Frequently Asked Questions about MS
Causes of MS
What is the cause of Multiple Sclerosis?
The cause of multiple sclerosis (MS) is still unknown. Some factors may be related to it, such as genetics, smoking, and certain infections caused by viruses that make the immune system more vulnerable.
The exact cause of the immune system attacking myelin is still under investigation.
How important is the role of genetics in this disease?
There is a 0.1% risk of developing MS in the general population. In the case of twins, if one has MS, the other has a 2% risk of developing the disease. If they are identical twins and one has MS, the other has a 25% to 30% chance of having it. This suggests that genes may play an important role in the development of MS, but also that an additional factor is necessary for the disease to manifest itself, such as the environment.
Is it true that MS is more frequent in people living far away from the Equator?
Yes, MS is more frequent in Northern Europe and Scandinavia. In these places, there is less sunshine, and some researchers believe that deficiency of vitamin D, a substance produced thanks to the sun's rays, may be related to several of the disorders in which the body defends itself against its healthy components (autoimmunity), as in the case of MS.
Is there any other factor increasing the risk of MS?
Besides genetics, the environment, infections, and the immune system, other risk factors may increase the chances of developing MS. For example:
- Gender: women are 2 to 3 times more likely to manifest MS than men.
- Age: 20 to 40 years old.
- Ethnicity: people with Northern European origins are at higher risk of developing MS.
Fertility and Pregnancy
How does multiple sclerosis affect the desire to become a mother?
Multiple sclerosis (MS) mainly affects women in their reproductive stage (between 20 and 40 years old). When young women are first diagnosed with MS, one of the questions that comes to their minds is whether the disease will make it impossible for them to become pregnant. Fortunately, despite what many believe, MS does not interfere with women’s ability to conceive. There is no information indicating that MS affects fertility or increases the risk of having miscarriages or babies with genetic malformations. Several studies have shown that pregnancy, labor, delivery, and fetal complications in women with and without MS are not different.
How might pregnancy affect the disease?
In the past, it was believed that pregnancy worsened MS, but nowadays, it is known that being pregnant reduces the number of relapses of the disease, especially during the last two trimesters. It is possible that, being pregnant, women feel a little more fatigue, that the normal constipation of pregnancy increases, and that, with weight gain, the lack of balance increases.
In the event of relapse during pregnancy, some medications may be administered without causing harm to the baby.
Pregnancy has not been shown to have a long-term impact on the disability level of women with MS. On the contrary, some data suggests that there may be a significant reduction in disability accumulation if the pregnancy occurs after the onset of the disease.
Can women continue taking medication during pregnancy?
None of the available disease-modifying therapies are approved for use during pregnancy, as most have the potential to cause harm to the fetus. Women are advised to stop taking medication for at least one complete cycle before trying to conceive. They can restart their medication immediately after delivery unless they plan to breastfeed.
Does multiple sclerosis cause complications during labor?
In general, labor and delivery for women with and without MS are similar. However, some women with MS may require a C-section or the use of forceps due to MS-related fatigue, weakness of abdominal muscles, or inability to feel contractions.
The commonly used anesthesia regimen is not modified, and it is considered safe to use anesthesia in patients with MS.
What happens during the postpartum period?
The risk of relapse may increase in some cases after childbirth. To prevent so, women should consult their neurologist about what measures can be taken and when to restart the medication.
Does breastfeeding increase the risk of relapse?
Exclusive breastfeeding does not increase the risk of relapse after delivery. In fact, some data suggests that exclusive breastfeeding may reduce that risk, although this has not been conclusively verified.
Is the disease transmitted from parents to children?
MS is not included among the hereditary conditions.
What should the diet of people with MS be like?
There is no specific diet for MS patients, but, as in most people, healthy foods can benefit them in multiple ways. A helpful rule is to think that ‘if it is good for the heart, it is good for the rest of the body.’ Therefore, let us consider the following:
- The National Multiple Sclerosis Society recommends eating foods low in saturated fats, such as butter, and increasing fiber intake, which is found in fruits, vegetables (broccoli, Brussels sprouts, artichoke, etc.), and legumes such as lentils, peas, turnips, cereals, nuts, and seeds.
- Combining a healthy diet with exercise is recommended. A healthy diet helps the body to feel better. Keeping a healthy weight can also help since it undoubtedly improves mobility.
- A healthy diet reduces fatigue. Food is fuel for the body, and vitamins and minerals are needed to work well. Without them, you will have less energy.
- Fiber will also help with constipation.
- Meals should not be skipped. It is recommended to eat five to six meals a day, three of which are main meals.
- When cooking, ingredients such as pre-cut vegetables and pre-shredded cheese can be helpful. For people who may get tired of cooking, preparing food one day and freezing it to consume it on other days of the week can be a good strategy.
Is a gluten-free diet recommended?
This diet is helpful for people with celiac disease but has not been proven beneficial in patients with MS.
Is physical activity helpful?
Yes. Exercising can help people with MS feel better, but it must be done carefully and moderately. Phrases such as “no pain, no gain” and “muscles must burn” are extremely popular; however, these are not good advice for MS patients. Exercising “too much” not only makes people with MS feel more tired but –by straining their muscles—it also increases pain and stress on the body and mind. It is essential to never exercise to the point of exhaustion. Before taking up any physical activity, the plan should be revised with the treating physician, who should consider the type of exercise that each individual can do and how intense and prolonged the routines should be. Besides, the physician should revise if there is any physical limitation to performing such a routine and if it is necessary to be referred to a kinesiologist.
