What is Multiple Sclerosis?

The name sclerosis comes from the build up of scar tissue in the spinal cord and/or brain called sclerosis. Through a process called demyelination, scar tissue or plaques form when a protective and insulting coating covering the nerves, called myelin, is destroyed. With the myelin gone, no signals can reach the spinal cord or brain, potentially causing a deterioration of the nerves, an irreversible development.Multiple Sclerosis can form in men or women, with women more likely to develop it, and at any age, but with 20 to 40 years olds developing the most cases.

Symptoms

Warning signs and symptoms will differ extensively from patient to patient. In some cases, symptoms can disappear for months, making it difficult to pinpoint a true diagnoses. Symptoms will depend on the location of damaged nerves and the amount of damage to those nerve fibers. Beginning symptoms may include blurry vision, muscle stiffness, tingling, numbness or weakness.

Some also experience urinary issues or cognitive troubles. As the disease progresses, beginning symptoms continue and partial or complete loss of vision, dizziness, electric shock sensations, tremors or muscle spasms, sensitivity to heat and lack of coordination may form. An increase in body temperature may cause symptoms. Some lesser known symptoms include an onset of paralysis, slurred speech with swallowing troubles, coupled with some of the other symptoms being experienced.

Muscle symptoms:

• Loss of balance
• Numbness or abnormal sensation in any area
  
• Pain because of muscle spasms
  
• Pain in the arms or legs
  
• Problems moving arms or legs
  
• Problems walking
  
• Problems with coordination and making small movements
  
• Slurred or difficult-to-understand speech
  
• Tremor in one or more arms or legs
  
• Uncontrollable spasm of muscle groups (muscle spasticity)
  
• Weakness in one or more arms or legs
  

Eye symptoms:

• Double vision
  
• Eye discomfort
  
• Uncontrollable rapid eye movements
  
• Vision loss (usually affects one eye at a time)
  

Other brain and nerve symptoms:

• Decreased attention span
  
• Decreased judgment
  
• Decreased memory
  
• Depression or feelings of sadness
  
• Dizziness and balance problems
  
• Facial pain
  
• Hearing loss
  
• Fatigue
  

Bowel and bladder symptoms:

• Constipation
  
• Difficulty beginning urinating
  
• Frequent need to urinate
  
• Stool leakage
  
• Strong urge to urinate
  
• Urine leakage (incontinence)
  

Treatment

Although there is no cure forMultiple Sclerosis, several drugs have been proven to slow the progression of the disease in some people. Disease modifying drugs as they are known, work by altering or suppressing the body's immune system activity. They can reduce the regularity and severity of attacks and decrease the development of new brain lesions.

Medications used to slow the progression of multiple sclerosis may include:

• Immune modulators to help control the immune system, including interferons (Avonex, Betaseron, or Rebif), monoclonal antibodies (Tysabri), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), methotrexate, azathioprine (Imuran), cyclophosphamide (Cytoxan), and natalizumab (Tysabri)
• Steroids may be used to decrease the severity of attacks

Medications to control symptoms may include:

• Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine
• Cholinergic medications to reduce urinary problems
• Antidepressants for mood or behavior symptoms
• Amantadine for fatigue

The following may help MS patients:

• Physical therapy, speech therapy, occupational therapy, and support groups
• Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
• A planned exercise program early in the course of the disorder
• A healthy lifestyle, with good nutrition and enough rest and relaxation
• Avoiding fatigue, stress, temperature extremes, and illness

The majority of doctors suggest that treatment be administered immediately upon diagnosis so quality of life may be maintained. As always, potential side effects should be considered.

Therapies such as strengthening and stretching exercises may be suggested to help perform daily tasks. Muscle tone, strength and overall endurance are shown to be improved with these therapies.

Some people that do not respond to intravenous steroids, may receive a plasma exchange (plasmapheresis) to separate blood cells from plasma. This is performed to help severe symptoms from relapsing.

Causes

Research doesn't provide a true cause for Multiple Sclerosis, although factors such as genetics, childhood infections, or environmental situations may lead someone to develop MS. Siblings of an affected individual have a 2% to 5% risk of developing MS. Some scientists hypothesize that a person is born with a genetic predisposition to react to an environmental factor which may trigger an autoimmune response. For example, Scandinavia, Scotland, and northern Europe have a higher percentage of people with MS. Some research shows exposure to certain environments prior to puberty could predispose someone to MS. It has also been found that living further from the equator may increase prevalence of the disease.

