Multiple sclerosis (MS) is a chronic, potentially
debilitating disease that affects your brain and
spinal cord (central nervous system). The illness is
probably an autoimmune disease, which means your
immune system responds as if part of your body is a
foreign substance.
In MS, your body directs antibodies and white
blood cells against proteins in the myelin sheath
surrounding nerves in your brain and spinal cord.
This causes inflammation and injury to the sheath
and ultimately to your nerves. The result may be
multiple areas of scarring (sclerosis). The damage
slows or blocks muscle coordination, visual
sensation and other nerve signals.
The disease varies in severity, ranging from a
mild illness to one that results in permanent
disability. Treatments can modify the course of the
disease and relieve symptoms.
It
generally first occurs in people between the ages of
20 and 50. The disease is twice as common in women
as in men.
Signs and symptoms
Symptoms of MS vary depending on the location of your affected nerve
fibers. Signs and symptoms may include:
-
Numbness, weakness
or paralysis in one or more limbs
-
Brief pain,
tingling or electric-shock sensations
-
Quick, involuntary
muscle jerks (myoclonus)
-
Impaired vision
often with pain during eye movement
-
Disordered eye
movements, causing double vision or a moving field of vision
-
Fatigue
-
Dizziness
As the disease gradually worsens, muscle spasms, slurred speech, vision
loss, problems with bladder, bowel or sexual function, and paralysis may
develop. Occasionally, mental changes such as forgetfulness or confusion
occur.
Causes
Your central nervous system contains millions of nerve cells joined by
nerve fibers. Electrical impulses originate in nerve cells and travel
along the nerve fibers to and from your brain. Myelin, a fatty
substance, coats and protects the fibers, similar to the way insulation
shields electrical wires.
MS appears to result from an autoimmune process. Before symptoms of MS
develop, immune cells flood into the central nervous system. These cells
normally circulate into and out of the brain, checking for viruses and
helping to fight disease. But doctors believe that with MS, the immune
cells that have been primed outside the brain by a protein that mimics
myelin mistakenly destroy the cells that produce the myelin sheath.
Myelin becomes inflamed, swollen and detached from the fibers.
Eventually, the detached myelin is destroyed. Firm or hardened (sclerosed)
patches of scar tissue form over the fibers. When nerve impulses reach a
damaged area, some impulses are blocked or delayed from traveling to or
from your brain. Ultimately, this process leads to degeneration of the
nerves themselves, which likely accounts for the permanent disabilities
that develop in MS.
What triggers this process is unknown. Some researchers suspect a virus
in either immune cells or in sheath-producing cells.
MS occurs in five main types:
-
Benign.
In 10 percent to 15 percent of people with MS, symptoms are mild to
moderate, don't worsen and don't lead to permanent disability.
-
Relapsing
remitting.
In this type, one or two flare-ups of MS occur every one to three
years, followed by periods of remission. The flare-ups typically
appear suddenly, last a few weeks or months, and then gradually
disappear. Symptoms may accumulate with each recurrence. About 75
percent of people with MS begin with this form, and more than half
will have this form of the disease at any one time.
-
Primary
progressive.
After symptoms first appear, deterioration occurs without periods of
remission. About 15 percent of people with MS begin with this
pattern of the disease.
-
Secondary
progressive.
Usually after years of relapsing remitting MS, at least half the
people with relapsing remitting MS enter a stage of continuous
deterioration. Sudden relapses may occur, superimposed upon the
continuous deterioration that has developed.
-
Progressive
relapsing.
This is primary progressive MS with the addition of sudden episodes
of new symptoms or worsened existing ones. This form is rare,
occurring in approximately 10 percent of people with MS, and behaves
in a manner similar to primary progressive MS.
Risk factors
These factors may increase your risk of developing MS:
-
Heredity.
People of Northern European descent, especially those of
Scandinavian heritage, may be genetically predisposed to MS. The
disease appears to run in some families. As many as 20 percent of
people with MS have at least one affected relative. Compared with
the general population, if you're a first-degree relative (child or
sibling) of someone with MS, you have a 20- to 40-fold increase in
risk of eventually having MS.
