Multiple Sclerosis (MS)

Multiple sclerosis is a chronic, progressive autoimmune disease of the central nervous system (brain, brainstem and spinal cord). In an autoimmune disease, the body's immune system mistakenly attacks the body's own tissues. In MS, the body attacks a fatty substance called myelin that covers and insulates nerves. When the myelin is damaged, signals between nerve cells are interrupted, leading to diminished or lost body functions in the areas those nerves control. Myelin damage also results in many small patches of hard, scarred tissue called plaques. The myelin damage may eventually reach the axons, long nerve fibers that carry signals from nerves to the organs they control.

MS can range from mild to severely disabling, and its symptoms can vary in severity, depending in part on where the plaques occur and the extent of myelin damage. In the early stages of the disease, symptoms usually ease or vanish. As the disease progresses, however, symptoms return and linger, and can become progressively worse. MS is not fatal, but it has significant effects on emotional and physical health. Many people with MS die of complications of the disease, and suicide rates are much higher than normal.

MS can be one of two forms. In the more common form, relapsing-remitting MS, symptoms occur for several days and may be mild. Symptoms then improve or disappear for a month or more; this is called remission. This form of MS may not progress to a chronic form with more severe symptoms for years. The second form of MS, chronic-progressive, occurs less frequently. In this form, symptoms occur and do not improve, but slowly worsen, with nerves and muscles deteriorating. A person with this form of MS may have occasional flare-ups in which symptoms become worse, times of remission during which symptoms improve and plateaus in which symptoms don't change.

Women are affected by MS 1.5 to 2 times as often as men. It is more common in whites of northern European descent than in other ethnic groups. It is more common in temperate regions than in the tropics, and is most prevalent in northern and central Europe, Italy, southern Australia and the northern states of North America.

Symptoms of MS usually first appear between the ages of 20 and 40, but because diagnosis is difficult, many people may not immediately discover the cause of their symptoms. MS seldom occurs in children younger than 15 or in adults older than 60.

MS can be difficult to diagnose because the symptoms are the same as those of many other diseases. No single test exists to diagnose MS. A diagnosis often is made only after other illnesses are ruled out. Your doctor may order an MRI, a test of your spinal fluid, a simple test of nerve function called an evoked potential, and visual tests to aid in determining the diagnosis.

Causes

The cause of the autoimmune response that leads to MS is not known. Some researchers suspect that a person's genetic makeup combined with some environmental factor causes MS. One theory says that a virus is the environmental factor. That virus, which may be contracted in adolescence and then lie dormant for years, has not yet been identified.

Another theory says that MS and other autoimmune diseases are a result of a cleaner environment and fewer childhood infections. The theory proposes that infections in early childhood affect the immune system in a way that later protects adults against autoimmune diseases. With a cleaner environment and a widespread use of antibiotics, people don't get as many childhood infections and thus their immune systems don't develop protective factors.

Symptoms

• Blurred or double vision

• Eye pain, involuntary eye jerking or eye movement, usually in just one eye

• Distortion of colors, especially reds and greens

• Blindness in one eye

• Fatigue, usually worse in the afternoon

• Changes in how arms and legs feel; common sensations include heaviness, weakness, clumsiness, numbness and tingling

• Muscle weakness, spasms, loss of dexterity and inability to control specific movements

• Problems with bladder and bowel control, and sexual dysfunction

• Speech difficulties

• Tremors

• Dizziness

• Hearing loss

• Difficulty with concentration, attention and memory, usually after many years

• Depression and mood swings, usually after many years

Treatment

Once MS is diagnosed, treatment should begin as soon as possible. Treatment focuses on relieving symptoms, decreasing the frequency and severity of attacks and preventing disability. Drugs prescribed include corticosteroids and various types of interferons, which may slow progression of physical disability and ease the severity of an MS attack. Other drugs that may be prescribed include a synthetic form of myelin basic protein, called copolymer I; and mitoxantrone and other drugs that suppress the immune system. Drugs to relieve symptoms of MS include steroids, muscle relaxants, pain relievers, tranquilizers and antidepressants; medications also may be given to help with bladder and bowel control and sexual dysfunction.

Drugs being researched as future MS medications include monoclonal antibodies, which are special antibodies to target immune system areas that may cause MS; aminopyridines, which block the body's use of potassium to improve the function of damaged nerves; and cannabinoids, which may protect nerve cells.

Calcium and vitamin D supplements, along with medications to prevent bone loss, are also prescribed because osteoporosis is common in people with MS.

A person with MS often requires help from family or friends because of long-term physical, financial and psychological needs.

Self-Care Steps for Multiple Sclerosis

• If possible, get help for daily tasks.

• Limit stress as much as possible, because it can cause and worsen symptoms.

• Enroll in an aerobic exercise program to stimulate your muscles as much as you are able. Water aerobics is an excellent choice.

• Do stretching and range-of-motion exercises to help with spasticity.

• Be careful not to become overheated, because this may make your symptoms worse. Use an air conditioner in the summer, and don't swim in overheated pools.

• Join a support group to help you learn how to cope with the disease.

• Avoid getting colds and the flu. Get an annual flu shot; the nasal vaccine, however, is not recommended for people with MS.

• Talk to your doctor if your symptoms return or become worse.

• Don't forget to have recommended tests and exams to detect other health conditions such as high blood pressure or cancer.