Multiple Sclerosis


MULTIPLE SCLEROSIS:

Description:

Multiple sclerosis or MS is a disease that affects the brain and spinal cord resulting in loss of muscle control, vision, balance, and sensation (such as numbness). With MS, the nerves of the brain and spinal cord are damaged by one's own immune system. Thus, the condition is called an autoimmune disease.

Autoimmune diseases are those whereby the body's immune system, which normally targets and destroys substances foreign to the body such as bacteria, mistakenly attacks normal tissues. In MS, the immune system attacks the brain and spinal cord, the two components of the central nervous system. Other autoimmune diseases include lupus and rheumatoid arthritis.

MS gets its name from the buildup of scar tissue (sclerosis) in the brain and/or spinal cord. The scar tissue or plaques form when the protective and insulating myelin covering the nerves is destroyed, a process called demyelination. Without the myelin, electrical signals transmitted throughout the brain and spinal cord are disrupted or halted. The brain then becomes unable to send and to receive messages. It is this breakdown of communication that causes the symptoms of MS.

Although the nerves can regain myelin, this process is not fast enough to outpace the deterioration that occurs in MS. The types of symptoms, severity of symptoms, and the course of MS vary widely, partly due to the location of the scar tissue and the extent of demyelination.

MS is two to three times as common in females as in males and its occurrence is unusual before adolescence. A person has an increased risk of developing the disease from the teen years to age 50 with the risk gradually declining thereafter.

There's also a genetic susceptibility; having a parent or sibling with the condition increases your risk of acquiring it, compared to the general population. One theory suggests people with the disease have an inherent genetic predisposition. But only after exposure to one or more environmental agent(s) is their immune system triggered to attack the nervous system.

Multiple sclerosis usually begins between the ages of 20 and 40 and it's twice as common in women as in men. There are between 12,000 and 15,000 people with MS in Australia and an estimated 2.5 million people worldwide.

Symptoms:

When multiple sclerosis strikes an area of nervous tissue, the function of the area declines. For instance if it happens in the optic nerve, loss of sight or blindness results. If it happens in an area of the spinal cord from which nerves to the leg muscles travel, it results in weakness or paralysis of the legs. But it can affect any part of the brain or spinal column at any time. Usually initial symptoms improve (sometimes completely), only to worsen again, or occur in some other part of the brain or spinal cord. The recovery events are known as remissions and the deterioration events as relapses.

It is impossible to predict which particular area will be affected, how long the relapse will last (hours, days or weeks), or whether it will produce permanent loss of function. But as time goes on, more and more permanent damage is done to brain tissue and there is progressive loss of function. In about 15 per cent of cases, there is no recovery and deterioration is progressive from the outset.

Some of the most common symptoms are:

1. Impaired vision.

2. Weakness and paralysis of muscles.

3. Numbness.

4. Loss of balance and muscle coordination.

5. Slurred speech.

6. Bladder and bowel problems.

7. Memory loss

8. Depression and mood swings.

Treatment:

There's no treatment that will cure multiple sclerosis. However there are some drugs that will slow the progress of the disease.

There are four drugs available (Betaferon, Copaxone, Rebif and Avonex) which have been shown to reduce the frequency and severity of attacks, and slow the progress of the disability. The earlier they are given after the onset of the condition, the more effective they are.

Other drugs, together with physiotherapy and rehabilitation, can control specific problems like muscle spasms and help restore and maintain mobility. Counselling and antidepressant medication can help combat depression, which is understandably common among people with multiple sclerosis. Many people with the condition find it helps to join a support group.

Many people with MS - three out of four - use complementary and alternative medicines and most visit alternative practitioners more often than their doctors. However there's little hard scientific evidence that these complementary treatments are effective.

The disease is not fatal, and those affected live between 90 and 95 per cent of the normal life span. Most don't become severely disabled; two-thirds remain able to walk, although they may need to use a walking aid at some point (usually years after the first attack).

