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Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic, often disabling disease that attacks the central nervous system (CNS). It afflicts young adults.  Multiple Sclerosis causes inflammation in random areas of the brain, spinal cord and optic nerves. The inflammation destroys the myelin sheath that covers nerve cell fibers. The loss of the myelin leads to a slowing down or complete blockage of nerve signals. The areas of inflammation are called plaques and can be seen as lesions on an MRI of the brain and/or spinal cord. A worsening of inflammation is called a “relapse” or “exacerbation”.

The diagnosis of Multiple Sclerosis can sometimes be made soon after the initial onset of symptoms. However, some cases require months or years for the symptoms to evolve sufficiently for the diagnosis to be clear. Approximately 300,000 people in the U.S. have been diagnosed with Multiple Sclerosis and about 200 people are newly diagnosed each week. There is no single test that can definitively diagnose MS, so a variety of tests are performed to collect information and rule out other causes of neurological symptoms. Commonly performed tests include MRI of the brain and spinal cord, visual evoked potentials and spinal fluid analysis. The course of Multiple Sclerosis is unpredictable and can vary from person to person. The majority of people with MS are mildly affected, but severe cases can render a person unable to write, speak or walk as connections between the brain and other parts of the body are disrupted. Fortunately, a variety of Multiple Sclerosis treatments are available that can reduce the number of MS attacks and slow disease progression for many people.
 
Targeted Population

Most people experience their first symptoms of Multiple Sclerosis between the ages of 20 and 40. Although there have been cases of Multiple Sclerosis in young children and elderly adults, symptoms rarely begin before age 15 or after age 60. Whites are more than twice as likely as other races to develop Multiple Sclerosis and women are twice as likely as men to develop MS. However, among patients who develop the symptoms of Multiple Sclerosis at a later age, the gender ratio is more balanced.

Causes of Multiple Sclerosis

The exact cause of Multiple Sclerosis remains unknown. Multiple Sclerosis is an autoimmune disease, one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of Multiple Sclerosis, it is the myelin sheath that surrounds nerve cells which comes under assault. Such assaults may be associated with a combination of genetic risk and some external trigger, such as viral infection.

Course of Multiple Sclerosis

Multiple Sclerosis symptoms tend to evolve. Each of these may be described as mild, moderate or severe.

  • Relapsing-Remitting Multiple Sclerosis (RRMS) is the most common “type” of MS, affecting 85% of people with Multiple Sclerosis. Multiple Sclerosis symptoms appear as an “attack” with a sudden worsening of symptoms. These attacks (also called “flare-ups” or “exacerbations”) are followed by a complete or partial remission of symptoms. There may be periods of stability between these attacks that last months or years, during which time there is no disease progression.
  • Primary-Progressive Multiple Sclerosis (PPMS) affects about 10% of people with MS. It defines a type of multiple sclerosis that results in slowly worsening function from the time of disease onset with no distinct relapses nor remissions. The rate of progression for those with PPMS can change over time, with occasional periods of stability and temporary minor improvements.
  • Secondary-Progressive Multiple Sclerosis (SPMS) describes a type of MS that may develop in those with relapsing-remitting MS in which MS symptoms worsen more steadily. Before the advent of interferons and other Multiple Sclerosis treatments, about one-half of people with RRMS developed SPMS within 10 years.
  • Progressive-Relapsing Multiple Sclerosis (PRMS) is relatively uncommon. People with PRMS experience a steady worsening of symptoms from the onset of symptoms with additional attacks that lead to declines in neurological functioning. There may or may not be some recovery following these attacks, but the disease continues to progress without full remissions.

20% of people with Multiple Sclerosis have a benign form of the disease in which symptoms show little or no progression after the initial attack. These individuals remain fully functional. A few patients experience “malignant MS”, defined as a swift and relentless decline resulting in significant disability or even death shortly after disease onset. However, Multiple Sclerosis is very rarely fatal.

Symptoms

Multiple Sclerosis symptoms may be mild or severe, of long duration or short, and may appear in various combinations, depending on the part of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70% of those with Multiple Sclerosis. The main symptoms are: muscle weakness, MS-related fatigue, cognitive impairment, spasticity, altered sensation of temperature and pain, moderate to severe pain, ataxia, tremor, speech disturbances, visual disturbances, bladder dysfunction, bowel dysfunction, sexual dysfunction, depression and euphoria.