-
Environmental
factors.
Environmental factors have some influence on MS. Many viruses and
bacteria may be associated with MS. These factors may trigger the
disease if you're susceptible to MS. This requirement of an
environmental trigger on top of a genetic predisposition may explain
why in identical twins, only one twin develops MS 70 percent of the
time.
When to seek medical advice
Numbness and tingling in your arms, legs or elsewhere in your body and
double vision are among the early indications of MS. Although numbness
most often doesn't indicate MS, if you have these symptoms, see your
doctor to determine whether a neurologic condition such as MS may be the
cause.
Screening and diagnosis
Your doctor may base a diagnosis of MS on the following:
-
Medical
history.
Your doctor reviews with you your symptoms and the pattern of the
symptoms.
-
Neurologic
examination.
This examination systematically tests various parts
of your nervous system, including your reflexes, muscle strength,
muscle tone, and sensations of pain, heat, touch and vibration. Your
doctor may also observe your gait, posture, coordination and
balance, and ask you questions to help determine the clarity of your
thinking, judgment and memory.
-
Magnetic
resonance imaging (MRI) scan.
The cylinder-shaped MRI scanner creates tissue-slice images on a
computer from data generated by a powerful magnetic field and radio
waves. Your doctor can view these images from any direction or
plane. Examinations of the brain, neck, spinal cord and soft tissues
are best seen by an MRI scan. Your doctor may be able to see areas
of your nervous system where damage to myelin has occurred.
-
Spinal tap
(lumbar puncture).
This procedure can
determine the concentration of immune cells and proteins in your
cerebrospinal fluid, the fluid that surrounds your brain and spinal
cord. While you lie on your side with knees pulled to your chest,
your doctor uses a thin, hollow needle to remove small samples of
your cerebrospinal fluid from within your spinal canal for
laboratory analysis.
Treatment
If your attacks are mild or infrequent, your doctor may advise a
wait-and-see approach, with counseling and observation. However, if your
diagnosis is a relapsing form of the disease, the form that affects the
great majority of people with MS, your doctor may recommend treatment
with disease-modifying medications as soon as possible.
These medications include:
-
Beta
interferons.
Interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif)
are genetically engineered copies of proteins that occur naturally
in your body. They help fight viral infection and regulate your
immune system. If you use Betaseron, you inject yourself under your
skin (subcutaneously) every other day. If you use Rebif, you inject
yourself subcutaneously three times a week. Avonex is self-injected
into your muscle (intramuscularly) once a week. These medications
reduce flares of MS. It's uncertain which of their many actions lead
to a reduction in disease activity and what their long-term benefits
are. Beta interferons should never be used in combination with one
another. Only one of these medications should be used at a time.
-
Glatiramer (Copaxone).
This medication is an alternative to beta interferons if you have
relapsing remitting MS. Glatiramer shouldn't be used at the same
time as beta interferons. Glatiramer is as effective as beta
interferons in curbing MS attacks. Doctors believe that glatiramer
works by blocking your immune system's attack on myelin. You must
inject glatiramer subcutaneously once daily. Side effects may
include flushing and shortness of breath after injection.
Medications to relieve symptoms in progressive MS may include:
-
Corticosteroids.
Doctors most often prescribe oral or intravenous corticosteroids to
reduce inflammation in nerve tissue and shorten the duration of
flare-ups. Prolonged use of these medications, however, may cause
side effects such as osteoporosis and high blood pressure (hypertension).
-
Muscle
relaxants.
Tizanidine (Zanaflex) and baclofen (Lioresal) are oral treatments
for muscle spasticity. If you have MS, you may experience muscle
stiffening or spasms, particularly in your legs, which can be
painful and uncontrollable. Lioresal often increases weakness in the
legs. Zanaflex appears to control muscle spasms without leaving your
legs feeling weak but can be associated with drowsiness or a dry
mouth.
-
Medications to
reduce fatigue.
