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Definition:

• Multiple Sclerosis (MS), is a chronic neurological disease that affects the central nervous system (CNS). The CNS consists of the brain, spinal cord, and the optic nerves (the nerve at the back of the eye that carries visual information from the eye to the brain). Surrounding and protecting the nerve fibers of the CNS is a protein coating called myelin. When myelin becomes inflamed or is destroyed, scar tissue (sclerosis) is left behind and there is an interruption in the normal flow of nerve impulses to and from the brain. It is this interruption that produces the symptoms of MS. This can eventually lead to damage to the nerve fibers themselves, a process that is irreversible.

  There are four "types" of MS:

  Relapsing-Remitting - The most common form of MS (approximately 85% of MS diagnoses), Relapsing-Remitting MS results in clearly defined flare-ups (also called relapses, attacks, or exacerbations). People may experience acute worsening of neurologic function, followed by partial or complete recovery periods (remissions) free of disease progression.

  Primary-Progressive - A rarer form of MS (approximately 10% of diagnoses), Primary-Progressive MS results in a slow but nearly continuous worsening of the disease from the onset, with no distinct relapses or remissions.

  Secondary-Progressive - 50% of people with Relapsing-Remitting MS developed this form of the disease within 10 years of their initial diagnosis. (Note: This form appears to be more common in those diagnosed before the introduction of “disease-modifying” drugs.) With this type of MS the initial period of relapsing-remitting disease is followed by a steadily worsening disease course.

  Progressive-Relapsing A rarer form of MS (approximately 5% of diagnoses), Progressive-Relapsing MS results in a steady worsening of the disease from the onset but includes clear acute relapses, with or without recovery. In contrast to relapsing-remitting MS, the periods between relapses are characterized by continuing disease progression.

Causes:

• MS is thought to be an autoimmune disease, a disease that causes your immune system to attack healthy tissue. While it is not yet known what triggers the immune system to do this, several factors are involved, including: genetics, gender and environmental triggers (viruses, trauma, and heavy metals).

Risk factors:

• Though it can occur at any age, MS most often begin between the ages of 20-40.
• Women are twice as likely to get MS as men.
• MS may be linked to the Epstein-Barr virus, which causes mononucleosis, though how Epstein-Barr increases the risk of MS is unclear.
• Caucasians, particularly those of Northern European descent, are at highest risk. Asians, Africans, and Native Americans are at lowest risk.
• Those with parents or siblings with MS have a 1-3% chance of having it themselves, compared to 0.1% of the general population. Those with an identical twin that has it, have a 30% chance of having it themselves.
• MS seems to occur more frequently in countries with temperate climates, such as Europe, the northern US, and southern Canada. Climate, however, seems to have no effect after puberty.
• Thyroid disease, type 1 diabetes, and inflammatory bowel disease may increase one's chances of having MS.

Characteristics:

• Symptoms of MS, which are unpredictable and vary from person to person and from time to time in the same person, may include:
  • Bladder and Bowel Dysfunction
  • Memory Problems
  • Dizziness/Vertigo (feelings of spinning, whirling, falling, or tilting)
  • Fatigue
  • Difficulty Walking
  • Numbness
  • Pain
  • Spasticity (inability to control muscles)
  • Loss of eyesight, usually in one eye at a time, with possible pain during eye movement
  • Double vision, blurred vision
  • "Electric shock" sensations from head movements
  • Lack of coordination, unsteadiness, tremors
  • Tingling/pain

• Symptoms of MS come and go, sometimes disappearing for months at a time, making diagnosis more difficult. The symptoms and the severity of the condition depend on which specific nerves are damaged and the degree of the damage to them.
• Especially in the early stages of MS, symptoms appear, subside or completely vanish, then reappear. Appearance/worsening of symptoms may be triggered by heat.
• In extreme cases, people with MS can lose the ability to walk or speak. Other complications include bowel/bladder problems, muscle spasms and paralysis, and epilepsy.

Statistics:

• Approximately 400,000 Americans currently have MS
• About 200 people per week are newly diagnosed

Tests/Prognosis:

• There is still no cure for MS. There are however various treatment options that can modify the disease course, treat exacerbations, and manage symptoms.
• Blood tests and spinal taps are used to rule out diseases with similar symptoms to MS; spinal taps can also identify abnormal protein levels and white blood cell counts associated with MS. MRIs are used to see damage to the nervous system caused by MS.

Awareness:

Viewpoint

• Each person's journey with Multiple Sclerosis is unique; symptoms should not be generalized or predicted.

On-Line Discussion

Treatments and Rehabilitation

• Because symptoms vary so greatly, it is best to work closely with a physician well versed in MS to develop a personalized treatment plan.
  • Medications can reduce future disease activity for many individuals with relapsing forms of MS.
  • Corticosteroids (a hormone) can lessen the severity of and/or shorten "flare ups".
  • Rehabilitation can be useful in restoring function after flare ups.
• Corticosteroids (a hormone) can lessen the severity of and/or shorten "flare ups". Examples include oral prednisone and intravenous methylprednisolone.
• Interferons, which include drugs such as Betaseron, Avonex and Rebif, slow the rate at which MS symptoms worsen, but carry the risk of serious liver damage.
• Glatiramer (Copaxone), injected once daily, is believed by doctors to block damage to myelin by the immune system. Flushing and shortness of breath may occur after injection.
• Tysabri interferes with the movement of immune system cells from the blood to the brain and spinal cord. This drug is generally reserved for patients who see no results from other treatments or for whom other treatments aren't an option, as it increases the risk of progressive multifocal leukoencephalopathy, a fatal brain disease.
• Mitoxantrone (Novantrone) suppresses the immune system. This drug is generally reserved for patients with severe MS, as it can cause heart damage.
• Therapists can teach stretching/strengthening exercises to lessen the muscle-related symptoms of MS and demonstrate use of devices to make daily tasks easier.
• Plasma exchange, a procedure similar to dialysis, is sometimes used to combat severe MS symptoms, particularly if intravenous steroid treatments are not working.

Learn More about Multiple Sclerosis

Organizations and websites that provide information about Multiple Sclerosis.

References