Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is a disease of the central nervous system (brain, spinal cord and optic nerve). This disorder causes destruction of the protein coating (myelin) that surrounds and protects nerve fibers (axons). As a result, the damage disrupts the normal flow of messages (nerve impulses) from the central nervous system (CNS), causing a reduction or loss of body function. In many cases, the nerve fibers (axons) are also destroyed.

In the United States, MS affects 400,000 people, two-thirds of which are women. The disease varies with geographic location, family characteristics and age. Dealing with the physical, practical and emotional demands of MS is not easy, either for those affected by the disease or for their families and caregivers. With treatment, however, many people with MS can find ways to cope with their disease.

Symptoms

MS can cause problems with muscle control and strength, vision, balance and sensation (such as numbness or tingling in the feet or hands). People who have MS do not all have the same symptoms. Symptoms vary according to the parts of the brain or spinal cord affected by the disease. Symptoms may come and go or become more or less severe from day-to-day. The most common early symptoms of MS include:

Muscle (motor) symptoms, such as weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness or a lack of coordination (ataxia);
Visual symptoms, such as blurred, foggy or hazy vision, eyeball pain (especially with movement), blindness or double vision. At some point in the course of the disease, about 40% of people have an attack of optic neuritis, which causes sudden vision loss and eye pain, usually in only one eye;
Cognitive (thinking) problems may include memory loss, difficulty concentrating or speech problems;
Emotional symptoms may include depression or mood disorders.

As MS progresses, symptoms may become more severe, including:

Stiff, mechanical movements or uncontrollable shaking
Pain and other sensory symptoms
Inability to control urination or an inability to urinate
Constipation and other bowel disorders
Impotence (erectile dysfunction)

Causes

The cause of multiple sclerosis is unknown. Because the risk of MS is significantly higher when a parent has the disease, genetic factors may play a role. The unusual relationship between a person's geographic location during childhood and the risk of MS later in life suggests that there may be environmental factors at work in the disease. Some researchers think that these may be viral illnesses or other infectious diseases. However, there is no clear proof that any specific infection causes MS.

Furthermore, a childhood viral illness or other environmental factor is by itself not enough to explain why some people later develop MS. More and more research suggests that a problem with the body's natural defense system (immune system) occurring later in life may trigger the onset of MS in people who were exposed to certain factors during childhood. The trigger may be an autoimmune reaction in which the immune system attacks the protein coating (myelin) that protects nerve fibers.

Diagnosis

Multiple sclerosis (MS) is diagnosed when one or both of the following are present without another explanation for the symptoms:

The person has at least two neurologic episodes of signs and symptoms that could be caused by MS (weakness or clumsiness, vision problems, tingling or numbness or balance problems). Each episode must last at least 24 hours, and the episodes must occur at least one month apart.
There is at least one symptom that indicates an injury to one part of the central nervous system, and laboratory testing shows abnormal findings in at least one other area of the central nervous system.

Confirming a diagnosis of MS may take several years from the time the first symptoms appear. A medical history and neurologic examination, which can identify possible nervous system problems, are usually enough to give strong evidence of MS. Other tests may help confirm the diagnosis, including:

Magnetic resonance imaging (MRI) scan of the brain and spinal cord. More than 90% of people who have MS have an abnormal MRI. For people already diagnosed with multiple sclerosis, MRI scans may also be used to follow the progression of the disease.
Lumbar puncture (spinal tap) and cerebrospinal fluid analysis are abnormal for people with MS, including elevated levels of a protein called immunoglobulin (Ig), the presence of a certain type of protein (oligoclonal banding of Ig) or a mild increase in white blood cells in the spinal fluid.
Evoked potential testing can often reveal problems in the brain and spinal cord (central nervous system) that a neurologic exam and other tests may not find.

Treatment

Multiple sclerosis has no cure. However, there are medications (such as interferon beta and glatiramer acetate) that can reduce the number and seriousness of attacks in people with relapsing-remitting (come-and-go) MS and may slow the progression of the disease in people with secondary progressive MS. There is also some evidence to suggest that interferon beta may reduce or delay future disability.

When a person has an attack of MS, corticosteroids can be given to shorten the relapse and limit how severe it is. However, these do not prevent disability from MS and have not been shown to delay or prevent worsening of the disease.

Symptoms, such as spasticity (stiff, tight muscles), pain, fatigue, tremor, depression and bladder problems, can be relieved by medications. Physical therapy, occupational therapy and home treatment methods may also help a person manage symptoms and adjust to living and working situations.

Many other treatments have been tried by people with MS, including electric stimulation of the brain or spinal cord, manipulation of the blood and lymph systems, special diets and nutritional supplements. None of these treatments have been scientifically proven to be effective in the treatment of MS.

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