Can women with MS take contraceptives?
It is important to ask a doctor for recommendations on the best contraceptive method in each case. Doctors will probably recommend using two contraceptive methods: a barrier method (such as a condom) and a hormonal method, such as combined oral contraceptives.
How does MS affect sexual function?
Many MS patients do not suffer from any sexual dysfunction. However, some patients may suffer changes attributable to their disease that may generate some type of dysfunction.
Changes in sexual function in MS are associated with the neurological and psychological involvement of the disease. It is important to remember that, in MS, myelin is damaged, so the messages sent by the brain to other parts of the body, including the sexual organs, may be altered. The disease may cause depression and anxiety, fatigue, genital pain sensation, and increased sensitivity. This may lead to difficulties in maintaining an erection or ejaculating, decreased vaginal lubrication, and difficulties in reaching orgasm.
How to protect intimacy
Some MS patients report a decreased libido or sexual desire. With fatigue, muscle spasms, and loss of bladder control, is it possible to think about sex? There are several things that people with MS can do to improve sexual function and protect intimacy. Talking to partners and explaining the situation can be really helpful. Communication is key to keeping peace with our loved ones. If MS starts affecting sexual desire, the couple should talk about it. Trusting each other can deepen intimacy and help solve concerns related to sexual intimacy.
How to manage medication
The patient must collect the following documents to submit to their health coverage:
- National ID (DNI)
- Member card
- Medical prescription
- Updated summary of medical history
- Note justifying such medical prescription
- Photocopy of all the studies that support the diagnosis
- Certificate of Disability
- Application form (if requested by the health coverage)
How long does this procedure take?
Once the procedure has been initiated, the request must be evaluated by the medical audit of the health insurance company. This usually takes 20 business days on average. When the authorization is confirmed, the updated prescription must be submitted to the pharmacy to request the product. Note that the requirements, delay times, and steps to follow vary from one health coverage insurance to the other. For personalized guidance, please contact the patient program.
Certificate of Disability
What is a certificate of disability?
The Unique Certificate of Disability (CUD, by its acronym in Spanish) is a public document that allows patients to access the Health System. It also provides them with the tools to be fully protected by the law.
What are the advantages of having a certificate of disability?
The CUD makes it easier to:
- Obtain a free pass in Public Passenger Transportation Services to travel for free.
- Obtain the International Automobile Access Symbol (logo) and patent exemption.
- Access free transit and free parking (Act No.19279, section 12).
- Access the Family Allowances Regime in ANSES (Argentine Social Security Administration).
- Obtain discounts for the purchase of automobiles (Act No. 19279).
- Administer a small business.
- Obtain some tax exemptions. For example, people working autonomously in the Province of Buenos Aires are exempt from gross income tax.
- Apply for employment in the public administration, among others.
In addition, the certificate makes it possible to access a series of rights and benefits stipulated by National Acts No. 22431 and No. 24901. It grants access to the Comprehensive Coverage of Basic Habilitation and Rehabilitation Benefits and the Comprehensive Medication Coverage (Act No. 23661, section 28); this means that the patient is covered for all MS-related treatments.
What is the procedure to obtain the CUD?
1. Find out where to apply for the CUD.
According to the address stated in your National Identity Card, you must find out which is the corresponding Evaluation Board to apply for the CUD.
To find the address of the corresponding Evaluation Board, visit: www.snr.gob.ar/dondetramitarelcud or contact the Free Call Center of the National Rehabilitation Service: 0800-555-3472
2. Request an appointment.
You should contact the corresponding Evaluation Board and request an appointment for the evaluation.
3. Go to the appointment.
The Interdisciplinary Evaluation Board will determine if the CUD should be issued.
What documents must be presented?
- ID (original document and copy).
- Original copy of the medical certificate with complete diagnosis and treatment carried out, signed and stamped by the physician, and dated (within the previous six months).
- Complementary medical studies and reports from the treating team, if necessary.
- Photocopy of the health coverage card.
- If you are working: last pay stub. If you are not working, the last pay stub of the primary holder of the health coverage.
- If you are retired: the last receipt of payment.
Who can apply for the CUD?
The CUD application is personal and must be completed and signed by the person who wishes to obtain the disability certificate or their legal representative.
Where to obtain information to apply for the CUD?
On the following website, you will find all the necessary information to apply for a certificate: http://www.buenosaires.gob.ar/tramites/certificado-de-discapacidad
What are the patient’s rights?
Argentine Act No. 26529 establishes that all patients have the following rights:
- To receive adequate, quality, and safe medical care, with equality, consideration, and without distinction.
- To be treated with dignity and respect.
- To be treated privately and confidentially.
- To consent or not to consent to procedures.
- To be informed about the costs of health care.
- To receive sufficient, clear, relevant, and true information.
- To have the chance to ask for a second opinion.
- To decide freely about their care.
- To receive medical care in case of an emergency.
- To have a clinical record.
- To consult or complain about the health care received.