or even ₹2 crore. It is generally advisable to have at least ₹10 lakh to ₹20 lakh of insurance cover. A higher sum insured can provide better financial protection.