• Cognitive Challenges- MS can affect people's memory, concentration, and information processing.

• Emotional Challenges- Anger and grief are common among those with MS. These emotions can be exacerbated by the uncertainty of the disease's progression.

• Physical Limitations- MS can lead to physical limitations like brain fog, fatigue, and spasticity. These symptoms can make an individual's daily routine challenging.

• Social Relationships- MS can create challenges in maintaining social relationships. The unpredictable nature of the disease can lead to reduced productivity at work, school, and difficulties maintaining social connections.

For example:

-Dissatisfaction with quality of life, causing anxiety, depression, and negatively impacting relationships.

-Isolation from friends and family.

-Increases in mood changes and can cause separation in relationships.

To help with this, many scientists have encouraged keeping a healthy lifestyle and healthy communication with friends, family, and other forms of support.

For example, you can do these things:

-Keeping a healthy and happy mind, like thinking positively.

-Talking with friends and family about issues.

-Working out, drinking water, staying active, etc.

-Meditating, allowing time to rest, and working on hobbies.

-Asking for medical or therapeutic support.

• Muscle Weakness

  • Muscles in the feet, legs and truck become weak, making basic movement difficult.

• Balance Problems

  • Challenging to maintain stability; falling become more common.

• Spasticity

  • Muscles become stiff and tight, making it painful and hard to move.

• Foot Drop

  • Weakness in muscles that lift feet, causing them to drag.

• Fatigue

  • Difficult engaging in activities like walking.

As stated by studies, nutrition and dietary factors affect the mechanisms of MS pathology, its development, and the degree of activity. Although studies have shown the important role of nutrition in MS, the current therapy is not combined with any specific nutritional or lifestyle recommendations.

Possible recommendations for diet in MS patients include:

-Plant-based foods, including fruits, vegetables, whole grains, beans, legumes, nuts, and seeds

-Gut-healthy food with probiotics

-Fatty Fish

-Low-fat milk and dairy products

Depression:

Depression affects %50 of MS paitents. This can manifest as sadness, irritability, loss of interest in activities, and decreased appetite.

Anxiety:

MS can weigh heavily on patients' minds, with the potential for symptom development, such as cognitive impairment or more neurological effects that may lead to more pain signals to the brain.

Stress, Grief, Fear:

These emotions can be amplified after receiving a diagnosis of MS. Paitents may also experience frustrations with cognitive impairments such as memory loss.

• Compared to non-smokers, smokers are almost two times more likely to be diagnosed with MS. This has been seen in both adult and children even just exposed to smoke.

• Once diagnosed with MS, smokers may experience more severe symptoms, increased relapsed frequency, and greater disability compared to non-smokers.

• The relapse rate in smokers may have increased due to an increased risk of infection, and smokers have been found to have more enhancing lesions on MRI compared to non-smokers with MS.

Age: MS can develop at any age, but the onset of MS most likely develops between the ages of 20 and 40 years old.

Genetics: If one of your parents or siblings has MS, you have a higher probability of obtaining MS.

Ethnicity: People of Northern European descent or people of white skin have the highest distribution of MS. Though there might be some evidence of a larger percentage of Hispanic and Black populations having MS.

Smoking: Increases the risk of MS and can lead to a faster progression of the disease

Vitamin D Levels: This is often linked to less sun exposure, which increases the risk of MS.

Obesity: particularly during adolescence, can increase the risk of MS

Infections: Certain viruses (ex. Epstein-Barr virus) have been linked to an increased risk of MS

2 Main Theories that cause MS:

• "Outside-in" Theory, where an unknown antigen triggers proinflammatory T-cells attachment to the CNS endothelium and crossing of the blood-brain barrier, causing an immune attack via cross-reactivity.

• "Inside-Out" Theory, where there is an intrinsic CNS abnormality causing inflammatory tissue attacks.

Depending on the region of "legions" or plaques, where the local inflammation occurs, neurological symptoms can differ. Because MS affects myelin sheaths, they can also affect other structures such as:

• Cortical gray matter

• Periventricular and juxtacortical white matter

• Optic nerves

• Spinal cord

• Cerebellum

• Meninges.