Recent research is suggesting that hormones can affect and be affected by the immune system. Two important female sex hormones - estrogen and progesterone - may suppress some immune activity. This theory is thought to be true because a pregnant woman with MS usually has less disease activity. Since men have much higher levels of testosterone, this could explain why women are more likely to develop MS over men.

New, advanced gene research is thought to eventually lead to answers about the development of MS and the role genetics holds.

Tests & Diagnosis

Diagnosing Multiple Sclerosis is not a guaranteed procedure. A neurologist that specializes in treating MS will evaluate your symptoms. Upwards of 10% of people are misdiagnosed with MS. They may instead have multiple strokes, vitamin deficiency, inflammation of the blood vessels, a brain infection or lupus. Several procedures may be performed to accurately diagnosis MS. A spinal tap, MRI, electrical tests, blood analysis, or an examination of the cerebrospinal fluid found in the spine may be ordered.

The MRI - a test that produces a nearly crystal clear picture of the body - diagnoses more than 90% of people with MS symptoms. Conversely, 5% of people with MS produce a 'negative' scan. Not everyone is advised to have an MRI performed. Women that are pregnant, those with a heart pacemaker, someone with a cochlear implant, people with cerebral aneurysm, or those with an insulin or narcotics pump may be told not to have an MRI. Also, if a patient weighs more than 300 pounds and cannot lie on their back for more than 30 to 60 minutes they may be advised against an MRI.

A blood test will assist in ruling out other infectious or inflammatory diseases that have symptoms comparable to multiple sclerosis.

A Spinal tap - or lumbar puncture - will collect a small sample of cerebrospinal fluid for examination. This will show abnormalities associated with MS such as low levels of white blood cells or proteins.

In an evoked potential test, an electrical or visual stimuli will be sent to your brain to measure the electrical signals the brain responses with.

An eye examination may show:

• Abnormal pupil responses
• Changes in the visual fields or eye movements
• Decreased visual acuity
• Problems with the inside parts of the eye
• Rapid eye movements triggered when the eye moves

Tests to diagnose multiple sclerosis include:

• Cerebrospinal fluid tests, including CSF oligoclonal banding
• Head MRI scan
• Lumbar puncture (spinal tap)
• Nerve function study (evoked potential test)
• Spine MRI

Prognosis

Studies recently have shown that about seven out of 10 people with Multiple Sclerosis are still alive 25 years after their diagnosis, compared to approximately nine out of 10 people of similar age without disease.

Most people with MS will be able to still function at home and work and walk many years after their diagnosis. Each case varies and less than 5% of people with MS have a severe progressive form of the disease, leading to death from complications within five years. There are 10 - 20% of people with a benign form and will have slow or no progression of their symptoms, especially if it's benign for the first five years. Comparing affect of the disease to women and men, MS will shorten women’s lives by approximately six years, and men approximately 11 years. The degree of disability a person experiences five years after the onset of MS is, on average, about three-quarters of the expected disability at the 10 - 15 year mark. Anti-MOG and anti-MBP or of TRAIL (TNF - Related Apoptosis Inducing Ligand), antibodies that have shown promising results, are helping to predict prognosis and therapeutic response, even though there are no clinically established laboratory investigations available as of yet to determine these factors.

The following typically have the best outlook:

• Females
• People who were young (less than 30 years) when the disease started
• People with infrequent attacks
• People with a relapsing-remitting pattern
• People who have limited disease on imaging studies

Prevention

Some believe that Multiple Sclerosis may be activated by vaccinations, shock, pregnancy or some type of injury. However, there is no hard evidence that any of this is true. MS is not preventable, but if you have MS, certain factors may trigger a relapse. It is advised to avoid overheating your body as some believe this will cause symptoms to flare up. Certain drugs may reduce the frequency of a relapse such as glatiramer acetate. An interferon beta may delay disability.

Complications

Complications from Multiple Sclerosis may include depression, forgetfulness or concentration issues, paralysis (of the legs most frequently), muscle stiffness or spasms, bowel, bladder or sexual functions, or epilepsy. Improved treatment for lung and bladder infections, have increased life expectancy of MS sufferers. When the initial disease course is relapsing remitting, a wheelchair may be needed 20 years after diagnosis. This means that many multiple sclerosis patients will never need a wheelchair. If the disease course is primary progressive, a wheelchair, on average, will be needed after 6 to 7 years.