Multiple Sclerosis: Gradation

Multiple Sclerosis: Gradation
Estimated reading time: 4 minutes 24 seconds. Contains 545 words

The loss is never 100%. It’s granular. A scale or series of successive changes, stages, or degrees. When you put your foot on the accelerator pedal in a car, it doesn’t shoot up to 100 km/hr. It increases stage-wise with each successive gear change. Similarly, the degree of change in the disability in functionality of any bodily function, with the progression of Multiple Sclerosis (MS), is granular in its increment depending on the extent of scars (sclerosis) formed on the nerves.

Genre: Health

Hindi: उन्नयन

Gujarati: ક્રમાંકન

Malayalam: ഗ്രേഡേഷൻ

I have done some transliteration here, since I don’t know the exact translation of the word.

Hashtags: #health #medication #fitness

I recently saw the critically acclaimed movie, ‘Sound of Metal’ (recommend it) in Amazon Prime, where the protagonist is a heavy-metal drummer. His life is thrown into freefall when he begins to lose his hearing.

He doesn’t go completely deaf one fine day. It’s not binary; not like a snap of a finger. Rather gradual. Although the fall in the auditory function of the drummer was quite steep as shown in the movie, but it wasn’t complete, all of a sudden. Similarly, the loss of functions is not sudden in MS. Depending on the extent of the scar formation on the nerves the degree of disability is gradual.

As defined MS is progressive in nature, hence it is a downward slide. The speed at which this downward slide happens is arrested, to a certain extent (questionable), by medications, physiotherapy and other exercises. For some the acceleration is like a cycle on a upward slope, while for others it is a Ferrari. Most of the time, an MS patient lies somewhere in between. For Ruben (character played by Riz Ahmed in Sound of metal), the region affected was only his auditory function, that’s not the case with MSPs (MS patients). The region affected varies for each MSP. The acceleration is delayed, or sometimes to a great extent minimal as one ages; but it is, as of now, never reversed.

I, personally, don’t know the medical technology used to determine the extent of hearing loss, as shown in the movie (screenshot attached). We do have something equivalent in MS to determine disability called EDSS (Expanded Disability Status Scale). It is a method of quantifying the disability in Multiple Sclerosis (MS) and monitoring changes in the level of disability over time. It is widely used in clinical trials and in the assessment of people with MS. But, EDSS is more of a speculative model based on questionnaires to the patient. Also, it doesn’t consider the full extent of MS Disabilities.

Some of the Disabilities are totally hidden, unless the patient mentions it. For example the character, Ruben has to mention in the movie that he is deaf to the communicator otherwise the other person won’t realize. He comes across as perfectly normal to the naked eye. This is called an invisible symptom in MS. Obviously at later stages of MS, the symptoms are pretty obvious, and doesn’t require to be announced on a loudspeaker.

The granularity in increase in symptoms of MS is very subtle, hence the patient doesn’t realize unless a significant time has passed. Also, that’s somewhat the same reason, I didn’t realize the progression in the initial stages before getting diagnosed with MS.