Multiple Sclerosis
What is it?
Multiple sclerosis (MS) is a disease of the central
nervous system, which consists of the brain and spinal
cord. With MS, the protective covering on the nerves in
and around the brain and spinal cord is damaged or
destroyed, causing symptoms that range from loss of muscle
control and coordination to visual disturbances.
Who gets it?
Roughly 400,000 people in the United States have MS.
Women are more likely than men to have this disease. MS is
most common in Northern Europe, the United States, and
Canada. People with a family member with MS are at a
greater risk for developing this disease.
What causes it?
While the cause of MS is unknown, it appears to be
related to an autoimmune response. Something, perhaps a
virus, triggers the immune system, which produces
antibodies (disease-fighting cells) that attack the body’s
own myelin. Myelin is the coating that insulates the nerve
fibers in and around the brain and spinal cord. The myelin
lets nerve impulses travel freely over the fibers to and
from the brain. Scar tissue forms in the areas where the
myelin is damaged or destroyed, creating areas called
plaques. Wherever plaques have developed, the nerve
impulses travel more slowly, carry a weaker signal, or
can’t get through at all. When this occurs, the patient
experiences the symptoms of MS. In addition to a virus,
researchers believe the autoimmune response may be
triggered by environmental factors and genetics.
What are the symptoms?
Most patients begin to notice symptoms sometime between
the ages of 20 and 40. The types of symptoms and how they
progress are related to the location of the plaques.
Damage to the myelin surrounding the nerves that conduct
signals to the muscles results in symptoms related to
movement. Damage to the myelin surrounding the nerves that
conduct signals concerning sensations to the brain results
in symptoms related to the senses. Symptoms usually begin
with unexplained exhaustion, as well as general weakness
and clumsiness. This weakness may occur in just one leg or
hand. Some patients experience blurred or double vision;
numbness or tingling in the face, arms, legs, or trunk;
memory loss; muscle stiffness, which makes walking
difficult; loss of balance; tremors; dizziness; problems
with swallowing or speech; and loss of bladder control.
Many patients with MS have chronic pain. A small number of
patients have acute pain, which is sudden and severe,
often in the face or back area. When symptoms occur, it is
called an episode. When symptoms go away, it is called
remission. The course of MS is unpredictable. Some
patients have long periods of remission and their symptoms
remain mild. Others experience shorter and shorter
remissions between episodes, or no remission at all. These
patients are more likely to experience permanent
disability, such as paralysis. Heat and stress can make
symptoms worse. Many patients with MS become depressed,
although researchers are not sure whether this is a
symptom of the disease or a response to having a chronic
illness. MS generally does not affect a person’s life
span.
How is it diagnosed?
Doctors suspect MS when relatively young patients have
motor and sensory symptoms that follow a pattern of
episodes and remissions. To make a diagnosis, your doctor
will take your medical history and perform a thorough
physical examination. A definite diagnosis is made through
a combination of tests to rule out other possible causes.
The best tool for revealing areas of myelin damage is
magnetic resonance imaging (MRI). MRI a painless
diagnostic test that uses a strong magnetic field to
produce extremely detailed images of the structures inside
the body. Your doctor may also order an evoked potential
test, which measures the electrical signals sent by the
brain when the nerves are stimulated. People with MS will
have slower responses to stimulation. Your doctor may also
order a lumbar puncture, in which a small sample of
cerebrospinal fluid (CSF) is removed. The CSF of people
with MS often has elevated levels of protein and white
blood cells.
What is the treatment?
There is not yet a cure for MS. A combination of
medication and physical therapy is recommended to reduce
symptoms and even prolong remissions. MS is treated by a
team of health care providers that includes a neurologist
and a physical therapist. You may also see an occupational
therapist, psychotherapist, and a social worker.
Corticosteroid drugs such as prednisone and
methylprednisone have been helpful in relieving symptoms
when used for short periods. Corticosteroids can also help
with vision problems. Other drugs, such as beta-interferon
and glatiramer acetate, can actually reduce the frequency
of episodes. These types of drugs are injected and help
prevent the immune system from attacking the myelin. Other
medications are used to treat symptoms such as depression,
urinary problems, and spasms, as necessary. Spasms respond
well to injection with botulinum toxin, which also helps
relieve the pain associated with the spasm. Patients with
severe bladder problems often learn to use a catheter to
empty the bladder. Physical and occupational therapy help
the patient maintain range of motion, strength, and
flexibility; learn techniques to compensate for loss of
coordination and balance; and to continue to function
fully with a disability. While there are medications that
your doctor might recommend to fight the fatigue
associated with MS, you may find that adjusting your
lifestyle to allow more frequent periods of rest will help
with this symptom.
Self-care tips
Researchers have not yet discovered a way to prevent
MS. If you have been diagnosed with MS, it is extremely
important to have a good support system among your family,
friends, and health care team. Maintaining a healthy
lifestyle, including a nutritious diet, a medically
approved program of physical activity, and plenty of rest,
goes a long way toward keeping you in the best health
possible. Although it may be difficult, you can reduce
your symptoms by keeping stress to a minimum and avoiding
spending too much time outdoors in extremely hot weather.
Also avoid hot showers, saunas, or hot tubs, which can
make symptoms worse.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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