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Tina

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Tina

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Thursday, 01/31/2008 9:00:31 PM

Thursday, January 31, 2008 9:00:31 PM

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Multiple Sclerosis (MS).(Disease/Disorder overview)
Health A-to-Z. August 21, 2006 pNA.

Full Text: COPYRIGHT 2006 Copyright by President and Fellows of Harvard College. All Rights Reserved.

Multiple Sclerosis

What Is It?

Multiple sclerosis, sometimes called just MS, is a disabling, neurological illness that affects the brain and spinal cord. The disease also is progressive, meaning it continues to get worse over time.

Nerve cells normally are surrounded by an insulating sheath made of a fatty substance called myelin that helps to transmit nerve impulses. In MS, this myelin sheath is inflamed or damaged, which disrupts or slows nerve impulses and leaves areas of scarring called sclerosis. These areas of myelin damage and scarring are called MS plaques.

The disruption of nerve signals causes a variety of symptoms that can affect vision, sensation and body movements. These symptoms usually come and go through a series of episodes when symptoms suddenly get worse (called relapses) alternating with periods of recovery when symptoms improve (called remissions). Many patients have a long history of multiple sclerosis attacks over several decades. In these cases, the disease may worsen in steps, when the attacks occur. For others, the disease worsens steadily. In a minority of patients, multiple sclerosis causes relatively few problems.

Although the exact cause of multiple sclerosis has been debated for decades, scientists now believe it is an autoimmune disease, which means the immune system mistakenly attacks its own body, in this case the myelin sheaths of the nerves. In some cases, the trigger for an attack seems to be a viral infection, but at other times, other physical or emotional stress is blamed. As a rule, the timing, duration and damage of attacks is unpredictable.

Multiple sclerosis is the most common neurological disease in young people, and it affects more than 1 million young adults worldwide. It is five times more common in temperate climates than in the tropics and affects women twice as often as men. Close relatives of a person with multiple sclerosis are 8 times more likely than the average person to develop the disease themselves, and children of a person with multiple sclerosis have 30 to 50 times the average risk. However, even though genetic (inherited) factors seem to play a large role in the development of this disease, no single multiple sclerosis gene has been identified. Instead, scientists suspect that the disease develops because of the influence of several genes acting together.

The symptoms of MS usually begin in someone who is younger than 40, people between ages 40 and 60 sometimes are affected.

Symptoms

Symptoms of multiple sclerosis vary depending on which areas of the brain and spinal cord are affected.

Multiple sclerosis can cause the following problems:

Sudden loss of vision; blurred or double vision

Slurred speech

Clumsiness, especially on one side

Unsteady gait

Loss of coordination

Trembling of a hand

A feeling of extreme tiredness

Facial symptoms including numbness, weakness or pain

Loss of bladder control (incontinence)

Inability to empty the bladder

Tingling, numbness or a feeling of constriction (constriction) in the arms, legs or elsewhere

Weakness or a heavy feeling in the arms or legs

Diagnosis

Your doctor will look for signs of neurological problems, including vision changes, difficulty in walking or in coordinating body movements, muscle weakness, trembling hands, or loss of sensation.

To confirm the diagnosis of multiple sclerosis, your doctor probably will order a magnetic resonance imaging (MRI) scan of your brain and/or spinal cord to check for areas of inflammation and myelin sheath destruction. Other possible diagnostic tests include a detailed eye examination by an ophthalmologist (a physician who specializes in eye problems), evoked potentials (special tests to record electrical activity in the brain) and a lumbar puncture (spinal tap) to obtain spinal fluid for analysis. Spinal fluid may show abnormal types of proteins, called immunoglobulins, a characteristic finding in multiple sclerosis.

Expected Duration

Multiple sclerosis is a lifelong illness that can follow one of several different patterns. The three most common patterns are:

Relapsing remitting multiple sclerosis -- In this form, there are relapses (episodes when symptoms suddenly get worse), followed by remissions (periods of recovery). Between relapses, the patient's condition is usually stable, without deterioration.

