Multiple Sclerosis

Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptom of multiple sclerosis. They can include;

  • Visual disturbances
  • Muscle weakness
  • Trouble with coordination and balance
  • Sensations such as numbness, prickling, or "pins and needles"
  • Thinking and memory problems

Today, several therapies are available that can ameliorate the symptoms of multiple sclerosis and, in some cases, slow disease progression. These treatments include the beta interferons (Betaseron®, Rebif®, Avonex®), and copolymer 1 (Copaxone®, also called glatiramer acetate), a mixture of peptide fragments. The NIH supported the research that led to the development and approval of Avonex® and funded the basic research that led to the development of Copaxone®. For severe forms of multiple sclerosis of relapsing remitting and secondary progressive multiple sclerosis, the FDA approved mitoxantrone (Novantrone®), an immunosuppressant. Most recently, the FDA approved natalizumab (Tysabri®), an antibody-based therapy that represents a new class of immunomodulatory agents, for a restricted population of patients with multiple sclerosis.

No one knows what causes multiple sclerosis. It may be an autoimmune disease, which happens when your body attacks itself. Multiple sclerosis affects woman more than men. Most people experience their first symptoms between the ages of 20 and 40; the initial symptom of multiple sclerosis is often blurred or double vision, red-green color distortion, or even blindness in one eye.  Most multiple sclerosis patients experience muscle weakness in their extremities and difficulty with coordination and balance.  These symptoms may be severe enough to impair walking or even standing. In the worst cases, multiple sclerosis can produce partial or complete paralysis.  Most people with multiple sclerosis also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations.  Some may also experience pain.  Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with multiple sclerosis have hearing loss. Approximately half of all people with multiple sclerosis experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked.  Depression is another common feature of multiple sclerosis.

Multiple sclerosis was first recognized as a disorder in the late nineteenth century, but it wasn't until the nineteen sixties that researchers began to understand some of the disease processes that cause symptoms and long-term disability in multiple sclerosis. These processes seemed to involve inflammation and the loss of myelin, a protective covering around nerve fibers. The first standard guidelines for the diagnosis of multiple sclerosis and a disability rating scale were also established in the nineteen sixties, setting the stage for controlled research to test new therapies. In the late sixties, the first controlled clinical trials for multiple sclerosis therapy showed that treatment with adrenocorticotropic hormone speeded recovery from an attack. While this therapy helped to reduce inflammation during the acute symptoms of an attack, it did not slow the progression of multiple sclerosis.

Today, multiple sclerosis is recognized as a chronic, inflammatory, demyelinating autoimmune disease of the central nervous system (CNS). The damage to the myelin covering and to the underlying nerve cell fibers leads to slowed or blocked transmission of signals, which results in reduced or lost functions. Improved imaging techniques show that damage to nerve fibers can happen even at very early stages of the disease.

There are a number of myths about multiple sclerosis that are not based in research. First, multiple sclerosis is not contagious. Second, contact with heavy metals can cause damage to the nerves but there is no evidence of heavy metals or mercury from amalgam in dental fillings being linked with multiple sclerosis. Third, a number of viruses have been and are under study in relationship with multiple sclerosis. However, no virus has been found to cause multiple sclerosis.

Multiple Sclerosis Treatment

There is as yet no cure for multiple sclerosis. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. However, three forms of beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting multiple sclerosis. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. The FDA also has approved a synthetic form of myelin basic protein, called copolymer I (Copaxone), for the treatment of relapsing-remitting multiple sclerosis. Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third. An immunosuppressant treatment, Novantrone (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic multiple sclerosis.

One monoclonal antibody, natalizumab (Tysabri), was shown in clinical trials to significantly reduce the frequency of attacks in people with relapsing forms of multiple sclerosis and was approved for marketing by the U.S. Food and Drug Administration (FDA) in 2004. However, in 2005 the drug's manufacturer voluntarily suspended marketing of the drug after several reports of significant adverse events. In 2006, the FDA again approved sale of the drug for multiple sclerosis but under strict treatment guidelines involving infusion centers where patients can be monitored by specially trained physicians.

