A Nervous System Under Attack
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system affecting between 250,000 and 350,000 Americans. A major cause of disability, particularly among young and middle-aged adults, multiple sclerosis is a chronic, often disabling disease of varying severity. Symptoms may be as mild as numbness in the hands or feet, or as severe as paralysis or loss of vision. Notorious for its unpredictable, spontaneous remissions and exacerbations, multiple sclerosis presents a challenge to those diagnosed with the disease as well as to the healthcare community.
Significant advances have been made in treating multiple sclerosis and improving the quality of life of those affected by it. Continuing research and emerging treatments give hope to those afflicted by the disease.
Multiple sclerosis affects the central nervous system by disrupting the conduction of electrical signals along neurons. Neurons, the building blocks of the nervous system, wire the brain to every part of the body. Electrical impulses speed along the neurons thanks to myelin, a fatty insulating material that surrounds the long, stretchy part of neurons called the axon.
Multiple sclerosis causes the immune system to attack the myelin sheaths, primarily within the brain, spinal cord, and optic nerve. This attack ends up destroying patches of the sheaths in an affected area. These patches are called MS plaques or sclerosis. Normal flow of impulses telling the body what to do (e.g., talk, move, see) is no longer possible through these MS plaques.
Multiple sclerosis has three main types, the most common of which is called relapsing/remitting multiple sclerosis. Affecting about 70% of people with multiple sclerosis, it is characterized by sporadic attacks interspersed with normal health that can last for a few months or years. Some individuals go into permanent remission. However, most experience a slow accumulation of permanent neurological damage.
The second type of multiple sclerosis, chronic or progressive multiple sclerosis, worsens over time without any remission. In the very worst cases, a person can experience accelerated multiple sclerosis leading to death in just a few months.
The third type of multiple sclerosis has been described as secondary progressive multiple sclerosis. In this form, a person who originally had relapsing/remitting MS now enters a progressive phase with gradual but steady deterioration in nerve function. Secondary progressive multiple sclerosis ultimately affects about 50% of those with the relapsing/remitting form of the disease.
While about 10% of those with multiple sclerosis have a relatively mild form of the disease, most have some degree of neurologic problems.
How Common Is Multiple Sclerosis?
In the United States, 25,000 new cases of multiple sclerosis are diagnosed each year. It affects between 250,000 to 350,000 people in the United States, or about 0.1% of the population. Multiple sclerosis is most often diagnosed in the young adult years (16-40), and is more common among females than males by a ratio of about 2:1.
Goals of Treatment
The four primary goals of treatment may be summarized as follows:
- Decrease the severity of the acute phases (exacerbations) of the disease
- Improve recovery from exacerbations of the disease
- Prevent relapses and the onset of progressive disease
- Provide symptomatic relief from the complications of multiple sclerosis
No cure for multiple sclerosis has yet been found, but significant advances have been made in treating the complications of the disease and improving the quality of life of people affected by multiple sclerosis.
Medications are the primary treatment in multiple sclerosis. Other types of treatment may be necessary for secondary symptoms that arise as a result of multiple sclerosis (e.g., kidney stones or bed sores).
- Physical therapy is aimed at reducing progressive weakness, fatigue, and spasticity. Mobile people are also less likely to develop complications of inactivity such as contractures, decubitus ulcers (bedsores), venous thrombosis, or osteoporosis (with its associated fatigue fractures), as well as bowel or bladder complications. Physical therapy improves muscular strength, resistance to fatigue, work capacity, and power in people with multiple sclerosis.
- Surgery is only occasionally performed and only after drug therapy has proven ineffective. A procedure known as a stereotaxic thalamotomy is performed when tremors are so severe that they interfere with the person's ability to perform activities. A small lesion is created in the brain on the opposite side of the tremors to reduce spasticity.
- Plasmapheresis is a blood-filtering process occasionally used to remove the antibodies that cause multiple sclerosis symptoms. Its success is variable and only lasts a short time.
