Multiple sclerosis (MS) is a progressive disease that destroys the myelin sheath which surrounds and
protects nerve fibers of the brain and spinal cord (the central nervous system).
The central nervous system contains millions of nerve cells which are joined by nerve fibers. Electrical
impulses originate in nerve cells and travel along the nerve fibers to and from the brain. Mylein is the substance that coats
and protects the nerve fibers, similar to the way insulation shields electrical wires. In MS, the myelin sheath is attacked,
becomes inflamed (swollen), starts to break down bit by bit and then detaches itself from the nerve fibers. Myelin gradually
disappears and is replaced by cells that build up to form multiple hardened (sclerosed) patches of scar tissue (lesions) over
the nerve fibers. When nerve impulses reach the damaged area, some impulses are blocked or delayed from reaching the brain,
which results in the development of the symptoms of MS. (see SYMPTOMS section for details). The prognosis of MS is variable
and unpredictable. Although the disorder is chronic and incurable, life expectancy can be normal or nearly so, with a life
span of 35 or more years after diagnosis. Most people with MS continue to walk and function at work with minimal disability
for 20 or more years. The amount of disability and discomfort varies with the severity and frequency of attacks and the part
of the central nervous system affected by each attack.
The average age of patients diagnosed with MS is 30, however, the first attack of MS can occur as early
as the age of 15 or as late as the age of 50. Women are affected at least twice as often as men, and it is more common in
persons of Northern European heritage and those living furthest from the equator. The cause of MS is not known. Although the
exact cause of MS is unknown, researchers believe that MS could be caused by (1) an autoimmune response in which the person's
body mistakenly destroys its own myelin, (2) a slow acting viral infection, or (3) genetically or environmentally based factors.
The symptoms of MS include:
- Tingling sensations of the extremities
- Numbness of the extremities
- Uncontrollable tremors
- Slurred speech
- Blurred or double vision
- Loss of vision
- Walking/gait abnormalities
- Hearing loss
- Muscle weakness
- Poor coordination
- Unusual fatigue
- Muscle cramps
- Problems with bladder, bowel and sexual function
- Symptoms vary, depending on where the MS occurs in the central nervous system.
- Symptoms vary from person to person and from time to time in the same person.
- Symptoms tend to appear, remit and reappear. There is no way at present to predict when or even if
attacks of the disease will recur. In general, the typical pattern of MS is marked by periods of active disease, called exacerbations,
and symptom-free periods, called remissions.
- Symptoms may occur in any combination and can vary from mild to very severe.
Doctors diagnose MS based on symptoms and medical history, a full neurological examination and laboratory
tests. Two factors must be clearly shown to establish the diagnosis of MS: (1) there must be clinical and laboratory-supported
evidence of one or more lesions in different parts of the central nervous system, and (2) there must have been at least two
separate exacerbations of the disease. Confirmation of these factors may take years, because of MS exacerbations/remissions
cycles and vagueness of early symptoms. Medical History The doctor will ask about the symptoms, how often the patient
is experiencing them, how long the patient has been experiencing them (in time) and other past medical illnesses or operations,
family history and personal habits. Neurological Examination The neurological examination includes testing the patient's
mental and language functions, movement/coordination skills and vision abilities, along with a number of tests, such as memory
tasks (remembering dates, names and places), touching the nose with a finger, listening to a tuning fork and checking the
person's reflexes. Laboratory Tests If the patient seems to show signs of MS, a number of laboratory procedures may
help to confirm it. The laboratory procedures and tests may include a complete blood count (CBC) workup, magnetic resonance
imaging (MRI) and evoked potentials (EP) studies. A CBC will be ordered to rule out other causes for the neurologic symptoms,
such as Lyme disease, collagen-vascular diseases, AIDS and certain rare hereditary diseases. An MRI uses computers and a strong
magnetic field to produce pictures of the brain that make it possible to visualize and count lesions in the white matter (the
part of the brain that contains myelinated nerve fibers) of the brain. EP studies show the slowing of nerve impulses (messages)
in the various parts of the central nervous system. Some of the EP studies are visual evoked potentials (VEP); brainstem auditory
evoked potentials (BAEP); and/or somatosensory evoked potentials (SSEP). For these studies, electrodes are placed on the scalp,
and the body systems being evaluated are stimulated (evoked) in various ways so the electrical reaction produced in the central
nervous system can be recorded. If after administering the above tests, the diagnosis is inconclusive, the doctor may order
a cerebrospinal fluid (CSF) examination as well. To extract the fluid, the doctor will insert a hollow needle into the lower
part of the spinal canal (called a lumbar puncture or spinal tap) and withdraw a small amount of cerebrospinal fluid (a watery
liquid that surrounds the brain and the spinal cord). This fluid is then checked for the presence of increased levels of oligoclonal
bands, gamma globulin or myelin basic protein, which alerts the doctor to deterioration.
Currently, there is no prevention or cure for MS, however, there are medications available to lessen
the severity and frequency of MS attacks and treat many of the symptoms. To treat the attacks, medications such as Betaseron,
Avonex, Copaxone and corticosteroid drugs (such as ACTH, Orasone, Decadron or prednisone) have proven helpful. These drugs
are used for the treatment of relapsing-remitting MS. To treat general pain associated with MS, medications such as aspirin,
acetaminophen, Tegretol, Neurontin, Depakene, Dilantin and Elavil are often used. To treat spasticity, medications such as
Lioresal, Dantrium, Valium, Zanaflex and Klonopin have proven effective. To treat fatigue, medications such as Cylert, Prozac,
Zoloft and Symmetrel seem to help the patient. To treat sensory symptoms, such as tingling and pins-and-needles sensations,
medications such as Tegretol, Dilantin or amitriptyline can help. Preventive measures are also beneficial. Overexhaustion,
emotional stress, viral infections and a rise in body temperature (from a hot bath or hot and humid weather, for example)
are thought to trigger or worsen symptoms and should therefore be avoided. Patients should follow a well-balanced, nutritionally
sound diet and maintain a desirable weight. Muscle stiffness may be aided by physical therapy, and moderate exercise can help
keep the limbs supple and maintain muscle function. Certain exercises can also alleviate muscle spasms.
Will the disease progress? What is the prognosis in this case? Can I do anything to lessen the progression
of the disease? Are there any warning signs to an attack? Are there any medications to treat the symptoms of MS? If so, what
are they and what are the side effects?