Multiple Sclerosis (MS) is an inflammatory condition of the brain and spinal cord affecting about 1 in 1000 people. The cause of MS remains unknown, though genetic and environmental risk factors have been identified. MS can be divided into two main subtypes based on the course of disease.
Relapsing MS is the most common form of multiple sclerosis. The condition is characterized by attacks of inflammation in the brain white matter, referred to as relapses, resulting in the sudden appearance of new symptoms. Common symptoms of an MS relapse include loss of vision, double vision, imbalance, loss of strength or sensation in a region of the body. Symptoms of an MS attack typically last days or weeks, and often resolve spontaneously. However, treatment with corticosteroids can promote a faster recovery.
Progressive MS is a form of multiple sclerosis in which patients experience slow and gradual loss of function without obvious relapses. About 10-15% of MS patients have primary progressive multiple sclerosis, in which they never experience an attack. The first signs of progressive MS often include difficulty with walking, gradual weakness of one or both legs, and difficulty with controlling urination or bowel movements. Secondary progressive MS is the term used when someone who previously experienced relapses begins to develop progressive disability without new attacks or lesions on MRI.
Diagnosis of MS
Advances in imaging technology allow us to diagnose MS much earlier in the course of disease than previously possible based on disease course alone. MRI imaging of the brain and spinal cord helps neurologists distinguish between MS and other disorders that have similar symptoms. Spinal fluid obtained by lumbar puncture (LP) can help confirm the diagnosis by showing antibodies (known as “oligoclonal bands”) against the myelin cells that coat the nerve fibers in the brain. LP can be performed in the clinic by your neurologist, or can be done by an interventional radiologist with assistance of X-ray fluoroscopy. During the lumbar puncture, you lie on your side with knees bent and pulled up toward your chest, and after injecting a local anesthetic, a needle is placed in the lower back to obtain spinal fluid. This procedure takes about 20 minutes and is well tolerated with minimal discomfort. With advances in MRI imaging, LP is not always necessary to make the diagnosis, but can be important to rule out alternative diagnoses.
Disease Modifying Therapy
Treatment options for controlling MS have evolved at an astounding rate over the last decade. Before 1993, there was no treatment that could prevent MS attacks, and the only treatments were steroids or the steroid-stimulating hormone ACTH to speed recovery from attacks. In 1993, interferon beta was introduced as the first disease-modifying therapy, followed by glatirimer acetate in 1998. In recent years, new medications have been introduced at an increasing rate. While previously all medications for MS required frequent skin or muscle injections, today patients have access to oral medications and intravenous infusions. These newer treatments are not only more convenient than earlier injected medications, they are also more effective for preventing relapses and quieting inflammation.
Our team takes a patient-centered approach to choosing the most appropriate treatment for each patient, balancing your personal preferences, medication side effects and risks.
Comprehensive MS Care
In addition to offering a tailored approach to the prevention of MS relapses and progression, our clinic strives to address the multifaceted concerns that come with multiple sclerosis. Patients with MS may experience symptoms including fatigue, cognitive difficulty, urinary urgency or incontinence, depression or anxiety, pain, difficulty walking, muscle stiffness and spasticity. Our team aims to provide relief from the many symptoms an MS patient may experience, with the help of other UConn Health specialists. We believe that a multidisciplinary approach is the best way to provide you with superior control of your condition and the best quality of life.
Neuromyelitis optica (NMO), once known as Devic’s disease, is an autoimmune condition affecting the white matter of the spinal cord and optic nerve, typically sparing other areas of the brain which distinguishes it from MS. The inflammatory NMO lesions in the optic nerve are referred to as optic neuritis and can cause poor vision or blindness, while attacks of the spinal cord known as transverse myelitis can cause severe weakness, spasticity and poor control of bowel and bladder. Both optic neuritis and transverse myelitis are also common in MS relapses, and NMO was originally suspected to be a form of MS. In 2004, the distinction between NMO and MS was confirmed when an antibody to the water channel protein, aquaporin-4, was found to be specific to NMO. This antibody is now used in diagnosing the disease, and 80-85% of patients with NMO spectrum disorders will have anti-aquaporin-4 antibodies in their blood. The distinction between NMO and MS is critical, because the treatment options are remarkably different. In fact, a number of medications used to treat MS should be avoided since they can worsen the course of NMO.
Our clinic offers expertise in the diagnosis and management of NMO. The UConn Neurology team includes a neuro-ophthalmologist with additional expertise in NMO, as well as advanced diagnostic technologies such as optical coherence tomography (OCT), which can show loss of axon fibers in the retinas of patients with NMO.
Sarcoidosis is a multi-organ inflammatory disease which can affect the lungs, heart, skin, as well as the brain, spinal cord, and nerves. It is quite uncommon, but more frequently seen in people of African and Scandinavian ancestry. About 5 to 15% of patients with sarcoidosis have nervous system involvement. Manifestations of neurosarcoidosis are varied, and include facial numbness, double vision, headaches, weakness, and cognitive complaints. Symptoms of sarcoidosis tend to be progressive unless treated. Serious complications can arise from hydrocephalus and damage to the hypothalamus.
Diagnosing neurosarcoidosis can be challenging, since it is hard to distinguish sarcoidosis lesions from other diseases by MRI, and there is no specific blood or spinal fluid test to establish the diagnosis. Confirmation of neurosarcoidosis often requires biopsy of affected lymph nodes, and if no other tissues are affected, biopsy of a brain lesion may be necessary.
Treatment for neurosarcoidosis relies on immunosuppressive medications including steroids, azathioprine or methotrexate, with a good possibility of achieving long-term remission.
You can find out more about neurosarcoidosis at the National Institutes of Health.