May 21, 2012
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May 21, 2012
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Multiple Sclerosis (MS) is a disease of the central nervous system, or CNS (the brain, optic nerves, and spinal cord). Its course is unpredictable and severity can range from mild to disabling. MS disrupts communication between the brain and other parts of the body. As a result, people with MS may experience vision changes, muscle weakness, and difficulty with balance and coordination, along with many other symptoms.
MS is often considered an autoimmune disease, or a disorder where instead of attacking foreign substances such as germs, the body’s immune system attacks its own healthy tissues. In people with MS, the immune system attacks the myelin, which insulates and protects the nerves of the CNS.
MS affects both men and women but is significantly more common in women—almost twice as many women as men have MS. It’s estimated that approximately 400,000 people in the United States have MS. MS is most often diagnosed in people between the ages of 20 and 50 but can also appear in children, teenagers, and older adults.
There are four different types, or courses, of MS. Each can be mild, moderate, or severe.
Relapsing-remitting MS
This is the most common form of MS, affecting approximately 85 percent of people diagnosed with the disease. Relapsing-remitting MS is characterized by attacks (also called relapses, flares, or exacerbations) that are followed periods of complete or partial recovery (remissions).
Primary-progressive MS
This type of MS affects approximately 10 percent of those diagnosed with MS. Unlike relapsing-remitting MS, there are no distinct relapses or remissions. Primary-progressive MS is instead marked by progression, which may vary in severity. People may experience occasional plateaus in progression as well as temporary minor improvements.
Secondary-progressive MS
Many people who initially have relapsing-remitting MS develop secondary-progressive MS. This type of MS involves disease that steadily worsens. There may or may not be occasional flare-ups, remissions, or plateaus.
Progressive-relapsing MS
This is a relatively rare type of MS, making up 5 percent of cases. It’s characterized by a steady worsening of the disease along with attacks of worsening symptoms. Some people do experience periods of recovery, but there are no remissions, and the disease continues to progress.
The cause of MS is not known, but researchers have identified several potential factors in its development. It’s generally believed that MS is an autoimmune disease, meaning that it is the result of abnormal activity in the immune system, where the myelin is attacked. As well, environmental factors may be involved—MS occurs more frequently in regions farther from the equator, suggesting a geographic link; and because people in these regions receive less sun exposure and therefore may have lower levels of vitamin D than people in sunnier regions, researchers are questioning the role of Vitamin D deficiency in the development of MS. There may also be genetic factors that make some people more susceptible than others. And, although MS occurs in most ethnic groups, it’s more common in Whites of northern European ancestry than in other groups. It’s also thought that certain viruses or infections may trigger MS.
More is understood about what causes the symptoms of MS than about causes of the disease itself. Symptoms of MS are the result of an immune system attack on the myelin. These attacks damage and scar the myelin in multiple places within the CNS and permanently sever some underlying nerve fibers. The scars are referred to as sclerotictissue. As a result, the CNS can’t effectively send nerve signals to other parts of the body. This altered communication between the CNS and the rest of body causes the symptoms of MS.
Symptoms
No one experiences MS in the same way. Symptoms vary for each person. Symptoms are also unpredictable—some may come and go, and others may remain constant.
Most Common Symptoms:
Less Common Symptoms:
Diagnosis
Consistent with the mysterious nature of MS, there is yet no definitive test to diagnose or rule out the disease. Diagnosis is further complicated by the fact that symptoms of MS are similar to several other disorders. Doctors take several steps to make a diagnosis: a medical history, a neurologic exam, and various tests including magnetic resonance imaging (MRI), visual evoked potentials (VEP), and cerebrospinal fluid analysis. As well, several criteria are applied to make a diagnosis of MS; these include evidence of damage in at least two separate areas of the CNS, evidence that that damage occurred at least one month apart, and the ruling out of other possible diagnoses.
How the tools for diagnosis work:
Research into a cure for MS is ongoing, but there is no cure yet. Treatment is instead focused on symptom management, on slowing the course of MS, and on maintaining quality of life and ability to function. Because MS is different for each patient, treatment plans with vary and will also be determined by the type of MS a patient has.
Medication
Drugs approved by the FDA to treat MS are intended to reduce the severity and frequency of MS attacks, reduce the areas of damage (lesions) in the brain, and may slow the progression of disability.
The following drugs are examples of agents that may reduce disease activity and progression in people with relapsing forms of MS and people with secondary-progressive disease who have relapses:
In addition to controlling symptoms and disease progression, treatment of MS also involves managing flares (exacerbations or attacks). Flares may be mild and short-lived, or they may be severe and persist for weeks or months. Severe flares are most commonly treated with high-dose corticosteroids, which reduce inflammation.
Other drugs are often prescribed to help manage symptoms of MS. Symptoms for which medication may be prescribed include spasticity, pain, bladder problems, fatigue, sexual dysfunction, weakness, and cognitive problems.
Other Approaches to Managing Symptoms
In addition to medication, symptoms of MS can be managed with lifestyle choices, or self-care techniques (for example, moderate exercise when appropriate, adequate rest, nutrition, and avoiding excessive heat), with rehabilitation (with a physical or occupational therapist, speech pathologist, cognitive rehabilitation specialist, and others), and with the use of assistive devices such as canes, foot braces, walkers, and wheelchairs. These interventions are intended to help people with MS maintain the ability to function—at home and at work.
What to Expect
While it’s true that MS can be disabling, it’s important to know that most people with MS do not become severely disabled, and for most life expectancy is normal or near-normal. Many people continue to walk, though some eventually need help doing so, such as a cane or crutches. If weakness, fatigue, or balance makes walking difficult, some people find using a scooter or wheelchair helpful.
Many people with MS benefit from emotional support, as the disease, its progression, and unpredictable nature can present evolving emotional challenges and ups and downs. Caregivers of people with MS can also benefit from such support. Mental health professionals (including psychiatrists, psychologists, social workers, and counselors) as well as support groups can help people with MS and their caregivers develop coping, communication, and stress management skills and address emotional changes like mood swings and depression.
Multiple Sclerosis Association of America
National Multiple Sclerosis Society
NINDS Multiple Sclerosis Information Page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm. (Accessed October 2010).
About MS. The National Multiple Sclerosis Society website. Available at:http://www.nationalmssociety.org/about-multiple-sclerosis/index.aspx. (Accessed October 2010).
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