Friday, October 23, 2009


Multiple Sclerosis

Multiple sclerosis is a disease of the central nervous system (brain and spinal cord) that usually first appears between the ages of 20 and 40, and affects women twice as often as men. Also known as MS, multiple sclerosis is the leading cause of disability among young adults.
An unpredictable disease of the central nervous system, multiple sclerosis can range from being relatively benign to somewhat disabling to devastating as communication between the brain and other parts of the body is disrupted.
Although multiple sclerosis was first diagnosed in 1849, the earliest known description of a person with possible MS dates back to fourteenth-century Holland.

Types of Multiple Sclerosis

There are a few different types of multiple (MS). Each case of MS follows one of several patterns regarding how it appears and the course it follows. The patterns of multiple sclerosis include:
  • Relapsing-remitting
  • Primary-progressive
  • Secondary-progressive
  • Progressive-relapsing.
Most commonly, multiple sclerosis begins as a series of attacks followed by complete or partial remissions as the symptoms mysteriously lessen, only to return later after a period of stability. This is called relapsing-remitting (RR) multiple sclerosis.
Primary-progressive (PP) MS is characterized by a gradual clinical decline in function, with no distinct remissions. However, there may be temporary plateaus or minor relief from symptoms.
Secondary-progressive (SP) multiple sclerosis begins with a relapsing-remitting course followed by a later primary-progressive course.
In rare cases, patients may have a progressive-relapsing (PR) course in which the disease becomes progressively worse, with acute attacks flaring up along the way. Primary-progressive, secondary-progressive, and progressive-relapsing are sometimes lumped together and called chronic progressive multiple sclerosis.

Benign Types of Multiple Sclerosis

In addition to the four main patterns of MS, 20 percent of the multiple sclerosis population has a benign form of the disease in which symptoms show little or no progression after the initial attack. Patients with benign MS remain fully functional.

Malignant Types of Multiple Sclerosis

A few patients experience malignant multiple sclerosis, defined as a swift and relentless decline resulting in significant disability or even death shortly after the disease begins. Even so, MS is rarely fatal, and most people with MS have a fairly normal life expectancy.

Specific Early Multiple Sclerosis Symptoms

In the early stages of MS, people can often experience the following symptoms:
  • Muscle weakness
  • Tingling or numbness
  • Loss of balance
  • Blurred or double vision and/or eye pain.
Usually, these early multiple sclerosis symptoms come and go unpredictably. The times when a person is having multiple sclerosis symptoms are called episodes, or MS attacks. The episodes may last a few days or for weeks at a time.

Other Multiple Sclerosis Symptoms

Other possible multiple sclerosis symptoms include:
  • Double vision
  • Weakness of the arms and legs
  • Muscle stiffness
  • Dizziness
  • Loss of bladder control
  • Depression
  • Memory loss.
The times between episodes (when a person is not having multiple sclerosis symptoms) are called remissions. Many people with multiple sclerosis are able to function quite normally between episodes.

Myelin and Multiple Sclerosis Symptoms

The symptoms that a person experiences -- and the severity of these symptoms -- will vary from person to person.This depends on how much myelin (the covering of the nerves) has been lost and what parts of the central nervous system are affected.
The name "multiple sclerosis" simply refers to the buildup of scar tissue in the brain and spinal cord. With MS, this scarring, or "sclerosis," happens in multiple locations inside the central nervous system.
As the myelin sheath becomes damaged, the electric signals have a harder time getting though -- or become blocked entirely. As the damage progresses, this leads to the various symptoms of multiple sclerosis mentioned previously.

Multiple Sclerosis Causes

The cause of multiple sclerosis is still not known. For reasons not yet understood,

The Autoimmune Process as a Possible Cause of Multiple Sclerosis

Currently, most scientists believe that the loss of myelin is caused by an autoimmune process. This means that the body mistakenly reacts to some part of itself as though it was a foreign invader and attacks it. In the case of multiple sclerosis, the body destroys areas of its own myelin.

The Role of Genetics as a Multiple Sclerosis "Cause"

In addition to a possible autoimmune process, increasing scientific evidence suggests that genetics may play a role in determining a person's susceptibility to multiple sclerosisSome populations, such as Gypsies, Eskimos, and Bantus, never get multiple sclerosis. Native Indians of North and South America, the Japanese, and other Asian populations have low incidence rates. It is unclear whether this is due mostly to genetic or environmental factors.
In the population at large, the chance of developing multiple sclerosis is less than a tenth of 1 percent. However, if one person in a family has multiple sclerosis, that person's first-degree relatives -- parents, children, and siblings -- have a 1 to 3 percent chance of getting the disease.

Multiple Sclerosis Diagnosis

There is no single test used to make a multiple sclerosis diagnosis. When a patient's symptoms, neurological exam results, and medical history suggest multiple sclerosis (MS), doctors use a variety of tools to rule out other possible disorders. They also perform a series of laboratory tests, which, if positive, can confirm the diagnosis.
Today, most patients who undergo an evaluation for multiple sclerosis will be classified as either having the disease or not having it. However, there are still cases where a person may have the clinical symptoms of MS but not meet all the criteria to confirm a diagnosis. In these cases, the classification "possible multiple sclerosis" is used.

