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19 / 10 / 2017
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Multiple sclerosis (MS)

 

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) Links

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    Last Modified : 17/06/09 11:10 PM