MS – Multiple Sclerosis
Multiple sclerosis (MS; pronounced multiple skluh-RO-siss) is a chronic autoimmune disorder that affects the nerves. In this case "chronic" means that it develops slowly over time; "autoimmune" means that the body's immune system becomes confused about some part of the body it is designed to protect. It attacks that part of the body as if it were a foreign invader. MS affects a person's ability to move, feel and to control his or her body functions.

Description
Nerve messages consist of electrical impulses that travel through the body by means of nerve cells. Nerve cells are also called neurons. Neurons are covered by a thin layer of tissue known as myelin that acts as an insulator. It prevents the electrical currents that pass through neurons from leaking away.

MS occurs when the myelin that surrounds neurons in the brain and spinal cord is destroyed. The loss of myelin causes electrical impulses to pass through neurons more slowly. Over time, scar tissue forms around the damaged myelin. This scar tissue, called plaque (pronounced PLAK), also reduces the neurons' ability to function normally.

Damage to myelin can lead to many different symptoms. A person may lose the ability to use his or her senses, such as touch and vision. Loss of muscular control also occurs because movement of muscles is controlled by nerves. A person with MS may have problems dealing with strength, balance and coordination.

MS affects more than 250,000 people in the United States alone. The majority of MS victims tend to have their first symptoms around the ages of twenty to forty. These said symptoms rarely begin before the age of fifteen or after sixty. MS is more likely to occur in women compared to men (2:1 ratio) especially in their young age. .MS is also more common among some ethnic groups compared to the others. For example, the disease is more common in North America and northern Europe than in other parts of the world. MS is very rare among Asians, Indians of North and South America, and Eskimos.

Multiple Sclerosis: Words to Know

Evoked potential test (EPT):
A test that measures the brain's electrical response to certain kinds of stimulation; such as light in the eyes, sound in the ears, or touch on the skin.

Myelin:
A layer of tissue that surrounds nerves and acts as an insulator.

Plaque:
Patches of scar tissue that form in areas where myelin tissue has been destroyed.

Primary progressive:
A form of multiple sclerosis in which the disease continually becomes worse without any major improvement.

Relapsing-remitting:
A form of multiple sclerosis in which symptoms appear for at least twenty-four hours and then disappear for a period of time.

Secondary progressive:
A form of multiple sclerosis in which a period of relapses and remissions is followed by another period in which the disease becomes progressively worse without improvement.

Causes
Multiple sclerosis is an autoimmune disease in which the immune system begins to attack myelin. It happens when the immune system "decides" that the myelin is a foreign substance that threatens the body and must be destroyed. Researchers are still baffled as to why this condition occurs.

As myelin is destroyed, neurons no longer function normally. Brain neurons cannot receive and process information from the outside world in the normal manner as it used to. Neurons in the brain and the spinal cord are unable to send messages to other parts of the body. Normal muscular functions such as standing, walking, lifting, and turning, become difficult or impossible.

The progress of MS is dependent on the appearance of new plaques. These plaques will decrease the nerve messages rate and also cause the symptoms of the disease to worsen. Scientists do not understand how, where, and why plaques develop. For that reason, they cannot predict how the disease will progress in any one person over time.

Finding the reason for a body's autoimmune reaction to myelin is a major field of research. So far, no concrete evidence have been found and the search continues. However, researchers have reason to believe that some of the possible factors leading to this condition are a person's heredity (his or her genes), environmental factors, viruses, or a combination of these factors.

The reason that heredity is considered a possible factor is that MS seems to run in some families. An individual who has a family member with MS is more likely to develop the disease compared to individuals whose family has no history of MS. In addition, the tendency of some ethnic groups to contract (get) the disease suggests a hereditary factor.

Support for environmental factors comes from data on migration. Migration is the process of moving from one part of the world to another part. Studies have been conducted on individuals who has migrated from a low-risk part of the world (such as Asia) to a high-risk part (such as the United States). Young people who make such moves have a higher risk of developing MS compared to those who are the same age and remain back home. Older people do not experience an increased risk. These data suggest that environmental conditions in the new location might be responsible for MS.

Another possible possible environmental factor is viruses. There are certain kinds of viruses that attack the body very slowly. HIV, the virus that causes AIDS, is one such virus. Some researchers think that a slow-acting virus may be responsible for MS. However, as at the moment, no sufficient scientific data has been available to support the theory.

Symptoms
Multiple sclerosis can develop in one of the following three patterns. The most common pattern is called "relapsing-remitting." In this pattern, symptoms appear and then disappear. An individual may feel fine for a period before re-experiencing the symptoms of MS for a period of twenty-four hours or even possibly more. The symptoms will then go on to disappear for any amount of time. That span may be as long as a year or more at the beginning of the disease. But the span grows shorter as the person becomes older. This pattern is especially common in younger individuals with MS.

"Primary progressive" is the second pattern associated with MS. It is where the disease worsens over time. In this pattern, the disease simply gets worse over time. An individual may experience short lapses in when the condition of the disease remain stagnant; but they are very rare. The primary progressive pattern is most common among older individuals.

The "secondary progressive" pattern is a combination of the first two patterns. A patient first goes through a period of relapsing and remitting. Eventually, the disease just continues to get worse, as in the primary progressive pattern.

