What is multiple sclerosis?
Multiple Sclerosis is a chronic progressive neurological disorder. The name
literally means “many scars” referring to the lesions in the
brain and spinal cord that accumulate during the course of the disease. MS
affects approximately 400,000 people in the US and approximately 2 million
people worldwide. The majority of patients with newly diagnosed MS are between
the ages of 20-40, making MS the most common neurological disorder to affect
young adults. MS is more prevalent in women and the disease appears to be
more prevalent in individuals living in the northern temperature zones of
North America and Europe. MS is felt to be an autoimmune disease that affects
the central nervous system (CNS). The CNS consists of the brain, spinal cord,
and optic nerves. Surrounding and protecting the nerves of the CNS is a fatty
coating called myelin, which helps nerve cells conduct electrical impulses.
In MS, myelin is lost in multiple areas leaving scar tissue called sclerosis.
These damaged areas are also known as plaques or lesions. Sometimes the nerve
fiber itself is damaged or broken. Myelin not only protects the nerve cells,
it also makes their job possible. When myelin is destroyed or damaged, the
ability for the nerves to conduct electrical impulses to and from the brain
is disrupted. This results in the various symptoms of MS.
Although a family history of MS plays an important role, MS is not believed
to be a hereditary disease. Genetic factors are thought to play an important
role in predisposing individuals to MS but the precipitating event that results
in the development of the disease is unclear.
What are the symptoms of MS and how is the diagnosis of MS made?
No single diagnostic test confirms or rules out the presence of MS. A positive
diagnosis based on a combination of medical history, clinical symptoms compatible
with MS, abnormal findings on neurological examination, and positive results
of diagnostic tests are markers of the disease. This includes MRI scan, spinal
tap, or special evoked potentials. A differential diagnosis should be performed
to limit any other conditions that may cause similar symptoms, abnormal findings
on examination, or diagnostic test results. The diagnosis of MS also requires
evidence that the disease process is ongoing; therefore a diagnosis may require
some time.
What are the different types of MS?
There are many different ways to classify MS, however the simplest and most
meaningful classification is four courses.
Relapsing-Remitting: Characteristics – People
with this type of MS experience clearly defined flare-ups called relapses
(or attacks). These are evidence of acute or worsening of neurological function
followed by partial complete periods of recovery (remissions). This is the
most common form of MS at initial diagnosis (85%).
Primary progressive. Characteristics – Patients
with this type of MS experience a slow but nearly continuous worsening of
the disease from the onset with no distinct relapses or remissions. However,
there are variations in rates of progression over time, occasionally plateaus
are temporary minor improvements. Frequency is relatively less at approximately
10%.
Secondary progressive. Characteristic – Patients
with this type of MS experience an initial period of relapsing-remitting
followed by a steady worsening course with or without occasional flare-ups
or minor recovers or plateaus. Frequency, 50% of patients relapsing-remitting
develop this form of disease within 10 years of initial diagnosis before
destruction of the disease modifying (drugs). Long-term studies are not yet
available to demonstrate if this is significantly improved by treatment.
Progressive relapsing. Characteristics – Patients
with this type of MS experience a steady worsening of the disease from the
onset but also have clear acute relapses (attacks or exacerbations) with
and without recover in contrast relapsing-remitting appears to have relapses
with continuous progression. Frequency is relatively rare, less than 5%.
What therapies are available to treat MS?
In most patients with MS, information of the brain and destruction of the myelin
are ongoing even when they are not experiencing symptoms. Disease modifying
agents (Copaxone, Rebif, Avonex, Betaserone, and Novantrone) are capable
of suppressing information of the brain and can limit the amount of tissue
related neurological damage caused by MS. Treatment that is initiated early
in the course of MS is more effective in sparing the brain and spinal cord
tissue and expected to be associated with better outcomes including less
long-term disability and improved quality of life. MS is not contagious and
is not directly inherited. It is not considered a fatal disease. The majority
of the patients with MS do not become severely disabled. Although there is
no cure for MS, early treatment helps greatly decrease relapses and slow
the progression of the disease on to the secondary progressive phase. Multiple
web sites are available to further assist in your research regarding MS including
the treatment options outlined below.
What are the symptoms of MS?
The symptoms of MS are unpredictable and vary from person to person and from
time to time in the same person. For example, one person may experience abnormal
fatigue or another may have severe vision problems. Persons with MS could
have loss of balance and muscle coordination making walking difficult. Another
person with MS could have slurred speech, tremors, stiffness, and bladder
problems. Your symptoms depend on where the MS plaque has occurred; whether
it is in the brain, brain stem, spinal cord, or optic nerves.
What are the treatments available for the acute relapses?
During acute relapses, the significant motor features, including weakness and
vision changes, your physician may treat an increased exacerbation with steroids.
This could be administered either orally such as Prednisone or high dose
intravenous Solumedrol since steroids are known to result in a more rapid
recovery from an exacerbation. They do not decrease the progression of the
disease or delay the development of the secondary progressive disease. Therefore,
it is very important to start immune modulating therapies as discussed previously.
What are the treatments available for the symptoms of MS?
For fatigue, which in some is the most disabling symptom, medication often
used is an antiviral drug called Amantadine. Another medication being used
for narcolepsy that has been effective is Provigil. If these fail, sometimes
stimulants such as Ritalin or Adderall may be used. Patients with MS may
have significant muscle stiffness and spasms. This can often be treated with
medications such as Baclofen or Zanaflex. In rare cases, Benzodiapines can
be used. If these fail and with the severe spasticity of individual muscle
groups, sometimes Botox can be used and very rarely if there is spasticity
of the lower extremities which is severe, a Baclofen pump can be considered.
The patient should be treated for depression and may need treatment for bladder
dysfunction with various medications and bowel dysfunction especially constipation.
There are treatments available if there is significant heat intolerance with
a cooling jacket which sometimes insurance does cover.
Websites
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