Multiple Sclerosis

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is unpredictable and can be relatively benign or disabling. Some individuals with MS may be mildly affected while others may lose their ability to write, speak, or walk when nerve impulses among the various parts of the brain and spinal cord begin to fail. The main problem is inflammation and damage to myelin in the brain and spinal cord. Myelin covers the nerve fibers as insulation to help nerve impulses travel without interruption. With myelin damaged, the nerve fibers can also be destroyed, leading to greater problems.

What causes multiple sclerosis?

There are no known causes of MS but our current understanding suggests that it is an autoimmune disorder due to genetic factors which can be triggered by viral infections and perhaps other environmental factors.

What are the symptoms of MS?

The symptoms of MS are often erratic and may include any part of the body. They may be mild or severe, of long duration or short. Each individual may experience symptoms differently.

• Symptoms of MS:
  
  The following may occur by themselves or in any combination:
  
  
  • blurred or double vision, or dimming of color vision
    
    
  • numbness, "pins and needles" sensation, or heat sensation
    
    
  • weakness in legs or arms, difficulty walking
    
    
  • loss of balance and coordination, dizziness, and tremors
    
    
  • fatigue
    
    
  • stiffness of leg muscles
    
    
  • difficulty controlling urinary bladder
    
    

  Some people experience cognitive impairments due to MS, which are mild, often detectable only after comprehensive testing. Any of the following may occur:
  
  

  • reduced energy
  • concentration and attention problems
  • slow thought process

  Problems existing due to MS can be a direct result of demyelination, inflammation and nerve fiber damage. Indirect problems may follow in the form of urinary bladder infections due to control difficulties, or as bedsores due to paralysis, etc. Further complications may include the loss of a job because of being unable to get to it.

  The symptoms of MS may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

  How is multiple sclerosis diagnosed?

  There is no definitive test available to diagnose multiple sclerosis. However, a probable diagnosis can be made by following a careful process which demonstrates findings that are consistent with MS, that also rule out other causes and diseases.

  There are two basic criteria used to diagnose MS?

  1. There must have been two attacks (or relapses) at least one month apart. An attack is a sudden appearance of or worsening of any MS symptoms that lasts at least 48 to 72 hours.
     
     
  2. There must be more than one area of damage to the central nervous system seen as spots on an MRI brain scan, which have occurred at different times and were not caused by any other disease. Lesions can be seen in the spinal cord, too.

  What does an evaluation for MS cover?

  A clinical evaluation for MS often covers an extensive review of the following:

  • cognitive functions
  • emotional functions
  • movement and muscle strength
  • vision
  • balance and coordination
  • ability to feel various stimuli (pin, vibration, movement)

  Testing procedures for MS:

  None of these are fail-safe and require careful evaluation.

  • magnetic resonance imaging (MRI) - a painless diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of the spinal cord to detect the presence of MS lesions known as plaques or scars.
  • evoked potentials - procedures that record the brain''s electrical response to visual, auditory, and sensory stimuli; to show if there is a slowing of nerve impulses in the various parts of the brain and spinal cord.
  • cerebral spinal fluid analysis (obtained by spinal tap or lumbar puncture.) - a procedure used to make an evaluation or diagnosis by examining the fluid withdrawn from the spinal column; to check for the presence of abnormal antibodies often seen in MS.
  • blood tests (to rule out other causes for various neurological symptoms)

  Treatment for MS:

  Specific treatment for MS will be determined by your physician based on:

  • extent and activity of MS
  • age, overall health, and medical history
  • tolerance for specific medications, procedures, or therapies
  • projected course of MS
  • opinions or preferences by patients and physicians

  Treatments may include the following:

  • medication
  • assistive technology
  • rehabilitation measures

  Medications used in the treatment of MS are known as etiologic or symptomatic: Etiologic treatments can change the course of MS by slowing its progression. Among those are interferous beta (Avonex, Betaseron and rebif) and glatiramer (Copaxone), or less frequently used azthioprine (Imuran) and methotrexate. When MS does not respond to these, more powerful medications can be considered, all from the group of anti-cancer chemotherapies. Among them are mitoxantrone (Novatrone), cyclophosphamide (Cytoxan) and cladribine (Levstatin).

  For treatment of MS relapses (attacks) we use high dose intravenous cortico-steriods (Solu Medrol or Decoadron) over three to five days, followed by one to three weeks of oral treatment.

  Symptomatic therapies can be very beneficial by reducing or even eliminating:

  • fatigue
  • muscle stiffness
  • muscle weakness
  • depression
  • blurred vision
  • cognitive problems
  • pain
  • sudden brief occurrences of pain; clumsiness, spasms and slurring
  • bladder and bowel control difficulties
  • sexual dysfunction

  New experimental etiologic and symptomatic medications are on the way to becoming useful parts of the regular array of drugs that will control MS and its symptoms ever more effectively until, eventually the cure and repair therapies are discovered.

  Rehabilitation for people with MS:

  Rehabilitation varies depending upon the range, expression, severity, and progression of symptoms. MS rehabilitation may help to restore functions that are essential to the activities of daily living (ADLs), maximize independence, promote involvement of family and friends, educate about assistive devices, and adapt the environment to meet any specific needs.