Primary progressive multiple sclerosis -- In this form, symptoms worsen gradually and continuously. There are no episodes of relapses and remissions.

Secondary progressive multiple sclerosis -- In this form, someone who originally had relapsing remitting multiple sclerosis begins to have gradual deterioration in nerve function, with or without relapses. Secondary progressive multiple sclerosis ultimately affects 50% of people with relapsing remitting MS.

Prevention

There is no way to prevent multiple sclerosis.

Treatment

There is no cure for multiple sclerosis. There are two types of treatments: those that modify the immune system to suppress the disease, and those that improve the symptoms.

The following treatments improve some of these symptoms of multiple sclerosis:

Fatigue -- Feelings of overwhelming exhaustion are common in people with multiple sclerosis, and can be improved with a variety of medications including pemoline (Cylert), amantadine (Symmetrel), methylphenidate (Ritalin) and certain antidepressants.

Spasticity -- Muscle tightness and spasms can be disabling for multiple sclerosis patients who have spinal cord damage. These symptoms can be improved with medications such as baclofen (Lioresal), diazepam (Valium) and dantrolene (Dantrium).

Bladder dysfunction -- Bladder dysfunction is common in patients with spinal cord damage from multiple sclerosis, but symptoms can be improved with a variety of medications such as oxybutynin (Ditropan) or imipramine (Tofranil).

Depression -- This is a common problem for patients with multiple sclerosis, but this potentially disabling symptom can be improved with a variety of antidepressant medications.

Neurological symptoms -- Anti-seizure medications decrease the risk of repeat seizures, and these medications may reduce some of the uncomfortable neurological symptoms that commonly occur during multiple sclerosis attacks.

Treatments that suppress the disease include:

Corticosteroid drugs -- These are the primary treatment for multiple sclerosis relapses, and they usually are given intravenously (directly into a vein). Corticosteroids appear to shorten the length of relapses and may accelerate recovery in an attack, but their long-term effect on the course of the illness is not known.

Interferon beta -- This is used to treat relapsing remitting multiple sclerosis, and it comes in two different injectable forms: interferon beta-1a (Avonex) and interferon beta-1b (Betaseron). Studies have shown that these medications may lower the rate of multiple sclerosis relapses by as much as 30%. They may also reduce the risk of the disease getting worse and disability though not all studies have confirmed this.

Glatiramer acetate (Copaxone) -- This drug is an alternative treatment for relapsing remitting multiple sclerosis when interferon beta therapy either cannot be used or is no longer effective, or is not tolerated well.

Other immune-modifying medications -- Other medications that can be used to suppress the disease include azathioprine (Imuran), methotrexate (Folex, Methotrexate LPF, Rheumatrex), cyclophosphamide (Cytoxan, Neosar), mitoxantrone (Novantrone) and cladribine (Leustatin).

When To Call A Professional

Call your doctor immediately if you have symptoms of multiple sclerosis.

Prognosis

A minority of those with multiple sclerosis have a relatively harmless form of the illness, but the majority of patients suffer from some type of neurological disability. In general, multiple sclerosis is a progressive illness that can last 30 to 40 years, but the degree of progression and eventual disability varies from patient to patient. There is great hope that newer forms of treatment will have significant long-term effects in improving the lives of multiple sclerosis patients.

Additional Info

National Multiple Sclerosis Society 733 3rd Ave. 6th Floor New York, NY 10017 Phone: (212) 986-3240 Toll-Free: (800) 344-4867 http://www.nmss.org/ (http://www.nmss.org/)

Multiple Sclerosis Foundation 6350 North Andrews Ave. Fort Lauderdale, FL 33309 Phone: (954) 776-6805 Toll-Free: (800) 225-6495 http://www.msfacts.org/ (http://www.msfacts.org/)



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