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Multiple Sclerosis Symptoms, Treatment, Diagnoses, and Raising Awareness

Emma K. Baran

Wheaton College MA

PSY 225: Introduction to Neuroscience

Christina J. Reppucci, PhD

December 4th, 2023

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Multiple Sclerosis Symptoms, Treatment, Diagnoses, and Raising Awareness

Multiple Sclerosis (MS) is a debilitating and disabling disease of the central nervous

system, in which the immune system attacks the myelin that insulates neurons (Mayo Clinic,

2022). Myelin is essential to the overall function of the body, it encases, insulates, and assists in

sending action potentials down the axon, to the axon terminals, and eventually releasing

neurotransmitters into the postsynaptic region (Vorvick et al., 2023). An action potential starts in

the soma, or cell body, of a neuron. There, the summation of neurotransmitters from the

presynaptic cell is gathered and added together, resulting in a net potential (Watson & Breedlove,

2021). This net potential moves to the axon hillock, where if it reaches threshold (-40mV), it will

begin to depolarize the cell, moving the cell out of its resting phase (where the voltage is

-65mV). Depolarization occurs when voltage-gated Na+ channels open and Na+ begins to flow

rapidly into the cell. Once the potential hits its peak at -40mV, repolarization will occur.

Voltage-gated Na+ channels close immediately as the potential hits its peak, and voltage-gated

K+ channels open when the potential begins to fall. The voltage-gated K+ channels remain open

until the cell falls into the hyperpolarization phase, and the channels don’t close until the

potential returns to resting potential at -65mV (Grider et al., 2023). This occurs simultaneously

down the axon, efficiently sending an electrical signal to release neurotransmitters through the

axon terminals into the postsynaptic region, where they are absorbed by the next neuron (Watson

& Breedlove, 2021).

Throughout this process, the myelin sheath insulates the signal and allows the potential to

fluctuate as it needs. Without myelin, communication is disrupted, and the electrical signals

cannot properly travel down the axon, causing the action potential to slow down, or stop

altogether (Vorvick et al., 2023). This damage to the myelin creates the multitude of symptoms
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that individuals suffering from Multiple Sclerosis experience. Symptoms like numbness,

weakness, tingling, lack of coordination, and fatigue are just a few features of the debilitating

disease (Mayo Clinic, 2022). Though the symptoms of Multiple Sclerosis are widely known, the

diagnosis and treatment of it are highly underdeveloped.

The purpose of this report is to help bring about a better understanding of Multiple

Sclerosis and to provide awareness for those who may not know about the seriousness of this

condition. To prove why Multiple Sclerosis needs more attention, I will provide an overview of

the most common symptoms, the four types of Multiple Sclerosis, treatments, the difficulty of

the diagnosis, and lastly, the importance of Multiple Sclerosis awareness to me.

Symptoms

Most Common MS Symptoms

Symptoms of Multiple Sclerosis can vary from person to person, as the myelin does not

deteriorate in the same way for everyone suffering from MS, and not everyone experiences the

same symptoms. The most common symptoms are: limb numbness (typically in one side of the

body at a time), stiffness/spasms, tremors, tingling, weakness, fatigue, unsteady gait/ inability to

walk, Lhermitte’s Sign (electric shocks caused by certain neck movement), lack of coordination,

vision loss, vertigo, cognitive impairment, and mood/emotional swings (MS Society, Early Signs

of MS). The most widely supported hypothesis is that MS is triggered by a combination of

genetic predisposition, and environmental factors; however, it is still unknown exactly how an

individual gets Multiple Sclerosis (National Multiple Sclerosis Society, What Causes MS?).

Multiple Sclerosis is mostly suffered by women, but is not governed by gender. Around four

times as many women have MS than men, and around two hundred people a year are diagnosed
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with MS (Mowry & Calabresi, 2023). There is still no cure despite the growing number of MS

diagnoses, and treatments are still not enough to help stop the progressive types of MS.

Types of MS

Multiple Sclerosis is an unpredictable disease, though it can be divided into four different

types. As defined by the International Advisory Committee on Clinical Trials of MS in 1996, the

different types of Multiple Sclerosis are: Clinically Isolated Syndrome (CIS),

Relapsing-Remitting MS (RRMS), Secondary Progressive MS (SPMS), and Primary Progressive

MS (PPMS) (National Multiple Sclerosis Society, Types of Multiple Sclerosis). Clinically

Isolated Syndrome, or CIS, refers to the first episode of MS symptoms. Individuals will only be

diagnosed with CIS if the episode lasts twenty-four hours, but not all those diagnosed with CIS

will go on to develop MS itself. Symptoms of CIS include, but are not limited to: vision

problems, vertigo, loss of sensation in the face, weakness in the appendages, and lack of

coordination (National Multiple Sclerosis Society, Types of Multiple Sclerosis).

Relapsing-Remitting MS, or RRMS, refers to multiple attacks of MS symptoms, and or newly

developing MS symptoms. These attacks are followed by periods of recovery, then periods of

relapsing; however, during these periods MS does not seem to continue developing (National

Multiple Sclerosis Society, Types of Multiple Sclerosis). Secondary Progressive MS, or SPMS, is

described as the period following the Relapsing-Remitting phase where symptoms and

neurological function begin to worsen (National Multiple Sclerosis Society, Types of Multiple

Sclerosis). Different from all of the types listed above, is Primary Progressive MS, or PPMS.