In recent years there have been some very significant advances in our knowledge of how the disease works. Researchers have learned a great deal about how the body's own immune system attacks the central nervous system, and the search is on to find a way to switch it off.

Causes and Risk factors:

The specific cause of MS is not fully understood. Symptoms are caused by an abnormal inflammatory attack on the nerves of the brain or spinal cord. This inflammatory response may be triggered by genetic, environmental, and viral factors that initiate demyelination.

Demyelination is associated with an abnormal immune system response that causes a type of white blood cell (called T cells) to attack myelin. Damage to the myelin then leads to sclerosis of nerve fibers in the central nervous system (CNS). The CNS has the ability to repair some of the damage but may not be able to achieve complete restoration. Exacerbations and remissions (common in multiple sclerosis) result from the intermittent damage and restoration.

A higher incidence of MS in certain geographical areas, such as the northern United States, suggests that environmental factors may be involved, but none have been confirmed.

A specific viral risk factor has not been identified, but exposure to a virus that causes demyelination (especially prior to adolescence) may be a risk factor.

Diagnosis:

Multiple sclerosis (MS) diagnosis is extremely difficult. The reasons for this include:

1. More than 50 symptoms are linked to MS and each person develops symptoms differently.

2. Many of the symptoms mimic problems that occur with other diseases.

3. There is no blood test for MS, yet.

4. Symptoms usually come and go.

5. Many symptoms are vague and hard to quantify, such as fatigue, sexual dysfunction, depression and cognitive difficulties -- these often get attributed to stress by general practitioners and patients may never referred to a neurologist.

Diagnostic Tests and Procedures:

1. Magnetic Resonance Imaging (MRI) Scan: MRIs use magnetic waves to produce images of the brain and spinal cord. A special contrast material (gadolinium) is usually injected for the scan when MS is suspected, as it reacts to areas of inflammation and will "light up" when a, indicating demyelination is occurring The MRI does not hurt, but can be a strange experience - it helps if you know what to expect during this test. There are also some things you can do to make your experience better.

As mentioned, this is considered the best test for diagnosing MS, as abnormal lesions appear on MRIs in over 95% of people with MS. However, 5% of people with MS do not have abnormalities that can be detected on an MRI (producing a false negative), and some age-related damage looks like MS lesions.

2. Neurologic Exam: Functioning of the cranial nerves (these control the senses, as well as how you talk and swallow), coordination, strength, reflexes, and sensation. The doctor will perform the tasks (like touching your nose, then his finger in succession), touching you with various instruments (and having you report a sensation or looking for a response himself) and doing an examination of your eyes. These tests do not hurt. The entire test will probably last about 45 minutes, but may be as long as two hours.

3. Evoked Potential Testing: Three main types of evoked potential tests are used in the diagnosis of MS. Each of these tests requires that electrodes are attached to your scalp and connected to an electroencephalograph (EEG) to record brainwaves in response to different stimuli. The different tests are:

1. Brainstem Auditory Evoked Potentials (BAEP): A series of clicks are played in each ear through headphones.

2. Visual Evoked Potentials (VEP): A series of checkerboard patterns are displayed on a screen.

3. Sensory Evoked Potentials (SEP): Mild electrical shocks are administered to an arm or leg.

4. Lumbar Puncture: Also called a spinal tap, this test requires that a small amount of cerebrospinal fluid (CSF) is taken from your spinal column with a needle inserted between your vertebrae. The doctor is looking for the presence of oligoclonal bands (an increased number of certain antibodies), which is an indicator of increased immune activity in the spinal fluid. This test is positive in up to 90% of people with MS, but is not specific to MS - meaning a positive result could indicate another disease or disorder. Depending on results from the MRI, neurologic exam and symptom history, it is possible that you may not have to get a lumbar puncture to receive a definitive diagnosis of Ms. However, lumbar puncture results can be useful for ruling out other things if there is still a question about diagnosis. Lumbar punctures can be done using an x-ray technique known as fluoroscopy, which helps the doctor or technician guide the needle. Lumbar punctures done this way are usually faster and less stressful. However, many people, such as residents, interns and less experienced doctors are anxious to perform lumbar punctures without fluoroscopy, or a “blind” lumbar puncture, so that they can get the practice. Do not hesitate to insist on getting a fluoroscopy-guided lumbar puncture, even if you have to get referred to another facility for the test.

