Multiple Sclerosis

Multiple Sclerosis is an autoimmune disease that affects the central nervous system (brain, spinal cord, optic nerves).  The central nervous system is surrounded and protected by a fatty tissue, myelin.  Myelin is what helps nerve fibers conduct electrical impulses.  For people with MS, the myelin is lost in many areas that leaves scar tissue (sclerosis).  Myelin’s job is also to make the nerve fibers work.  Because the myelin is gone or damaged in multiple sclerosis, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted.  This is what causes the symptoms of Multiple Sclerosis.

Women are more likely to get MS than men and it usually afflicts people between the ages of 20 – 50.  There are currently about 400,000 people in the U.S. diagnosed with MS.

MS can take any one of four disease courses and depending on the patient, their symptoms can be mild to severe.

Relapsing-Remitting
This type of MS is where the patients symptoms will wax and wane, just like with CFS or FM.  This is the most common form of MS diagnosed (85%). There will be episodes of worsening acute neurologic function and then will have periods that are free of symptoms and disease progression.

Primary-Progressive
Patients with this form of MS will notice that their symptoms will start gradually and continually worsen. They will not have the remissions and flares as seen in the first type. This form of MS is only seen in about 10% of patients.

Secondary-Progressive
MS patients with this form of disease will experience a an initial period of relapsing-remitting MS, followed by a steadily worsening disease course with or without occasional flare-ups, minor recoveries (remissions), or plateaus.

The National MS Society reports:

50% of people with relapsing-remitting MS developed this form of the disease within 10 years of their initial diagnosis, before introduction of the “disease-modifying” drugs. Long-term data are not yet available to demonstrate if this is significantly delayed by treatment.

Progressive-Relapsing
In this type of MS, patients will have a steadily worsening illness from the beginning, but they will also have acute relapses with or without recovery. The difference between this form and the relapsing-remitting is that in this form, the patient will notice continual worsening of disease progression. This form is seen in only about 5% of MS cases.

Symptoms
The symptoms of MS will vary on the patient and their individual case. The MS Society says,

One person may experience abnormal fatigue, while another might have severe vision problems. A person with MS could have loss of balance and muscle coordination making walking difficult; another person with MS could have slurred speech, tremors, stiffness, and bladder problems. While some symptoms will come and go over the course of the disease, others may be more lasting.

• Fatigue
• Walking difficulties
• Bladder/bowel disturbances
• Visual problems
• Cognitive dysfunction
• Abnormal sensations in body – numbness, tingling
• Changes in sexual function/libido
• Depression
• Mood swings
• Pain
• Tremor
• Incoordination
• Speech problems
• Swallowing problems
• Hearing impairment

Diagnosis
There is currently not one single test that will diagnose Multiple Sclerosis. It takes a several tests for a diagnosis to be made. Physicians will take into account the patient’s complete medical history and symptoms. Testing of balance, reflexes, coordination and areas of numbness are looked at. MRIs are used to detect lesions on the brain that are common in MS. Spinal fluid is checked for signs of MS and evoked potential tests are done to determine how well a patient’s nervous system responds to certain stimulation.

Treatment
Click here to see the complete list of FDA approved medications and information about each one that is used to treat MS.

• Avonex – interferon beta-1a
• Betaseron – interferon beta-1b
• Copaxone – glatiramer acetate
• Rebif – interferon beta-1a
• Tysabri – natalizumab
• Novantrone
• Physical Therapy
• Occupational Therapy
• Speech Therapy
• Cognitive Rehabilitation
• Vocational Rehabilitation
• Alternative Therapy

Complications
A small proportion of people with primary or secondary progressive MS eventually develop symptoms and disabilities that require skilled care and special equipment. Some of those individuals with very severe MS will experience a somewhat shortened lifespan. This is almost always due to a complication, such as overwhelming infection, skin breakdown, or malnutrition.

Prognosis
The cause of MS is unknown, but most people with MS have a normal life expectancy. The vast majority of MS patients are mildly affected, but in the worst cases, MS can render a person unable to write, speak, or walk.

Resources for MS Patients
Multiple Sclerosis Foundation
National MS Society
UCSF Multiple Sclerosis Center
Direct MS
The Multiple Sclerosis Resource Centre