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HEALTH UPDATE

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
World Health Organization

Multiple Sclerosis

Edited by Nicole Day, MS, MBA

Guyana Journal, March 2009



What is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic, potentially debilitating disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves (the nerves that carry sight to the eyes). The body's immune system destroys the protective sheath (cover) overlying the nerves, interfering with the communication between the brain and the rest of the body. Ultimately, this may result in irreversible damage to the nerves. The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another.

Who gets MS?
An estimated 400,000 Americans have MS. Although it can occur at any age, it most often begins in people between the ages of 20 and 40. Women are more likely to develop MS than men. Studies indicate that some genetic factors make certain individuals more likely to develop the disease, but there is no evidence that MS is directly inherited.

What Causes MS?
The body’s own immune system attacks myelin, the fatty substance that coats and protects nerve fibers in the brain and spinal cord. The nerve fibers themselves can also be damaged. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms.

While the cause of MS is still not known, scientists believe that a combination of several factors may be involved including the immune system, the environment, infectious diseases and genetics. Understanding what causes MS will be an important step toward finding more effective ways to treat, cure, or even prevent it from occurring in the first place.

What are the Symptoms of MS?
The symptoms of MS may include tingling, fatigue, numbness or weakness in one or more limbs, and blurred or double vision. Some people experience slurred speech, poor balance, poor coordination, muscle tightness or spasticity (including prolonged muscle contractions or sudden movements), tremors, or paralysis, which may be temporary or permanent. MS can cause impaired thinking, forgetfulness or difficulty concentrating. It can also cause mood swings and may make people more likely to become depressed. Symptoms may come and go, appear in any combination, and be mild, moderate, or severe.

What is the progression of MS?
People with MS can typically experience one of four disease courses, or patterns of progression. The disease subtype is important not only for determining the patient’s possible outcome but also for therapeutic decisions.

Relapsing-Remitting MS
Approximately 85% of people are initially diagnosed with relapsing-remitting MS. People with this type of MS experience unpredictable attacks, called relapses, flare-ups, or exacerbations, which are followed by partial or complete recovery periods, during which no disease progression occurs.
Primary-Progressive MS
Approximately 10% of people are diagnosed with primary-progressive MS. This disease course is characterized by slowly worsening neurologic function from the beginning with no distinct relapses or
remissions. The rate of progression may vary over time, with occasional plateaus (stable states) and temporary minor improvements.
Secondary-Progressive MS
Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries, or plateaus.
Progressive-Relapsing MS

In this relatively rare course of MS (5%), people experience steadily worsening disease from the onset, with attacks of progressively worsening of neurologic function. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

How is MS diagnosed?
MS is not always easy to diagnose. MS symptoms often come and go. In addition, other diseases of the central nervous system have similar symptoms. Also, there is no single neurological or laboratory test can easily confirm or rule out MS. Medical imaging, particularly MRI (magnetic resonance imaging), helps to clarify the diagnosis. The MRI image gives the neurologist (doctor who studies the nervous system) evidence of scar tissue in the deep parts of the brain or spinal cord that is characteristic of MS. A conclusive or definitive diagnosis requires evidence of multiple patches of scar tissue in different parts of the central nervous system and evidence of at least two separate attacks of the disease. It can take several months or even years for a definitive diagnosis of the disease to be made.

Can MS be treated?
Although there is still no cure for MS, therapies are available to treat attacks, reduce the frequency and severity of attacks, manage symptoms, improve function and safety, and provide emotional support.

The National Multiple Sclerosis Society recommends that a person consider treatment with one of the FDA-approved "disease-modifying" drugs as soon as possible following a definite diagnosis of MS with active or relapsing disease. These drugs help to decrease the frequency and severity of MS attacks, reduce the accumulation of lesions (areas of damage) in the brain, and may slow the progression of the disease. In addition, there are many therapies for MS symptoms. People should consult a physician to develop a comprehensive approach to managing their MS.

Additional Resources
For further information on Multiple Sclerosis, please contact The National MS Society at nationalmssociety.org.


Nicole Day is a Senior Content Development Specialist in Horsham, PA.
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