The MS Alphabet: UTI, Vertigo, White Matter Lesions, and Other ‘U’ Through ‘Z’ Terms
Editor’s note: Tamara Sellman continues her series on the “MS alphabet” with this column referencing terms starting with the letters “U” through “Z.” This is the last post in this series.
Symptoms of MS
People with MS are often heat-sensitive and experience overheating due to hot weather, fever, use of hot water (in saunas, tubs, or showers), and exercise. The increased core body temperature may have a slowing effect on nerve conduction, better known as Uhthoff’s phenomenon.
Uhthoff’s can lead to a sense of fatigue or slowed physical or mental response to external stimuli. It is also known to worsen one’s overall symptoms in MS and other neurological or demyelinating conditions. However, once a body restores normal core temperature, Uhthoff’s usually disappears or becomes more tolerable.
Generally speaking, uveitis refers to a cluster of inflammatory diseases of the eye characterized by swelling and damage to the tissues of the eye. It can lead to reduced vision or vision loss. Uveitis can happen in people with or without MS.
The link between MS and uveitis was established over seven decades ago. MS-associated uveitis is found in patients who experience other kinds of eye disorders (such as pars planitis, an intermediate form of uveitis) shown to occur in those who ultimately develop MS.
However, uveitis is less common than the vision disorder known as optic neuritis, which is frequently a symptom marking the onset of MS or its relapse.
This symptom occurs in about 20 percent of all people with MS. Vertigo is another word for disequilibrium, or extreme dizziness. It’s experienced as a feeling of spinning or unsteadiness while upright. Vertigo may be caused by the development of new lesions or the activity and disease course related to established lesions.
One variety of vertigo — benign paroxysmal positioning vertigo (BPPV) — is not the result of demyelination but happens when you move your head. It has been described as a kind of tilting sensation that occurs even when completely upright. It is related not to MS lesions, but to the collection of crystals in the semicircular canals of the inner ear, which is responsible for helping to maintain balance. The tiny hairs lining the ears sense the presence of this debris and delivers information to the brain that results in this confused sense of body position.
White matter lesions
White matter (which makes up the brain and spinal cord tissue in the central nervous system) is the prime target for immune system attacks in MS. Unlike gray matter, white matter is composed of nerves coated in myelin, the substance under attack by certain immune system cells during demyelination. Using MRI to identify the locations of these attacks, the presence of “white spots” or lesions (also called white matter hyperintensities) indicates new evidence of demyelination or captures evidence of new activity in pre-established lesions.
Urinary tract infection (UTI)
Problems with bladder function are common among people with MS. The bladder can feel like it needs frequent voiding, even if it’s not full. That sense of urgency can lead to urinary incontinence. When using the bathroom, some patients may not realize they are only partially emptying the bladder. In all of these cases, the risk of developing a urinary tract infection is increased, especially when these problems require regular catheterization for the bladder to empty fully.
UTIs are painful, causing burning sensations during urination. They can last for at least a week, and often longer, if they’re not treated immediately. For some MS patients, UTIs can lead to hospitalization and complications from treating these unpleasant infections can be, in some cases, fatal.
White blood cells (WBC)
White blood cells are the actively engaged part of the immune system. They exist primarily to protect the body from pathogens and foreign particles. However, in the case of MS, the immune system has run afoul of normal immune system protocols and engages in attacks against the central nervous system by mistake.
There are three kinds of WBCs most active in the disease course of multiple sclerosis: B-cells, T-cells, and NK-cells.
- B-cells have been shown to act in both inflammatory and anti-inflammatory roles in those with MS.
- T-cells are in charge of coordinating immune system activity, but in MS, they tend to “misread” the markers of other cells (such as those in the central nervous system) and employ attacks against the myelin of nerve cells in error.
- Natural killer cells, or NK cells, are free-ranging immune system rapid responders that identify and attack invaders as soon as they appear, and without a need to be activated by other controls in the immune system.
Common MS terms
When a person presents symptoms that suggest they might have MS, they receive an MS workup from a neurologist. This comprehensive investigation usually entails a patient history, neurological exam, blood draws, evoked potential tests, MRI, lumbar puncture, and other diagnostic efforts to accurately diagnose a case of MS.
While MRI is considered the gold standard for identifying key markers of MS disease course, the addition of X-rays in the diagnostic period can be used to identify other potential diseases or disorders, such as sarcoidosis, which cannot be seen on MRI, to differentiate these “mimics” from MS.
While Zoloft (generically known as sertraline) is not used as a disease-modifying therapy, this medicine is often prescribed to treat certain kinds of depression or anxiety that occur in people with MS. It is taken once daily either in pill or liquid form.
This form of disease-modifying therapy was recently pulled from the market voluntarily by its manufacturer, Biogen, due to safety concerns in Europe.
Eight MS patients (seven in Germany, one in Spain) were found to have developed encephalitis or meningoencephalitis while using this medication, also known as daclizumab, which was approved by the FDA in the United States in 2016 for the treatment of MS.
A statement released by Biogen recently stated, “Given the nature and complexity of adverse events being reported with ZINBRYTA, characterizing the evolving benefit/risk profile of ZINBRYTA will not be possible going forward, given the limited number of patients being treated.”
Thank you for following along, I hope this has been a useful and informative journey for you!
Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.