Treatment

There is presently no cure for Multiple Sclerosis. However, there are medications that work well to reduce disease activity and disease progression for many individuals with relapsing forms of MS, including those with secondary progressive disease who continue to have relapses. Treatments are also available to treat acute attacks, manage MS symptoms and improve overall function. Together, these treatments can enhance the quality of life of people with MS.

Disease-Modifying Medications

Disease-modifying medications are the name for a class of medications used for the treatment of Multiple Sclerosis that can reduce the frequency and severity of MS attacks. The National MS Society (NMSS) recommends that a disease-modifying treatment be started early before the disease causes significant and permanent damage. There are currently several disease-modifying therapies that are taken on a long-term basis. They offer the best defense available to slow down the natural course of Multiple Sclerosis.

The goals of disease-modifying therapy are to: reduce the frequency and severity of MS exacerbations, reduce the accumulation of brain and spinal lesions seen on MRI, and slow down the accumulation of disabilities. The selection of a particular medication is based on several factors, including a person's response to previous treatments, clinical judgment of your physician, and personal preferences. It is important to keep in mind that none of these medications offer a cure for MS, nor will they prevent recurring MS symptoms, such as fatigue.  However, since these drugs were introduced in the 1990’s, they have resulted in a markedly improved quality of life for many patients.  

Treatment for Attacks

An MS attack or flare is defined as a worsening of symptoms that lasts more than 24 hours and is separated from a previous attack by at least 30 days. These may occur even while a person is taking a disease-modifying therapy. Most attacks last from a few days to several weeks or even months. A particular attack can be mild, moderate or severe enough to interfere with a person’s ability to function at home and at work. Severe exacerbations may be treated with high-dose corticosteroids to reduce the degree of inflammation.

Treatment for Symptoms

There are a variety of specific treatments available that may provide relief for the specific symptoms of MS. Your doctor will recommend medications, assistive devices and other therapies according to the symptom, its severity and the response to past treatments.
For instance, spasticity may be treated in different ways depending on its severity and duration. Oral anti-spasmodics, such as Zanaflex®, may provide relief for patients with mild, early spasticity. More severe or long-lasting spasticity may require use of botulinum toxin, or intrathecal baclofen.

Promoting Function through Rehabilitation

Rehabilitation programs focus on function. They are designed to help improve or maintain the ability to perform effectively and safely at home and at work. Rehabilitation professionals focus on overall fitness and energy management, while addressing problems with accessibility and mobility, speech and swallowing, and memory and other cognitive functions.

Rehabilitation is an important component of comprehensive, quality health care for people with MS, at all stages of the disease. Rehabilitation programs include: physical therapy, occupational therapy, speech and swallowing therapy, cognitive rehabilitation and vocational rehabilitation.

Alternative Therapies

Many people with Multiple Sclerosis will consider trying one or more alternative treatments to help manage the disease or its symptoms. This is understandable since there is no universally effective treatment and no known cause. However, MS has a natural tendency to improve spontaneously between flares. These episodes of improvements can be inappropriately credited to the alternative treatment. This opens the door to a variety of unsubstantiated claims. At one time or another, many ineffective and even potentially dangerous therapies have been promoted as treatments for Multiple Sclerosis. A partial list of these “therapies” includes: injections of snake venom, removal of the thymus gland, breathing pressurized (hyperbaric) oxygen in a special chamber, intravenous or oral calcium orotate (calcium EAP), removal of dental fillings containing silver or mercury amalgams, and surgical implantation of pig brain into the patient's abdomen. None of these treatments is an effective therapy for Multiple Sclerosis or any of its symptoms. Nonetheless, a variety of lifestyle changes including meditation, yoga, exercise and improved diet can be very helpful for those with Multiple Sclerosis. It is important that you inform your doctor of any vitamins, herbal supplements or alternative treatments that you may be taking since these could have an impact on the effectiveness and safety of other medications that you are prescribed.