While steroids do not affect the course of multiple sclerosis over time, they can reduce the duration and severity of attacks in some patients. Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers such as baclofen, tizanidine, diazepam, clonazepam, and dantrolene. Physical therapy and exercise can help preserve remaining function, and patients may find that various aids -- such as foot braces, canes, and walkers -- can help them remain independent and mobile. Avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue. If psychological symptomultiple sclerosis of fatigue such as depression or apathy are evident, antidepressant medications may help. Other drugs that may reduce fatigue in some, but not all, patients include amantadine (Symmetrel), pemoline (Cylert), and the still-experimental drug aminopyridine. Although improvement of optic symptoms usually occurs even without treatment, a short course of treatment with intravenous methylprednisolone (Solu-Medrol) followed by treatment with oral steroids is sometimes used.

Persons with multiple sclerosis often seek out clinically unproven treatments for the wide range of symptoms they experience - especially if the prescribed treatment has been ineffective. These complementary and alternative medicines come from many disciplines and traditions. They can include special diets, vitamin supplements, life-style changes and mental exercises. Before beginning such a program, discuss it with your physician. He/she can tell you if your proposed self-administered program will interfere with your currently prescribed treatment.

Multiple Sclerosis Diagnosis

A physician may diagnose multiple sclerosis in some patients soon after the onset of the illness. In others, however, doctors may not be able to readily identify the cause of the symptoms, leading to years of uncertainty and multiple diagnoses punctuated by baffling symptoms that mysteriously wax and wane. The vast majority of patients are mildly affected, but in the worst cases, multiple sclerosis can render a person unable to write, speak, or walk. M ultiple sclerosis is a disease with a natural tendency to remit spontaneously, for which there is no universally effective treatment.

Since there is no single test to identify or rule out multiple sclerosis, diagnosis of the condition can be difficult and take awhile. Physicians rely on medical history and a variety of tests and procedures to arrive at a diagnosis. Abnormal functioning of the nervous system, such as, loss of coordination and balance, delayed reflexes, blurred vision and numbness may suggest multiple sclerosis. Magnetic Resonance Imaging (MRI) may be used to look for scars on the nervous tissue in the brain or fluid may drawn from the spinal cord to look for antibodies associated with the disease. Definitive diagnosis is usually based on evidence of nerve damage in two different parts of the CNS and two separate flareups of multiple sclerosis symptomultiple sclerosis over time.

Multiple Sclerosis Symptoms

The symptoms of multiple sclerosis vary greatly from one person to another and within one person over time. Symptoms of multiple sclerosis may include bowel and/or bladder disfunction, changes in cognitive abilities, dizziness and vertigo, emotional problems, fatigue, difficulty in walking, numbness or "pins and needles," pain, vision problems, headaches, hearing loss, itching, seizures, spasticity, slurred speech, swallowing problems sclerosis, and tremors. Most individuals will experience only some of these symptoms and perhaps not at the same time.

Symptoms of multiple sclerosis usually appear in episodic acute periods of worsening (relapses, exacerbations, bouts or attacks), in a gradually progressive deterioration of neurologic function, or in a combination of both.

The most common presentation of multiple sclerosis is the clinically isolated syndrome (CIS). In CIS, a patient has an attack suggestive of demyelination, but does not fulfill the criteria for multiple sclerosis. Only 30 to 70% of persons experiencing CIS later develop multiple sclerosis. The disease usually presents with sensorial (46% of cases), visual (33%), cerebellar (30%) and motor (26%) symptoms. Many rare initial symptoms have also been reported, including aphasia, psychosis and epilepsy. Patients first seeking medical attention commonly present with multiple symptoms. The initial signs and symptoms of multiple sclerosis are often transient, mild, and self-limited. These signs and symptoms often do not prompt a person to seek medical attention and are sometimes identified only retrospectively once the diagnosis of multiple sclerosis has been made. Cases of multiple sclerosis are sometimes incidentally identified during neurological examinations performed for other causes. Such cases are referred to as subclinical multiple sclerosis.

The person with v can suffer almost any neurological symptom or sign, including changes in sensation (hypoesthesia and paraesthesia), muscle weakness, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia), Fatigue, acute or chronic pain, and bladder and bowel difficulties. Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common. The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale or EDSS.

Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors. Some attacks, however, are preceded by common triggers. Relapses occur more frequently during spring and summer. Infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse.Stress may also trigger an attack. Pregnancy may affect susceptibility to relapse, offering protection during the last trimester, for instance. During the first few months after delivery, however, the risk of relapse is increased. Overall, pregnancy does not seem to influence long-term disability. Many potential triggers have been examined and found not to influence MS relapse rates. There is no evidence that vaccination for influenza, hepatitis B, varicella, tetanus, or tuberculosis increases risk of relapse. Physical trauma does not trigger relapses.