• Vision Problems: Such as blurred or double vision

• Movement Issues: Including muscle weakness and difficulties with coordination

• Cognitive Difficulties: Problems with memory and thinking

• Emotional Changes: Mood swings and emotional instability

• fatigue

• numbness

• motor and muscle weakness

• vision changes

• spasticity

• bowel issues

• bladder issues

• difficulty thinking

Disease activity in RRMS is usually marked by inflammation and new lesions on your brain, but you might develop new lesions without experiencing symptoms. It's also possible for RRMS to be stable, with no new MRI activity or worsening symptoms.

Citations: Hedström A. K. (2023). Risk factors for multiple sclerosis in the context of Epstein-Barr virus infection. Frontiers in immunology, 14, 1212676. https://doi.org/10.3389/fimmu.2023.1212676

Tingling: Prickling, crawling, or burning sensations.

-Treatment for progression in symptoms varies and can depend on what form of MS the patient has. It's important not to put extreme aggressive treatments on a patient when first diagnosed, as that could worsen symptoms and increase attacks. 

-Injectable treatments include:

• Interferon beta medicines (reduce relapses, decrease inflammation, and increase nerve growth)

• Glatiramer acetate (Copaxone, Glatopa) (blocks the immune system's attacks on myelin

• Ofatumumab (Kesimpta, Arzerra) (decrease risk of new lesions or worsening symptoms)

-Oral treatments include:

• Teriflunomide (Aubagio)

• Dimethyl fumarate (Tecfidera)

• Diroximel fumarate (Vumerity)

• Monomethyl fumarate (Bafiertam)

• Fingolimod (Gilenya)

• Siponimod (Mayzent)

• Ozanimod (Zeposia)

• Ponesimod (Ponvory)

• Cladribine (Mavenclad)

-Infusion treatments include:

• Natalizumab (Tysabri). 

• Ocrelizumab (Ocrevus). 

• Ublituximab (Briumvi). 

• Alemtuzumab (Campath, Lemtrada). 

Citations: Mayo Clinic. “Multiple Sclerosis.” Mayo Clinic, Mayo Clinic, 1 Nov. 2024, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274.

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• Therapy: Physical and occupational therapy can help with stretching, and a mobile aid (when necessary) can help with walking. 

• Muscle relaxants: relief from muscle stiffness and spasms. 

• Medicines to reduce fatigue: decrease MS-related fatigue and depression.

• Medicine to increase walking speed: helps increase the speed of walking.

• Other medicines: medicines can also be prescribed to help with depression, pain, sexual dysfunction, insomnia, or bladder/bowel dysfunction. 

Citations: Mayo Clinic. “Multiple Sclerosis.” Mayo Clinic, Mayo Clinic, 1 Nov. 2024, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274.

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Double Vision: Seeing two of an object

Optic Neuritis: Inflammation of the optic nerve, which can cause the two mentioned above as well as eye muscle problems.

• Paitents would be examined to look into their own medical history and family history of MS after experiencing MS symptoms.

• Doctors commonly look for eyesight problems, numbness, weakness, and brain/spinal cord damage.

Symptoms: Vertigo, dizziness, tripping or falling, impaired coordination with hands and other parts of the body

Difficulty concentrating: Poor focus or attention

These plaques consist of scarred tissues of dead brain cells caused by MS.

• Other measures are taken, such as taking blood tests to rule out any other autoimmune disorders.

• Information-processing speed

• Memory

• Executive Functions

Due to the other varying symptoms, mental problems like depression, anxiety, PTSD, etc, can occur alongside these issues.

Depression is part of this disease, as the neurons are destroyed and create scarring. Depression can become a part of the paitents personality after the diagnosis of MS.Anxiety can also become more frequent. Inappropriate laughter or crying can also occur as the disease progresses because of the damage the brain is going through. This is called pseudobulbar affect (PBA).

Mood swings are also common as a long-term side effect.

Balance Issues: Feelings of unsteadiness, dizziness, or disorientation, making it difficult to stay steady.

Coordination Problems: Aligning joint movement, can lead to problems with basic functions.

These can impact daily lives, leading to isolation or depression.

These include:

• Immunomodulators

• Monoclonal antibodies

• Oral medications

• Stem cell transplant

Overall, these treatments can cost between $57,000 and over $92,000 annually. They could surpass $100,000 before discounts and rebates.