Specific Criteria for Diagnosing Multiple Sclerosis

A multiple sclerosis diagnosis is notoriously difficult to make because some people have few MS attacks or such mild symptoms in the early stages that they might not recognize an attack.Doctors use certain criteria to help in diagnosing multiple sclerosis. These criteria include:
  • The signs and symptoms begin between the ages of 15 and 60.
  • The signs and symptoms indicate a disease of the brain or spinal cord.
  • A doctor's exam finds evidence of a diseased brain or spinal cord.
  • An MRI scan shows at least two separate areas of scar tissue, or "sclerosis."
  • The disease has followed one of two patterns: First, there have been two or more episodes of symptoms that last at least 24 hours and happen more than a month apart. Or, second, the signs and symptoms have progressively increased over the past six months.

  • Finally, there can be no other explanation for the person's symptoms.

Conditions That Mimic MS

A number of other diseases may produce symptoms similar to those seen in MS. This fact is one reason why a diagnosis of multiple sclerosis can be difficult to make.
Other conditions with an intermittent course and MS-like lesions of the brain's white matter include:
  • Polyarteritis
  • Lupus erythematosus
  • Syringomyelia
  • Tropical spastic paraparesis
  • Some cancers
  • Certain tumors that compress the brainstem or spinal cord
  • Lyme disease.

Multiple Sclerosis Treatment

At this time, there is no cure for multiple sclerosis, but research continues to improve the understanding and treatment of this disease.
Current treatments for multiple sclerosis focus on controlling the immune system and managing the symptoms. It is important for people to work with their healthcare providers to find the best approach to address multiple sclerosis symptoms, such as:
  • Extreme fatigue
  • Bladder problems
  • Spasticity (muscle tightness and spasms).
  • Depression
  • pain
  • tremors
  • Sexual dysfunction
Specific multiple sclerosis treatment can include:
  • Medications
  • Physical or occupational therapy
  • Emotional support.

Medications Used in the Treatment of Multiple Sclerosis

Several medications are available as part of a multiple sclerosis treatment plan.The different categories of medications are discussed in the following paragraphs.

Medications That Manage Exacerbations
MS exacerbations (flare-ups) are usually accompanied by inflammation and breakdown of the myelin in the central nervous system. If your symptoms are severe, high doses of steroids, such as Solu-Medrol®, may be given through an IV to reduce the swelling and inflammation that contribute to demyelination.

Medications That Modify the Disease
A number of newer drugs have been shown to modify the course of multiple sclerosis. These medications work by altering or suppressing the activity of your immune system. A group of drugs called "beta interferons" mimic a protein that occurs naturally in your body. They appear to block certain white blood cells from attacking the myelin covering of the nerves. They also seem to stop other white blood cells, called T cells, from releasing cytokines -- which are chemicals that encourage inflammation and attract other immune cells to the area.
These medications include:

While they don't cure the disease, beta interferons have been shown to reduce the frequency and severity of MS attacks by about 25 percent or more, depending on the dose. These drugs may also reduce the amount of scar tissue that develops in the brain by 70 to 80 percent. With less damage occurring in the central nervous system, the progression of multiple sclerosis symptoms is slowed, possibly reducing the level of disability you may face in the future.
Other medications used in the treatment of multiple sclerosis include Copaxone®, a small protein that resembles a protein found in myelin. The U.S. Food and Drug Administration (FDA) has approved Copaxone for the treatment of relapsing-remitting MS. Copaxone has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one-third.
An immunosuppressant medication, Novantrone® (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic MS.

Medications That Manage MS Symptoms
There are a few types of medications available to help manage the symptoms of MS,options can include things like Botox® orbaclofen to reduce muscle stiffness (also known as spasticity). Botox is an injection, and baclofen can be given in pill form or through a small, implantable pump.
Multiple sclerosis can also be managed through deep brain stimulation, which uses a small electrode to stimulate a certain part of the brain. This can reduce the tremors sometimes seen in people with MS.

The Role of Emotional Support in Treating Multiple Sclerosis

An important part of multiple sclerosis treatment is emotional support. You may feel anxiety, anger, and fear. You may need help in getting treatment for the depression that often comes with MS.
Caring for someone with active MS requires a team approach. In addition to physicians and nurses, other members of your healthcare team may include:
  • Physical therapist
  • Occupational therapist
  • Social worker
  • Counselor.
The goal is to enable you to be as independent as possible while helping you deal with the intense emotional feelings that often accompany a disease that can become disabling.

Unproven "Cures"

MS is a disease with no known cause and for which there is no universally effective treatment. However, MS has a natural tendency to improve spontaneously. These factors open the door for a number of unproven claims of cures. At one time or another, many ineffective and even potentially dangerous therapies have been promoted as effective treatments or cures for multiple sclerosis.
A partial list of these "MS cures" includes:
  • Injections of snake venom
  • Electrical stimulation of the dorsal column of the spinal cord
  • Removal of the thymus gland
  • Breathing pressurized (hyperbaric) oxygen in a special chamber
  • Injections of beef heart and hog pancreas extracts
  • Intravenous or oral calcium orotate (calcium EAP)
  • Hysterectomy
  • Removal of dental fillings containing silver or mercury amalgams
  • Surgical implantation of pig brain into the affected person's abdomen (stomach).
None of these are effective forms of multiple sclerosis treatment.

Multiple Sclerosis Research

Multiple sclerosis research continues to make new advances, building on the success of the "Decade of the Brain." New understanding of the disease, and new medications to treat it, have stemmed from the multiple sclerosis research performed in the past several years. Continued research aims to find a cure for the disease or a way to prevent it entirely.

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