An Overview of Relapsing-Remitting Multiple Sclerosis

Relapsing-remitting multiple sclerosis is a type of neurological disease caused by the breakdown of a protective nerve covering called myelin. It is the most common type of multiple sclerosis—85 percent of those diagnosed with multiple sclerosis are diagnosed with the relapsing-remitting type. Multiple sclerosis affects over 1 million adults in the United States.

Symptoms

This breakdown of myelin can affect both the brain and the spinal cord. The damage of these nerve coverings may cause a variety of symptoms called an MS exacerbation, which can get so severe that individuals may be unable to walk or care for themselves. These symptoms are then followed by a remission period where symptoms partially lessen or subside entirely.

Symptomatology of relapsing-remitting multiple sclerosis includes but is not limited to:

Causes

While the etiology of multiple sclerosis is still not known, it is believed to be the result of an abnormal immune response against the central nervous system, likely the result of exposure to certain environmental factors in patients with a genetic predisposition. The different environmental factors that have been implicated in MS include exposure to the Epstein-Barr virus, smoking, low vitamin D, and obesity.

Geographic location also has an impact on the rate of multiple sclerosis developing. Individuals who live farther from the equator are more likely to develop multiple sclerosis.

Diagnosis

The diagnosis of relapsing-remitting multiple sclerosis is based on the clinical picture (a history of one or more flare-ups) and complemented by diagnostic testing, such as blood work (to rule out conditions that mimic MS), an MRI of the brain and spine, spinal fluid analysis, and evoked potential testing.

MRI should show at least two lesions involving specific areas of the brain and/or the spinal cord. Spinal fluid analysis may be obtained to look for the presence of abnormal proteins called oligoclonal bands in patients in which the clinical picture and MRIs are inconclusive.

Evoked potentials may show a delay in nerve transmission at the level of the optic nerves, brainstem, and spinal cord.

Treatment

Multiple sclerosis can be treated through a range of pharmacological interventions, depending on which phase the disease is in. Some of them, such as intravenous steroids, are used to treat multiple sclerosis flare-ups or exacerbations. Other treatments, called disease-modifying agents, are used to prevent future flare-ups. Those include:

• Aubagio (teriflunomide)
• Avonex (interferon beta-1a)
• Betaseron (interferon beta-1b)
• Briumvi (ublituximab)
• Copaxone (glatiramer acetate)
• Gilenya (fingolimod)
• Lemtrada (alemtuzumab)
• Mavenclad (cladribine)
• Mayzent (siponimod)
• Ocrevus (ocrelizumab)
• Tecfidera (dimethyl fumarate)
• Tysabri (natalizumab)
• Zeposia (ozanimod)

Medications are also used to treat common MS symptoms such as spasticity, gait difficulties, lack of bladder control, fatigue, and pain. In addition, occupational and physical therapies are commonly used to help strengthen the muscles of upper and lower extremities as well as help with balance. Speech therapy may also be indicated if symptoms include speech or swallowing deficits.

Coping

Living with relapsing-remitting multiple sclerosis can be difficult, especially as managing its different symptoms and the disease's unpredictability. However, learning as much as possible about this condition, avoiding MS triggers, and starting MS treatment ASAP will allow you to take charge of your illness.