Multiple Sclerosis: Understanding Symptoms, Diagnosis and Treatment

The Froedtert & MCW Multiple Sclerosis (MS) Program offers team-based care, helping patients manage symptoms and improving their quality of life and comfort. 

Ahmed Obeidat, MD, PhD, neurologist and MCW faculty member, works with adults in diagnosing, treating and managing MS and immune disorders of the central nervous system. We spoke with him to learn the basics of MS and how treatment is approached. 

What is multiple sclerosis? 

Multiple sclerosis, or MS, is a varied disease. Each person will have a different experience. Broadly, it’s a disease of the brain and spinal cord. Conventional thinking views it as immune mediated, or the result of abnormal activity of the body’s immune system, which attacks the brain and spinal cord, creating lesions or areas of inflammation. I think of it as a neurodegenerative disease, meaning that there is an ongoing loss of neurons, and the disease progresses over time. 

What causes MS? 

This is my major research interest. I believe it’s likely a combination of genetic and environmental factors. Some people have genes that predispose them to autoimmune conditions, so they are primed to develop MS if they are exposed to certain triggers. The triggers may be different for everyone. One trigger being studied is the Epstein-Barr virus, which is responsible for mononucleosis. At the Froedtert & MCW health network, we are studying the role of environmental exposures related to pollution, including air and water pollution. Vitamin D deficiency may also play a role. There’s likely more than one trigger or exposure. I think we haven’t found the cause of MS yet because we have been looking for a single cause for everyone. 

What are symptoms of MS? 

The most common symptoms are blurred vision; weakness; difficulty moving arms and legs; and sensations such as pins and needles or numbness in the face, tongue, arms, legs or torso. Balance and coordination issues are common too. People can have cognitive difficulties with memory and attention or brain fog. They can have severe fatigue, like you would experience with the flu, and bowel and bladder dysfunction. Importantly, people can have mental health disorders, like depression and anxiety. Pain can also be part of MS. Some people experience stiffness and spasticity in their muscles. 

How is an MS diagnosis made? 

We start with a person’s symptoms. Then, MRI plays an important role. We use it to look for inflammatory lesions in the brain, which appear white and typically have a central blood vessel running through them. We may also collect spinal fluid through a lumbar puncture and test it for markers that indicate inflammation. 

Who tends to get MS? 

Where a person lives seems to play a role. There is a high prevalence of MS in Wisconsin. The farther north you go, the more prevalent the disease, perhaps because we’re exposed to less sunlight, which leads to lower blood levels of vitamin D. My hypothesis is that we have more industrial work here in the north, which could increase our exposure to pollution, but more studies are needed. 

What treatment options are available? 

If someone is newly diagnosed or having new symptoms, we treat them with high doses of steroids to calm the inflammation. If steroids don’t help, we can use a treatment known as plasma exchange. We couple this with rehabilitation. The patient might meet with a physical or occupational therapist to address weakness and other symptoms. We may also prescribe a drug that reduces the chance of future or worsening attacks. These are important conversations. 

There are also nondrug treatments, including a healthy diet such as the Mediterranean diet, exercise, ongoing rehabilitation and stress reduction. We help patients address any mental health concerns, learn about their disease and build social support. We know that people who stay engaged in work and other activities do better.

What is the advantage of receiving care with an MS specialist within the Froedtert & MCW health network?

Managing MS is not one-size-fits-all, so seeing an MS specialist is important. MS diagnosis and treatment have become more individualized and sophisticated. Patients need careful monitoring, and they need to weigh risks and benefits at every step of treatment. 

We are also one of the largest centers in the country for clinical trials, with over 20 active clinical trials for MS. Seeing an MS specialist who sees patients daily and researches and teaches about the disease allows patients to get the best possible care.