5. Blood Tests: There is currently not a blood test for MS, although scientists are working on this, so there may be one in the near future. However, usually a series of tests will be run on your blood to rule out other things, such as Lyme disease, HIV, some rare genetic disorders and a group of diseases known as collagen-vascular diseases (these include lupus, rheumatoid arthritis, scleroderma and others).

Medicine and medication:

There is no magic pill that cures MS or relieves all of its symptoms, but there are different medications and therapies, which lessen many symptoms, shorten attacks, and may slow down the expected slow and ongoing progression of Multiple Sclerosis.

1. Avonex: Slows the accumulation of physical disability and decrease the frequency of clinical exacerbations, in Relapsing forms of Multiple Sclerosis. The dose is 30 mcg, taken once a week and over two years reduced disability progression by 37%.

2. Betaseron: Reduces the frequency of clinical exacerbations, in ambulatory, Relapsing/Remitting MS. The dose is 8 MIU, taken every other day and reduced the relapse rate by 33%.

3. Copaxone: Decreases the frequency of clinical exacerbations, in Relapsing/Remitting Multiple Sclerosis. The dose is 20mg, taken every day and reduced the relapse rate by 29%.

4. Rebif: Is chemically identical to Avonex, but Rebif is injected subcutaneously, in a larger dosage (44 mcg three times per week) and reduced the relapse rate by 32% in the PRISMS study.

5. Tysabri (Natalizumab): Is a monoclonal antibody bioengineered from part of a mouse antibody to closely resemble the human antibody. It is given intravenously once a month in a physician's office. Tysabri reduced the frequency of relapses by 66% relative to placebo.

Treating specific symptoms can be effective, even if it does not stop the progression of the disease. Symptoms that can often be controlled or relieved with medication include:

Fatigue: Medications to reduce fatigue or help you sleep better may include amantadine (Symmetrel) or fluoxetine (Prozac).

Muscle stiffness (spasticity) and tremors: Medications that may reduce muscles spasms or stiffness include baclofen (Lioresal), tizanidine (Zanaflex), dantrolene (Dantrium), gabapentin (Neurontin), diazepam (Valium), or clonazepam (Klonopin). Sometimes a combination of these medications works best to reduce your muscle symptoms.

Urinary problems and constipation: Medications used to reduce frequent urination may include propantheline (Pro-Banthine), oxybutynin (Ditropan), or tolterodine (Detrol). Medications sometimes used to relieve constipation include bulk agents such as psyllium (Metamucil) or daily use of laxatives.

Pain and abnormal sensations: Depending on the severity of the pain, both prescription and nonprescription medications may be tried. Over-the-counter medications may include acetaminophen, ibuprofen, or naproxen sodium. Prescription medications commonly used to reduce pain associated with MS include baclofen (Lioresal), carbamazepine (Tegretol), or gabapentin (Neurontin).

Depression: Antidepressant medications may be used to reduce depression that often occurs as a result of having MS. Antidepressants often tried include tricyclic antidepressants-such as amitriptyline (Elavil), desipramine (Norpramin), or imipramine (Tofranil)-or selective serotonin reuptake inhibitors (SSRIs)-such as fluoxetine (Prozac) or sertraline (Zoloft) among others.

Sexual difficulties: Medications used to relieve sexual difficulties that can be associated with MS include sildenafil (Viagra) for both men and women. Yohimbine and clomipramine may also be given to improve erectile dysfunction.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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