Quality of Life
Multiple sclerosis is notorious for its unpredictable nature, so living with this disease can demand flexibility and fortitude. The symptoms of multiple sclerosis can vary from relatively mild symptoms to blindness and immobility. Long periods of health may be punctuated by short, intense bouts of illness requiring medical attention.
People with multiple sclerosis can work to adapt to their individual disease. Often this involves avoiding excessive stress, fatigue, and temperature extremes. In addition, it is helpful to try and incorporate a long-term commitment to overall health. Healthful measures include nutritious eating as well as appropriate levels of activity with frequent rest periods.
TWomen are twice as likely to have multiple sclerosis than men. Additionally, pregnancy may exacerbate the disease.
Self care & Prevention
Preventing Multiple Sclerosis
Although no proven method for preventing multiple sclerosis is known, some researchers believe vitamin D-3 may be related to its development. Vitamin D-3, also known as 1,25-dihydroxyvitamin, is a hormonal version of vitamin D, and is its most common form. Not only has vitamin D-3 been shown to prevent a form of the disease in mice, but researchers also believe it may reduce the risk of multiple sclerosis and have some treatment potential for those who already have the condition.
Some researchers believe that the amount of vitamin D-3 produced in the skin may influence the development of this illness based on the results of some demographic findings. For instance:
- Multiple sclerosis occurs more frequently at low altitudes, and is less common in mountainous regions. Because high altitudes have more intense ultraviolet light, some experts theorize that greater synthesis of vitamin D-3 takes place in the skin, reducing the incidence of the disease.
- Multiple sclerosis is rare on the Norwegian coast, where fish oils provide a wealth of vitamin D-3.
Vitamin D-3 is found in fortified milk, herring, mackerel, salmon, sardines, and cod- and halibut-liver oils.
Self care for multiple sclerosis involves changes in activities and diet. Working closely with your doctor(s), you can adapt the following guidelines to suit your individual needs.
- Avoid MS triggers. Stress, fatigue, temperature extremes, infection, trauma, menstruation, and pregnancy are among the most common events that may trigger an acute phase of multiple sclerosis (MS). Plan for periods of rest during long activities. Avoid hot baths and showers. During hot weather, plan outdoor activities for the cooler parts of the day. Also, seek treatment for fevers and illnesses.
- Eat a well-balanced diet. A nutritious, high-fiber diet will provide you with the nutrition necessary to avoid illness, maintain your ideal weight, and prevent constipation.
- Drink lots of fluids. Drinking two to three quarts of liquids a day including some warm liquids, cranberry juice, and prune juice will help prevent kidney stones and constipation.
- Try semi-solid foods. If you have difficulty swallowing, it may be helpful to choose soft, semi-solid food. You can chop foods in a blender or mix them with other foods to make chewing and swallowing easier. Also, stroking upward from the base of the throat to the chin may help stimulate the swallowing reflex.
Last updated 25 May 2012
- Demyelinating disease
No direct causes of multiple sclerosis have been established.
Studies have shown that people with the progressive type of multiple sclerosis have about half the normal number of T-4 cells, a suppressor-inducer type of cell within the immune system. Some experts theorize that a shortage of these cells could disrupt the balance among all types of immune cells, causing them to lose control and attack the nervous system.
In addition to the immune system's role, genetic factors have long been suspected as causing multiple sclerosis, though evidence for this has been elusive. Monozygotic (identical) twins are much more likely to both have multiple sclerosis than dizygotic (fraternal) twins. Also, adults with multiple sclerosis are 30% to 50% more likely to have children with the disease. Despite these indications that multiple sclerosis may be hereditary, a specific gene or set of genes for the disease has yet to be identified.
Some researchers believe that a virus may cause multiple sclerosis. These researchers have pointed to studies showing an increased incidence of the disease at higher latitudes, clusters of cases within families, geographical clusters of cases, and animal studies of infectious myelin diseases. Still other researchers believe that multiple sclerosis is caused by a combination of factors, such as an autoimmune disorder triggered by environmental exposure to a toxin or virus early in life.
