MULTIPLE SCLEROSIS:


Description
MS begins with an inflammation in your central nervous system (the brain and spinal cord). This is followed by the loss of the protective myelin sheaths that are wrapped around nerve fibers. Myelin is like the insulation that covers and protects electrical wires. When the myelin is damaged, nerve impulses are slowed, garbled, or blocked. The inflammation causes lesions (called “plaques”) to develop in your brain and spinal cord. Symptoms then begin to appear. They can range from numbness in the arms and legs to paralysis or vision problems.

You have a little higher chance of getting MS if you have a close relative with the disorder, but it is not truly inherited in the general population. Researchers think there is a 1 or 2 per 1000 chance in the United States of getting MS. However, in families where MS already exists, the risk of another family member getting the condition is about 6 in 1000. This seems like a higher risk, but it is not thought to be a major reason for getting MS.

Symptoms
Symptoms of multiple sclerosis vary widely among individuals in severity, onset, and duration. They may include: abnormal fatigue, impaired vision, loss of balance and muscle coordination, slurred speech, tremors, stiffness, bladder and bowel problems, difficulties with gait (balance or walk), and in severe cases, partial or complete paralysis.

The cause of MS is not yet known. There is a belief that exposure to a triggering agent, such as a virus may initially trigger MS. There is research that indicates MS is the result of the person's immune system attacking their central nervous system or an autoimmune disease.

Disease Characteristics
Multiple Sclerosis affects twice as many women as men. Most people are diagnosed between the ages of 20 and 40. Infrequently, some are diagnosed in their late forties or fifties. There seems to be a larger number of Western Europeans diagnosed as well as a higher incidence in temperate climates.

MS is not a psychological disorder or a mental disease. It is not contagious. It is believed that there is a genetic predisposition to the disease, though it is not directly inherited. In rare cases it can be a fatal disease. Those with advanced disease states can have more complications and can be more susceptible to infections. Despite this, the projected life span for most people with MS is 93% of the non-MS population.

There are several disease patterns to MS:
  • Relapsing-Remitting: Clearly defined acute (sudden) attacks with full recovery or with a residual deficit upon recovery. Period between disease relapses are characterized by a lack of disease progression.
  • Primary Progressive: Signs of disability are evident from the onset of diagnosis. There can be occasional plateaus or remissions, but the disease and symptoms increasingly worsen.
  • Secondary Progressive: This pattern begins with a relapsing-remitting course until the disease progressively worsens as evidenced by increasing disabilities.
  • Progressive-relapsing: Signs of progression are evident from the beginning of diagnosis. There Can be clear acute relapses with or without full recovery.
There are several kinds of MS. Most people with MS begin with the “relapsing remitting” stage of the disorder. This means your symptoms come and go. Usually you will feel completely normal until another relapse, or MS attack, happens. Symptoms that come with relapses usually build up over a period of hours to days. They can last for a few days or weeks and then go away, sometimes even without any treatment. New attacks happen at irregular times.

Common symptoms include:
  • Vision loss
  • Numbness or tingling
  • Weakness or fatigue
  • Unsteady walking
  • Double vision
  • Greater sensitivity to heat
  • Partial or complete paralysis
  • Electric shock sensations when bending the neck
Over time, about 60 percent of people with relapsing remitting MS develop a secondary form of the disorder. It is referred to as “chronic progressive.” This means your symptoms do not completely go away at the end of an attack. You are left with some type of permanent neurological symptom. Attacks may also happen more often.

One in five people with migraine have a warning before the headache. This warning is called an aura. You may see flashing lights, temporarily lose your sight, or go numb on one side of your body. An aura usually lasts 5 to 30 minutes. It can happen without a headache.

Diagnosis
The diagnosis of MS is based upon the clinical history and physical examination. Imaging studies, such as an MRI scan, are helpful in identifying demyelinating plaques. A lumbar puncture is often done to detect characteristic abnormalities of the cerebrospinal fluid. Computer-assisted electrodiagnostic tests, known as evoked responses, may also be helpful in diagnosing MS.

Diagnosis is difficult as there is no single test which diagnoses MS. MS is not a reportable disease making it difficult to ascertain the prevalence in the United States. Difficulty diagnosing as well as a lack of desire to report MS as an active disease for fear of insurance and employment bias contributes to low incidence of reporting. It is estimated that about 350,000 people in the U.S. have MS.

Treatments
Right now, there is no prevention or cure for MS. However, this is a promising time for people with the disorder. Several new drugs have been approved or are awaiting approval by the US Food and Drug Administration. Current treatments are divided into three categories:
  • Treatments for the symptoms of MS
    These include drugs to decrease muscle stiffness, reduce tiredness, control bladder symptoms, ease pain, and address sexual problems.
  • Treatments that change attacks when they occur
    These treatments involve corticosteroids (a synthesized adrenal hormone) which can shorten an MS attack. Doctors most often recommend large doses of steroids injected into a vein for several days. Longer-term steroid use, however, does not do a good job of slowing progress of the disorder.
  • New drugs that change disorder activity
    Three drugs are now on the market to affect development of the disorder. They are interferon beta 1b, interferon beta 1a, and glatiramer acetate. These drugs can reduce the number of attacks and long-term damage to the brain caused by MS. In addition, there are stronger medications available that may be indicated for patients that continue to experience recurrent symptoms on standard medication.