Insurance coverage varies depending on the type of insurance. For example, most FDA-approved DMTs are covered under programs like Medicare and are subject to strict approval requirements. High out-of-pocket costs are a huge barrier to patients, but generally, major insurance plans will cover a significant piece of the cost.

If someone chooses not to seek treatment, the disease will progress faster, have more relapses, and accrue greater disability over time. The underlying immune activity of MS continues to damage the central nervous system, increasing the risk of physical disability, cognitive impairment, and decreased quality of life.

• Muscles can weaken over time, leading to more difficulty walking or standing

• Balance and coordination may worse, increasing the risk of falls

• Joint stiffness and spasticity can become permanent or painful

• Overall mobility and independence may decline, requiring more assistance later on

In short, physical therapy doesn't stop MS itself, but it's crucial for preserving function, independence, and quality of life over the long term.

• Bruton's tyrosine kinase (BTK) inhibitor: works for relapsing-remitting MS and secondary-progressive MS in which it alters the function of B-cells (important immune cells in the CNS).

  -Can cost $99,000-110,000 without insurance.

  -With insurance coverage, it can be as low as $0.

  -This might be very difficult to be coverage on due to expensive and particular form of therapy. Medicare users also might have to deal with larger payments and difficulty in obtaining therapy.

• Stem cell transplantation: completely removes the patients immune system and replaces it with a healthy person's stem cells. Almost "resets" someone's immune system.

  -Can cost $20,000-150,000 without insurance.

  -Most likely will not be covered by insurance as its still an experimental treatment.

• Research in CD40L: a type of protein that has shown a role in MS. Blocking this protein can possibly reduce symptoms or relapses.

  -Not covered and no cost as its experimental and still being researched.

• Phosphodiesterase inhibitor: a new medicine that works to reduce inflammation by changing damaging autoimmune attacks in MS.

  -Can cost from $10-1,000 without insurance.

  -Can cost as low as $0 with insurance.

  -Most likely to be covered in comparison to other treatments.

These are all varying forms of new treatments for MS and not necessarily the most common treatments for MS. New treatments are still being researched and not or doing these treatments does not remove other opportunities for oral/injectable/infusion medicine or physical therapy as well.

Citation: Mayo Clinic. “Multiple Sclerosis.” Mayo Clinic, Mayo Clinic, 1 Nov. 2024, www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274.

• Mindfulness Meditation: focusing on the present moment by observing your surroundings.

• Deep Breathing Exercises: Taking deep breaths to include the body's relaxation response.

• Progressive Muscle Relaxation: A relaxation technique where you systematically tense and then release different muscle groups throughout the body.

The goal is to build a person's ability to cope with daily and long-term stressors related to MS.

Since stress can worsen MS symptoms, this treatment is designed to help reduce the physical and mental impacts of stress. It can decrease the risk of anxiety and improve the overall quality of life.

This training can be done by multiple types of health professionals. This includes:

• occupational therapist

• psychologist

• other mental health providers

Psychological counseling is very beneficial for newly diagnosed paitents by providing support and educating paitents about the condition.

Occupational therapy can help MS paitents by teaching them proper coping mechanisms when they feel an episode coming on with day-to-day tasks.

Some coping mechanisms may look like mental distractions, such as counting objects or practicing deep breathing to relax and remain in control. Changing bodily positioning can also help the patient distract themselves from an episode.

A neurologist specializing in MS is most recommended for treating symptoms of MS.

Some short-term effects of medication can be:

-Improved brain chemistry

-Reduced stress response

-Increased neuroplasticity

But they can also have effects of:

-Cognitive Impairment

-Sexual Dysfunction

-Metabolic and Gastrointestinal Issues

-Addiction and Withdrawal Symptoms

Some long-term effects of medication can be:

-Other mental issues arising

-Mental numbness and changes in brain chemistry over time

-Weight loss or gain

-Fatigue

-Insomnia

This, of course, does not apply to all patients who take antidepressants or any form of pharmacotherapeutic medication, and symptoms vary from person to person.

Specialists that assign this form of medication can be:

-Psychiatrists

-Primary Care Doctor 

-Neurologists

-Therapists

-Counselors

Used to strengthen the muscles of the mouth, face, and respiratory system.

• Treats long-term dysarthria effects, such as imprecise articulation, low voice volume, impaired breathing control, and maintains/improves speech clarity.

