In this video, we'll answer some questions.

What are the most characteristic manifestations of multiple sclerosis?

How does a relapse present?

I have this symptom. Is it related to multiple sclerosis or not?

In Greek, manifestation means symptom. That's why we always say a symptom of multiple sclerosis.

We have symptoms that are characteristic of MS, and there are symptoms that aren't typical

initially when a characteristic symptom appears we immediately think could this

person have MS so what's typical for MS first is decreased vision in one eye

this vision loss can present in completely different ways for example a

dark spot may appear in your visual field in the center or off to the side

the eye might feel like it's covered by a curtain or gray film and one eye will

have decreased perception and the image you perceive when looking at your

environment may show altered color perception flashes of light or overlapping glare these are

the kinds of symptoms we see but most often it's decreased vision like a curtain or dark spot in

the visual field and importantly in just one eye this is a characteristic symptom that may indicate

the onset of multiple sclerosis most often this is a manifestation of what we call optic neuritis

The next characteristic symptom is double vision.

For instance, out of nowhere you start seeing horizontal image separation, or as patients

describe it, focusing problems.

You look at an object and it keeps doubling.

When you turn your head right or left, the doubling goes away, but when you turn the

other way, it gets worse.

This type of double vision can quite often be the first sign of multiple sclerosis.

Numbness in an arm or leg, fingers or the entire limb, clumsiness when performing movements.

You used to perform fine motor movements quite well, but now there's some awkwardness.

And of course, limb weakness.

Often it's leg weakness or numbness that comes on suddenly.

You might notice you're limping on one leg, or a feeling of heaviness in the legs when

walking.

These are the main manifestations, symptoms that are quite characteristic of multiple

multiple sclerosis.

There are rarer symptoms, not as typical for MS.

These symptoms can also appear at disease onset or later.

These include dizziness and coordination problems.

There's imprecision when performing fine movements, or walking balance becomes impaired.

A person walks and starts veering to one side, right, then left.

Another less common initial manifestation of MS is urinary dysfunction.

dysfunction. Most often, urinary problems are a symptom that appears later in more advanced

stages of MS. But it's important to keep in mind, especially with MS-related dysfunction.

These can vary, but with MS, so-called urgency is more characteristic. Meaning the person doesn't

feel the need to go at that moment. Then suddenly there's an urgent, commanding need to go,

and they literally have to run. That's how strong this urge is. This is called urinary urgency,

or imperative voiding. This is quite characteristic of people with multiple sclerosis.

Another fairly characteristic sign, but one that often escapes the attention of both doctors and

patients, is what we call fatigue. Persistent fatigue. It can hit you during the day and not

be related to any physical exertion. Sometimes this fatigue appears in the morning, after sleep.

You should wake up rested, but instead you wake up exhausted, as if you'd just done heavy physical

labor this is fatigue it prevents you from adequately completing your tasks at

work this fatigue this chronic long-term fatigue is a fairly characteristic sign

often people say yes I remember I didn't have any other symptoms before but I

remember I started getting tired at work I even had to quit my job I switched to

something easier because the fatigue was always with me this is also a

characteristic sign if it occurs in a young person it needs to be investigated

Although there are also atypical presentations. For example, MS can even debut with an epileptic

seizure or with rarer neurological symptoms. In any case, I'll put it this way. If a young

person between 20 and 30 starts experiencing dysfunction in any part of their body when

performing certain tasks, sensory disturbances or movement problems, we immediately start thinking,

thinking, could this be MS? You need to see at least a neurologist and not wait for it

to go away. And I have a strong request. If a neurologist examined you and said it's

degenerative disc disease, please get a second opinion to make sure this arm numbness is

actually related to a spinal problem, and not a manifestation of something more serious.

Feel free to share in the comments the symptoms that are characteristic for you.

Multiple sclerosis doesn't typically progress in a constant, steady manner.

It's characterized by a relapsing, remitting course.

There are episodes called relapses, when the person feels unwell, when a symptom appears,

vision decreased in one eye, an arm went numb, or a leg became weak.

If such a symptom appears and lasts more than 24 hours, that's important.

You still have it?

it? It appeared today, tomorrow you wake up and the symptom is still there. This could be an MS

relapse, either the disease onset, or if you already have MS, the beginning of a relapse.

In this situation, you need to see a doctor immediately, preferably an MS specialist,

so they can determine whether this is a relapse or not. And if it is a relapse,

they'll provide treatment to restore the impaired function as quickly as possible,

the function that brought you to the doctor. The second part of this relapsing-remitting course

is remission, when the person feels well or has some lingering issues that bothered them before.

No new symptoms appear during this time, and this state of remission is what we need to extend as

much as possible using disease-modifying therapies for MS, maximizing the remission interval.

The longer we maintain it, the lower the chance of developing a disabling complication in the future.

In a person with MS, relapses occur because the immune system at some point becomes activated.

You need to understand that in MS, we're dealing with autoimmunity. The disease doesn't mean the

immune system is constantly destroying myelin. No, it destroys myelin during relatively brief

time intervals. A sudden immune activation begins. Immune cells enter the brain, start damaging it,

forming new lesions, and then everything subsides. This entry of immune cells and appearance of new

lesions, that's what a relapse is. So, a relapse is essentially inflammation within the central

nervous system, inflammation within the system. In MS, it doesn't involve the entire brain at once.

Rather, it comes in measured doses, in the form of new lesions. New lesions appear, and importantly,

Certainly, during a relapse these lesions begin to accumulate contrast agent.

That's why we do MRI with contrast, to see if there's active inflammation in the brain.

But why do these lesions accumulate contrast?

We administer contrast agent intravenously, so it's in the bloodstream.

The brain is separated from our blood system by what's called the blood-brain barrier.

This barrier is completely impermeable to most molecules.

But if an area of inflammation develops, then in that area this section of the barrier becomes

permeable and various substances rush in, including the contrast agent.

It penetrates into this limited area of the new lesion.

And we see this and say, you've developed acute inflammation in the brain in the form

of a lesion, and it requires treatment.

A new lesion forming in the brain or spinal cord carries certain manifestations.

These are disruptions along the path of nerve impulses that manifest as movement problems,

typically, or sensory disturbances. So if we start treating the relapse quickly enough,

extinguishing this inflammation, the lesion becomes non-inflammatory, movement is restored,

and you feel that your function has recovered. This is typically achieved with certain medications.

First and foremost, we administer methylprednisolone, suppress the inflammation,

and the lesion becomes inactive. Function is restored. In addition to actual relapses,

there are also so-called pseudo-relapses. How are they different? The key difference is that

pseudo-relapses last several hours, never more than 24 hours. So if you develop a symptom,

say some visual flickering or hand numbness, and it lasted one or two hours, three at most,

Then it passed, came back, passed again, and the next day it doesn't appear anymore.

This belongs to the pseudo-relapse category.

What causes them?

In people with MS, this can occur due to stress, typically psycho-emotional stress, overheating,

or recent infections.

At that moment, a slight MS activation can occur.

The person starts feeling some disturbances, then the triggering factor resolves, the emotional

stress passes and everything returns to normal that's what causes a pseudo

relapse a true relapse involves formation of a new lesion contrast

enhancement and symptoms lasting more than 24 hours so as soon as you develop

a first symptom or any new symptoms and they last more than 24 hours don't delay

see an MS specialist right away to confirm or rule out a relapse and if a

relapse is confirmed, immediate therapy initiation to best restore the impaired function.