Finally, certain factors are said to be able to trigger or worsen an acute phase of multiple sclerosis, including:
- Sleep deprivation
- Concurrent organ dysfunction
- Heavy metals
Because of the unpredictable nature of MS attacks, it has been difficult to prove the contribution of these factors with scientific certainty.
The following factors are associated with a higher incidence of multiple sclerosis:
- Family history of multiple sclerosis
- Living in a temperate zone
- Northern European descent
Symptoms & Diagnosis
The symptoms of multiple sclerosis often fluctuate in no predictable pattern. They may appear during an exacerbation and completely disappear during remission. As the direct effects of multiple sclerosis may result in other problems, the symptoms of the disease are categorized into two classes: primary and secondary. For example, difficulty urinating (a primary symptom of multiple sclerosis) may cause urinary tract infections (a secondary symptom). Following are some primary and secondary symptoms of multiple sclerosis.
- Ataxia (inability to coordinate muscle movements)
- Cognitive changes
- Bowel or bladder problems, including difficulty urinating
- Gait (walking) problems
- Mood swings / depression
- Muscle spasms
- Nausea / vomiting
- Paresthesias (abnormal burning, pricking, tickling, or tingling sensations, especially in the hands and feet)
- Psychological changes
- Sexual problems
- Speech problems, including slurred speech
- Tremor (shakiness)
- Visual complaints
- Urinary tract infections
- Kidney or bladder stones
- Decubiti (bedsores)
- Muscle contractures
- Respiratory infections
- Poor nutrition
- Difficulty breathing (severe)
- Paralysis (severe)
Conditions That May Be Mistaken for Multiple Sclerosis
Many diseases affecting the nervous system can mimic multiple sclerosis, including:
- Amyotrophic lateral sclerosis
- Bechet's disease
- Brain-stem tumors
- Central nervous system infections
- Cerebellar tumors
- Friedrich's ataxia
- Hereditary ataxias
- Pernicious anemia
- Progressive multifocal leukoencephalopathy
- Ruptured intravertebral disc
- Small cerebral infarcts
- Spinal-cord tumors
- Systemic lupus erythematosus
How Multiple Sclerosis Is Diagnosed
No single test is available to diagnose specifically for multiple sclerosis, but a number of tests can help physicians in making a diagnosis. A definite diagnosis is usually reached after a review of the medical history, a medical examination, repeated observations, and other possible causes of symptoms have been ruled out. Physicians may also use one or more of the following techniques to aid in the diagnosis of multiple sclerosis.
Cerebrospinal fluid (CSF) analysis tests study the cells and protein. In patients suspected of having MS, doctors may also ask for measurement of immunoglobulin (IgG) and the amount of myelin in the cerebrospinal fluid. In multiple sclerosis, myelin components (lipids and proteins) are released into the fluid. An increased amount of myelin in the cerebrospinal fluid is suggestive of multiple sclerosis. Both the CSF IgG index test and the oligoclonal band test compare measured immunoglobulins in the cerebrospinal fluid to the amounts found in the bloodstream. The myelin basic protein test measures myelin levels in the CSF.
Other blood tests are often used to rule out other diseases.
Computerized tomography (also known as CT or "CAT" scan) or magnetic resonance imaging (MRI) may be performed to look for the plaques characteristic of multiple sclerosis. Also, these scans can detect structural abnormalities, edema, or brain and spinal-cord growths that could cause symptoms that mimic as multiple sclerosis. Positron emission tomography (PET) may also be performed to assess brain-cell function by determining how quickly brain tissues take up radioactive isotopes.
Evoked potential studies
These tests help determine nerve pathway integrity. They measure the nervous system's electrical response to visual, auditory, and sensory inputs. A technician places electrodes on the head and neck and records the patient's response to various pictures and sounds.
Nerve conduction studies
Nerve conduction studies measure the speed of electrical impulses along a nerve in the arms or legs. They are sometimes used to diagnose conditions that mimic MS.