• Treated by Speech-Language Pathologist

Techniques for Clearer Speech

These involve behavioral strategies like slowing down speech, over-articulating, and self-monitoring using recordings.

• Treats short-term and long-term communication difficulties by teaching practical coping mechanisms that improve speech intelligibility.

• Treated by Speech-Language Pathologist

Alternative Communication Methods

This involves using augmentative and alternative communication (AAC) devices or other tools like writing or communication boards.

• Treats severe and worsening speech loss by providing alternative ways to communicate, which helps preserve long-term independence.

• Treated by Speech-Language Pathologist

Swallowing Strategies

This treatment includes exercises, postural changes (like the "chin tuck"), and dietary modifications to make swallowing safer and easier.

• Treats dysphagia (swallowing difficulty) to prevent short-term complications like choking and aspiration while mitigating the long-term risk of malnutrition.

• Treated by Speech-Language Pathologist

-Memory Problems: difficulty in repetition and remembering storage in the brain. 

-Information Problem: trouble keeping up with information (from TV shows, conversations, books, school, etc.) 

-Attention and Concentration: easily distracted by interruptions and competing stimuli. Having difficulty moving from one task to another. 

-Executive Functions: difficulty in planning, prioritizing, and problem-solving. Have more problems with moving from one concept to another and struggle in completing more complex problems. 

-Perception: difficulty in describing the distance of objects or the direction. 

-General Intelligence: people with MS tend to feel “dumber”. General intelligence is not really affected by MS, but other functions like memory, executive functions, and perception make up intelligence. They are usually slowed or regressed. 

-Cognitive Rehabilitation:
+Restorative Activities: practicing memorization, combining modes of learning, practicing intervals, and using memory aids. 

+Compensatory Activities: centralize things and place things in a very clear location, planning (schedule planner, mobile apps/computer programs with all activities, appointments, and educational things), recording (recording yourself doing something and to-do lists), reminders, removing distractions (TV, phone, etc.), taking breaks, and doing one thing at a time. 

+Reduce Stress

+Sleeping more consistently and overall

+Healthy Physical Activity 

-Medication:

+Though there haven’t been any large-scale clinical trials of medication that have proven truly effective, any form of stimulants that help with attention, information processing, and memory problems will be useful. Some forms of DMT (disease-modifying therapies) could increase the rate of cognitive slowing. 

Professionals Involved:

-Physical therapists 

-Counseling 

-Therapists 

-Physical Trainers

-Fatigue:

+Energy Conservation Strategies

+Tracking periods of long-term fatigue to identify patterns

-Pain:

+Track locations of intensity, at rest, at activity, and which activities exacerbate pain or possible flares of MS.

+Physical agent modalities

+Manual Therapy Techniques

-Mobility:

+Therapeutic Exercise (like Tai-Chi, yoga, dance, swimming, weightlifting, etc...)

+Transfer Training (wheelcair training and management).

Overall, utilizing any of these exercises and techniques can help with MS flare-ups or has shown evidence of lower intensity attacks. Continuation of simply occupational therapies like these have shown better quality of life.

+Here are some ways that you can maintain a healthier diet or healthier eating habits:

• Prepare meals at home as much as possible.

• Incorporate colorful, fresh fruits and vegetables daily.

• Choose lean proteins and healthy fats.

• If you eat grains, choose whole grains over refined grains.

• Consider adding herbs and spices to add flavor to meals.

• Avoid or limit processed foods and added sugars as much as possible.

5/10: On a scale from 1-10, maintaing a healthy diet eating more whole foods, prepped meals, protien-full, and sugar-free food can be more difficult. Sometimes with more extreme symptoms, especially with mobility issues, eating can be difficult and maintaining a more healthy diet can be even more difficult. A healthy diet can be learned from dieticans, nutristionists, and even some personal trainers or physical therapists. A caretaker can help with a more healty diet as well. Unhealthy eating habits can be hard to break and eating healthier will take time and practice over a long period of time.

Professionals who can suggest recommendations for lifestyle modifications:

• Primary Care Physician 

• Mental Health Professionals (Therapists)

• Lifestyle Medicine Physician 

• Physical or Occupational Therapist 

• Dietitian or Nutritionist

Difficulty: 7/10

Reliance on Others:

Moderate to High. MS-related symptoms like fatigue, heat sensitivity, and mobility issues can make starting and maintaining exercise challenging. Reliance on others includes healthcare professionals to create a safe plan, family for encouragement, and potentially a workout partner or support group for motivation and social engagement. Assistive devices or exercising in a climate-controlled environment (like a cool pool) might also be necessary.