PPMS refers to the worsening progression of symptoms since they appeared, with an absence of

relapsing and remitting periods. Those with PPMS experience much faster disabling symptoms,

but only 15% of those diagnosed with MS are additionally diagnosed with PPMS (National
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Multiple Sclerosis Society, Types of Multiple Sclerosis). These types of Multiple Sclerosis are

just labels however, many individuals can be suffering from a combination of types, or not know

what type they are diagnosed with. When it comes to treating the various types, there are a few

ways to lessen symptoms, but no way to cure them entirely.

Treatments

Infusions

Although there are more types of treatments than infusions, like oral and injectable

medications, infusions are the most common and most effective, so I will be focusing solely on

them. Natalizumab is an infusion treatment that is given intravenously once a month, which

prevents immune cells from crossing the blood-brain barrier. It is only recommended for

individuals who have not responded well to other types of treatment (National Institute of

Neurological Disorder and Stroke, 2023). Ocrelizumab is the second most common type of

infusion, administered intravenously every six months, which targets circulating

antibody-producing immune cells. This type is usually reserved for individuals with Relapsing or

Primary Progressive MS because it is the only FDA-approved disease-modifying therapy for

PPMS (National Institute of Neurological Disorder and Stroke, 2023). Alemtuzumab is an

infusion administered for five consecutive days which is accompanied by another three

consecutive days of treatment one year later. This type of infusion targets proteins on the

surfaces of immune cells, rather than the immune cells themselves. Alemtuzumab is only

recommended to individuals who have been unresponsive to two or more other types of

treatment (National Institute of Neurological Disorder and Stroke, 2023). The fourth and final

type of infusion treatment is Mitoxantrone, an infusion administered intravenously four times a

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year. Mitoxantrone is only given to individuals with severe Relapsing or Primary Progressive

MS, the kind that quickly leaves them disabled and unable to function properly (National

Institute of Neurological Disorder and Stroke, 2023). These infusion treatments, however

helpful, are still extremely harmful in multiple other ways. Side effects can include, but are not

limited to: Progressive Multifocal Leukoencephalopathy, higher risk of infection, increased risk

of cancer like certain types of blood cancer, increased risk of autoimmune disorders, and

increased risk of heart disorders (National Institute of Neurological Disorder and Stroke, 2023).

Why MS Is So Difficult to Diagnose

Understanding MS

Multiple Sclerosis has many common symptoms of other diseases and ailments, making

it extremely difficult to diagnose (Nathonson, 2017). There are three different tests used to

correctly diagnose MS, they include: an MRI, a lumbar puncture, and an evoked potential test.

An MRI (Magnetic Resonance Imaging) is used to generate images of the brain that would show

the recognizable lesions created by MS. A lumbar puncture refers to a spinal tap, a procedure

that analyzes the cerebrospinal fluid surrounding the brain and spinal cord to look for the

characteristic signs of Multiple Sclerosis. Lastly, an evoked potential test is a test in which an

individual is connected to wires that admit electrical impulses and non-painful stimulating

signals to see how the nervous system will respond (National Institute of Neurological Disorder

and Stroke, 2023). Each of these test results can show that you have Multiple Sclerosis, but only

a combination of the test results, previous medical history, symptoms, and a ruling out of any

other disease will lead to a diagnosis (Nathonson, 2017). The process of getting to a diagnosis is

a long and painful one for individuals suffering from Multiple Sclerosis. Multiple Sclerosis has

no precise pattern of symptoms and no way to map out what symptoms you could feel next. This
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issue makes it extremely difficult for people seeking a diagnosis, or those who have no idea they

are suffering from Multiple Sclerosis.

Connection to Class

Importance to Me

Multiple Sclerosis is an incurable disabling disease of the central nervous system. The

reason I believe more awareness needs to be raised is because my father has been suffering from

Multiple Sclerosis since he was twenty-five years old. He was diagnosed after years of

experiencing symptoms, but not knowing what the cause was. When he was diagnosed, he

became unable to continue working as a chef. As someone who has watched his symptoms

worsen throughout my life, I realized that more research needs to be done, more help needs to be

given, and more people should be aware of how serious Multiple Sclerosis is. Though a four to

six-page paper is not nearly enough to cover all the debilitating aspects of Multiple Sclerosis, it

is a starting point for raising more awareness.

Although I do not want to pursue a career in Neuroscience, I am pursuing a career in law.

A law degree to help injured people recover and feel comfortable about their financial situation,

because I have experienced what it is like living with someone who has a disabling disease. I

hope to one day make enough money to help my mother pay for his treatments and to donate to

MS research. This course has given me a better understanding of my father’s disease and has

opened my eyes to how important it is to learn about our brain and the issues that surround it.

Having the knowledge of the brain that this course provided is useful to everyone. I have learned,

not only about my brain, but about everyone else’s around me. I will continue to utilize this

information to better my career, and to help my father in the future.

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