Multiple Sclerosis
Overview
![Picture](/uploads/1/6/9/7/16973174/8800408.gif?379)
Multiple Sclerosis (MS) is a chronic neurological disorder that affects the central nervous system. In the central nervous system, nerve fibers or axons are surrounded by a layer of insulation called myelin. Myelin allows nerve signals to travel properly. In MS, the myelin on the brain and spinal cordis destroyed. The scarring, located at multiple sites in the CNS, disrupts transmission of messages that communicate a desired action from the brain, through the spinal cord, to various parts of the body. The inflammation produced by MS damages the axons themselves and can cause permanent loss of function. In the process, the cells that produce myelin can also be damaged. This limits the ability of the brain to repair damaged myelin. This is similar to a frayed electrical cord. The insulation assures that the electricity running along the wire reaches its destination without short-circuiting. In MS, the transmission along the nerve fibers becomes faulty or absent. This can cause problems with vision, coordination, sensations in the limbs, and other symptoms. The course of the disease varies greatly from person to person. It is impossible to predict the severity or progression in any given individual. MS is divided into four classifications:
- Relapsing-Remitting - Clearly defined attacks lasting from days to weeks, with full recovery or with some remaining neurological symptoms and deficits upon recovery. Periods between relapses are stable and absent of disease progression.
- Secondary-Progressive – Begins initially with a relapsing-remitting course that becomes consistently progressive and includes occasional relapses and minor remission. Deficits are accumulated without recovery between attacks.
- Primary-Progressive – Progression of level of disability from the onset without any distinct relapses of remissions. Temporary, minor improvements may be experienced.
- Progressive-Relapsing – Clear progression in disability level from the onset, but also clear acute relapses that may or may not include memory.
Causes and Symptoms
![Picture](/uploads/1/6/9/7/16973174/5790931.jpg?405)
Causes:
Multiple sclerosis is not really considered a hereditary disease, but genetic variations have been known to increase the chance of getting this disease. The risk of acquiring the disease is higher in relatives of an infected person than in the general population. Specific genes have also been linked to multiple sclerosis. Differences in a group of genes in chromosome 6 that serve as the major histocompatibility complex increase the chance of getting multiple sclerosis. Different environmental factors also play a key role in getting multiple sclerosis. Multiple sclerosis is more common in people who live farther than the equator than people who live closer to the equator. Decreased sunlight exposure has been linked with higher risks of multiple sclerosis. Decreased vitamin D intake and production has been the main biological mechanism used to explain the higher risk among those less exposed to the sun. Severe stress may also be a risk factor. Smoking has also been shown to be an independent risk factor for developing multiple sclerosis. Many microbes have been proposed as potential infectious triggers of multiple sclerosis. Moving at an early age from one location in the world to another alters a person's subsequent risk of getting the disease.
Symptoms:
Symptoms of multiple sclerosis vary, depending on the location of the affected nerve fibers. Multiple sclerosis symptoms may include:
Multiple sclerosis is not really considered a hereditary disease, but genetic variations have been known to increase the chance of getting this disease. The risk of acquiring the disease is higher in relatives of an infected person than in the general population. Specific genes have also been linked to multiple sclerosis. Differences in a group of genes in chromosome 6 that serve as the major histocompatibility complex increase the chance of getting multiple sclerosis. Different environmental factors also play a key role in getting multiple sclerosis. Multiple sclerosis is more common in people who live farther than the equator than people who live closer to the equator. Decreased sunlight exposure has been linked with higher risks of multiple sclerosis. Decreased vitamin D intake and production has been the main biological mechanism used to explain the higher risk among those less exposed to the sun. Severe stress may also be a risk factor. Smoking has also been shown to be an independent risk factor for developing multiple sclerosis. Many microbes have been proposed as potential infectious triggers of multiple sclerosis. Moving at an early age from one location in the world to another alters a person's subsequent risk of getting the disease.
