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.
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.
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. 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%.
Disease modifying agents (either injections of Copaxone, Rebif, Avonex, Betaserone, Novantrone or an oral medication such as Tecfidera, Gilenya or Aubagio) 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.
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.
Prednisone could be administered orally 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.
For fatigue, which in some is the most disabling symptom, the medication often used is an antiviral drug called Amantadine. Another medication that is used for narcolepsy that has also 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 there is 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 as well as for bowel dysfunction especially constipation. There are treatments available if there is significant heat intolerance such as a cooling jacket which sometimes insurance will cover.