These may include the antidepressant medication fluoxetine (Prozac),
the antiviral drug amantadine (Symmetrel) or a medication for
narcolepsy called modafinil (Provigil). All appear to work because
of their stimulant properties.
Depression
Fatigue
high blood pressure
Many medications are used for the muscle stiffness, depression, pain and
bladder control problems often associated with MS. Drugs for arthritis
and medications that suppress the immune system may slow MS in some
cases.
In addition to medications, these treatments may relieve symptoms of MS:
-
Physical and
occupational therapy.
The goal is to preserve independence by having you do strengthening
exercises and use devices to ease daily tasks.
-
Counseling.
Individual or group therapy may help you and your family cope with
MS and relieve emotional stress.
-
Plasma
exchange.
Researchers are evaluating plasma exchange as an experimental
approach to treating MS. This procedure involves removing some of
your blood and mechanically separating the blood cells from the
fluid (plasma). Your blood cells then are mixed with a replacement
solution, typically albumin, or a synthetic fluid with properties
like plasma. The solution with your blood is then returned to your
body.
-
It's uncertain why
plasma exchange works. Replacing your plasma may dilute the activity
of the destructive factors in your immune system and help you to
recover. This treatment is only for people with sudden, severe
attacks of MS-related disability who don't respond to high doses of
steroid treatment. The treatment is most helpful for people with a
mild pre-existing disability before the attack. Plasma exchange has
no proven benefit beyond three months from the onset of the
neurologic symptoms.
Self-care
These steps may help you relieve symptoms of multiple sclerosis:
-
Get enough
rest.
Fatigue is a common symptom of MS, and getting your
rest may make you feel less tired.
-
Exercise.
Aerobic exercise may offer significant benefits if you have mild to
moderate MS. Those benefits include improved strength, muscle tone,
balance and coordination, and help with depression.
-
Be careful with
hot tubs.
Soaking too long in hot water may cause extreme muscle weakness.
Although some people with MS aren't bothered by heat and may enjoy
warm baths and showers, until you know how you'll react be very
careful before exposing yourself to any extremely warm situation.
Don't get into a hot tub unless there's someone nearby who can pull
you out if necessary. If you do experience heat-related worsening of
symptoms, merely cooling down for a few hours usually will return
you to your normal state.
-
Consider air
conditioning.
If you experience heat-related worsening of MS symptoms and you live
in a hot and humid area, strongly consider having air conditioning
in your home.
-
Eat a
well-balanced diet.
Eating a healthy diet and taking vitamins can help keep your immune
system strong.
-
Increase the
amount of fiber in your diet.
Constipation commonly occurs with multiple sclerosis. A diet high in
fiber, with plenty of whole grains, fruits and vegetables, can
counter constipation.
Depression
Fatigue
constipation
Coping skills
As is true with other chronic diseases, living with multiple sclerosis
can place you on a roller coaster of emotions. Here are some suggestions
to help you even out the ups and downs:
-
Maintain normal
daily activities as best you can.
-
Stay connected
with friends and family.
-
Continue to pursue
hobbies that you enjoy and are able to do.
If MS impairs your ability to do things you enjoy, talk with your doctor
about possible ways to get around the obstacles.
Remember that your physical health can directly impact your mental
health. Denial, anger and frustration are not uncommon when you learn
life has dealt you something painful and unexpected. Professionals such
as therapists or behavioral psychologists may help you put things in
perspective. They can also teach you coping skills and relaxation
techniques that may be helpful.
Sometimes, joining a support group, where you can share experiences and
feelings with other people, is a good approach. Ask your doctor what
support groups are available in your community.
In addition, many chronic illnesses are associated with an increased
risk of depression. This isn't a failure to cope but may indicate a
disruption in the body's neurochemistry that can be helped with
appropriate medical treatment.
If you have a chronic illness such as MS, there's no denying that it
affects your life. But how much you allow it to determine the quality of
your life depends, to some extent, on the way you choose to live day to
day.
Depression
Multiple sclerosis (MS)
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