Symptoms:
Symptoms of multiple sclerosis vary, depending on the location of the affected nerve fibers. Multiple sclerosis symptoms may include:
- Numbness or weakness in one or more limbs
- Partial or complete loss of central vision, usually in one eye, often with pain during eye movement
- Double vision or blurring of vision
- Tingling or pain in various parts of the body
- Electric-shock sensations that occur with certain head movements
- Tremor
- Lack of coordination
- Slurred speech
- Fatigue
- Dizziness
Diagnosis and Cures
Diagnosis:
By themselves, there are no specific tests that can determine if a person has MS or is likely to have it in the future. Current diagnosis of MS involves both clinical and paraclinical evidence. The diagnosis evolves from a discussion between the patient and the physician. A careful medical history is taken; symptoms and signs are assessed. Other ailments are ruled out. The diagnosis is highly dependent on the accuracy of the patient’s medical history and the physician's skill in eliciting and evaluating this information. The diagnosis is sometimes obvious and sometimes very difficult. Even in the hands of experts, the diagnosis is correct only 90 - 95 percent of the time. During the neurological examination the physician will check for exaggerated reflexes such as Babinski's reflex, an upward movement of the big toe when the sole of the foot is stimulated. For patients with balance and gait difficulties, and an eye examination is done to determine optic nerve damage. The physician must be able to find neurological evidence of lesions or plaques in at least two distinct areas of the Central Nervous System white matter, evidence that the plaques have occurred at different points in time, and most importantly, that these plaques have no other reasonable explanation thus ruling out other illnesses that mimic MS. For some patients no tests beyond medical history and neurologic exam are necessary to diagnose.
Cures:
Multiple sclerosis has no cure. Treatment usually focuses on strategies to treat attacks, manage symptoms, and reduce the progress of the disease. Some people have such mild symptoms that no treatment is necessary.
Strategies to treat attacks:
Strategies to slow progress of the disease
Strategies to treat symptoms
By themselves, there are no specific tests that can determine if a person has MS or is likely to have it in the future. Current diagnosis of MS involves both clinical and paraclinical evidence. The diagnosis evolves from a discussion between the patient and the physician. A careful medical history is taken; symptoms and signs are assessed. Other ailments are ruled out. The diagnosis is highly dependent on the accuracy of the patient’s medical history and the physician's skill in eliciting and evaluating this information. The diagnosis is sometimes obvious and sometimes very difficult. Even in the hands of experts, the diagnosis is correct only 90 - 95 percent of the time. During the neurological examination the physician will check for exaggerated reflexes such as Babinski's reflex, an upward movement of the big toe when the sole of the foot is stimulated. For patients with balance and gait difficulties, and an eye examination is done to determine optic nerve damage. The physician must be able to find neurological evidence of lesions or plaques in at least two distinct areas of the Central Nervous System white matter, evidence that the plaques have occurred at different points in time, and most importantly, that these plaques have no other reasonable explanation thus ruling out other illnesses that mimic MS. For some patients no tests beyond medical history and neurologic exam are necessary to diagnose.
Cures:
Multiple sclerosis has no cure. Treatment usually focuses on strategies to treat attacks, manage symptoms, and reduce the progress of the disease. Some people have such mild symptoms that no treatment is necessary.
Strategies to treat attacks:
- Corticosteroids – Corticosteroids are mainly used to reduce the inflammation that spikes during a relapse.
- Plasma exchange – This procedure removes some blood from your body and mechanically separates your blood cells from your plasma, the liquid part of your blood. Doctors then mix your blood cells with a replacement solution and return the blood to your body.
Strategies to slow progress of the disease
- Beta interferons – These types of drugs to slow the progress of multiple sclerosis, reduce the number of attacks and lessen the severity of attacks.
- Glatiramer acetate – This medication may reduce the number of MS attacks. Doctors believe that glatiramer acetate works by blocking your immune system's attack on myelin.
- Fingolimod – An oral medication given once daily, this works by trapping immune cells in lymph nodes. It may reduce attacks of MS and short-term disability.
- Natalizumab – This medication may reduce the number of MS attacks by interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord.
- Mitoxantrone – This immunosuppressant medication can be harmful to the heart, and it's associated with development of blood cancers like leukemia. Because of these risks, it's usually only used to treat active severe, advanced multiple sclerosis, based on both clinical assessment and MRI studies.
- Teriflunomide – This oral medication reduces attacks and lesions in people with MS.
Strategies to treat symptoms
- Physical therapy – A physical or occupational therapist can teach you stretching and strengthening exercises and show you how to use devices that can make it easier to perform daily tasks.
- Muscle relaxants – If you have multiple sclerosis, you may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen and tizanidine may improve muscle spasticity.
- Medications to reduce fatigue – Medications such as amantadine may help reduce fatigue due to multiple sclerosis.
- Other medications – Medications also may be prescribed for depression, pain, and bladder or bowel control problems that may be associated with multiple sclerosis.