Professionals:

• Physical Therapist

• Occupational Therapist

• Neuro Exercise Specialist

• Neurologist

Difficulty: 6/10 due to these specific stimulations being medically provided and supervised so accessibility might not come easy

Professionals:

• Neurologists

• Neuropsychologists

• Psychiatrist

-Problems that many women will face with MS include:

+Possible risks during pregnancy and post-partum (including increased inflammation and mental/physiological issues). 

+Possible developmental issues while growing up, as MS inflammation can develop earlier during childhood and develop largely during adulthood. 

+Menstruation issues, as many women will face worse symptoms during the menstrual phase. 

+General mental health issues (Depression, mood swings, fatigue, emotional numbness, etc.)

Children living with any chronic illness are terrible. Children should be able to enjoy their childhood. Kids might have a hard time in school with their symptoms and making friends if they have sudden, intense emotional outbursts. Children with MS may struggle with development, along with dealing with a chronic illness so early on in life.

• Limited sunlight exposure: People living in northern climates, indoor workers, or those with long winters may not get enough natural sunlight.

• Skin sensitivity or skin cancer risk: Some people must limit sun exposure for medical reasons, making it harder to maintain vitamin D naturally.

• Diet and Supplement Barriers: Not everyone can afford supplements, and vitamin-D rich foods are not commonly consumed in all diets.

Both poor sleep and high stress levels can contribute to; immune system dysregulation and a pro-inflammatory bodily state, potentially triggering autoimmune responses in susceptible individuals. 

Challenges:

• Modern Demands: Demands from work, school, and personal life often lead to chronically high stress levels and insufficient sleep in adults and adolescents alike.

• Subjective Nature: Stress and sleep quality are subjective experiences that are difficult to objectively measure and manage, as effective strategies (ex., meditation, therapy, sleep hygiene improvements) vary greatly among individuals.

• Mental Health Stigma: Seeking help for stress or sleep disorders may face stigma, and access to effective mental health and sleep medicine professionals can be limited or costly.

+Other voice activation systems include virtual personal assistants (such as Alexa and Google), automotive systems, smart home devices (like thermostats, refrigerators, and dishwashers), and other specialized equipment that can be modified to accommodate certain disabilities. These assist with treatment and everyday life. 

-Assistive Robotic Arms or Legs:
+For example, the Kinova Jaco Assistive Robotic Arm is flexible and has 16 different movements that correspond to the human arm. Assistive robotics can allow for more autonomy, enabling more independence in eating, drinking, pushing buttons, and coordination. Though these modifications can be quite expensive, especially without insurance, and can cost thousands of dollars. These are best for treatment after diagnosis. 

+A type of noninvasive brain stimulation that can treat cognitive, motor, and speech issues for people with PPMS and other neurological conditions. You can enroll in a personalized program (virtual or in-real life) that provides an electrode headset, which applies a low-grade electrical current to the scalp. The program also offers physical activity and cognitive rehabilitation activities.

+Shows evidence of helping mood and depressive episodes in people with MS.

-MS Managament Apps:

+Specific apps can help track PPMS symptoms and medical appointments. It also can help you and your MS care provider share more information about symptoms.

+Adding symptoms like pain metrics, ability to peform motor functions, etc... can help show disease progession and find treatments for PPMS.

• Ensuring people consistently take supplements

• Equity issues: limited sun exposure in northern regions

• Misinformation about vitamin D or fear of skin cancer leading people to avoid sunlight

• Cost or logistical barriers to expanding fortified foods

• Addiction makes quitting very difficult

• Communities with high smoking rates may resist policy changes

• Tobacco industry influence

• Lack of access to cessation services for low income populations

• No EBV vaccine exists yet

• EBV is extremely common and hard to prevent

• Hygiene interventions require consistent behavior

• Public acceptance of new vaccines may be low

• No simple test exists to predict MS with certainty

• Stigma or anxiety around being labeled "high-risk"

• Primary care clinics may lack time or specialists

• Insurance or cost barriers for neurological evaluations