Between 10 percent and 20 percent of MS patients have a benign form of MS. Benign means that the symptoms do not change very much throughout an individual's life-span.

The actual symptoms of MS vary considerably between an individual to the other. This is due to the fact that plaques are formed differently among individuals. Among some of the initial symptoms of the disease include:

* Muscle weakness causing difficulty in walking
* Loss of coordination or balance
* Numbness, feelings of "pins and needles," or other abnormal sensations
* Problems with vision, including blurred or double vision

As the disease develops, other symptoms may appear. These include:

* Fatigue
* Muscle stiffness
* Tremors (shaking)
* Paralysis
* Pain
* Vertigo (dizziness, lightheadedness)
* Difficulty with speech and/or swallowing
* Loss of bowel or bladder control
* Constipation
* Sexual problems
* Changes in one's ability to think clearly

Weakness in one or both legs is common. Often it appears to be the very first symptom noticed by a person with MS. Excessive tightness of muscles is also common. It may actually cause more problems than muscular weakness.

Damage to myelin in the optical (eye) nerves can cause visual problems such as blurred vision, changes in colour vision and even blindness. The condition may affect either a single eye or both of the eyes.

More than half of all MS patients have experienced pain during the course of their disease. The majority of them experience pain nearly all the time, often because of muscle spasticity (stiffness). The pain is often a sharp, stabbing pain; especially in the face, neck, or back. Numbness and weakness in the face are also common.

Changes to the mental that can occur include loss of memory, depression, and personality changes. Some of these changes may result from damage to neurons. Others may be a side effect caused by the patient's despair due the disease. In less common cases, an individual with MS may actually feel happier than usual.

The symptoms of MS can be affected by environmental conditions. Heat; increased body temperature; vigorous physical activity; or exposure to sun, hot baths, or showers can worsen the condition.

Diagnosis
Sometimes a doctor can make a reliable diagnosis of MS fairly easily and quickly. The distribution of symptoms is important since MS affects many different areas of the body over a period of time. The pattern of symptoms is also important. A case of relapsing-remitting MS can often be diagnosed because of the way the symptoms come and go.

Since the symptoms of MS are similar to those of other diseases, diagnosis can often be difficult and complicated. Many tests and extended observation may be necessary to decide what is causing the patient's symptoms.

The usual medical procedures used to make a diagnosis include a medical history, a standard neurological (nervous system) examination, and several laboratory tests. Among the tests most commonly used to confirm or rule out a diagnosis of MS are:

* Magnetic resonance imaging (MRI) can show plaques on the brain and spinal cord. However, plaques are present with other disorders as well. For example, the plaques caused by MS are sometimes difficult to distinguish from those caused by strokes (see stroke entry) or the simple process of ageing.

* A lumbar puncture (spinal tap) is a process in which cerebrospinal fluid (CSF) is removed from the patient's spine with a long, thin needle. The CSF is then studied. The presence of white blood cells and other substances may be an indication for the presence of MS.

* Evoked potential tests (EPT) are tests that measure how quickly an electrical current passes through neurons. Scientists know the normal rate at which currents pass. If they move slower than normal, plaques may be present. An EPT can be conducted in various ways. One method is to apply a small electrical charge to the skin. A light can also be shined into a person's eyes. Or a tone can be sounded near his or her ears.

The neurologist (nerve specialist) conducting these tests will then decide if the patient suffers one of the following three categories: "definite MS," "probable MS," or "possible MS." These three categories represent decreasing confidence in the accuracy of the diagnosis.

Treatment
Treatment of MS takes two forms. First, although there are no drugs that will actually cure the disease, there are drugs that can slow down the course of MS. Second, a variety of treatments can be used to ease the symptoms of multiple sclerosis.

As of 1997, three drugs had been approved to be used with multiple sclerosis: Avonex, Betaseron, and Copaxone. All three reduce the rate of relapses in the relapsing-remitting form of MS. All three drugs are administered by injection.

Immunosuppressant drugs have also been used to treat severe relapses. These drugs act on the immune system directly, causing it to work less effectively. The drugs carry some risks, so a patient may have to be hospitalized during treatment.

MS causes a large variety of symptoms. For that reason, many different treatments may be necessary to relieve those symptoms. An individual should be vaccinated against influenza. The vaccination can help protect against respiratory (breathing) problems, thus reducing the symptoms of MS. Preventing complications from MS is also important. Such complications include pneumonia, bed sores, injuries from falls, or urinary infections. These complications lead to death more often than does MS.

Physical therapy is important in treating MS. It helps the patient strengthen and retrain affected muscles, maintain range of motion to prevent muscle stiffening, learn to use devices to assist them such as canes and walkers, and learn safer and more energy-efficient ways of moving and sitting.

A physical therapy program usually includes exercise and stretching. These activities can be taught and practised at home. Swimming is often recommended. It provides a way for a patient to get exercise without becoming overheated.

Treatment programs usually include occupational therapy as well. People with MS are taught how to deal with daily activities such as dressing, feeding, and washing. The occupational therapist can make suggestions for arranging the home and work environment so that a MS patient can function more safely and efficiently.

A MS patient may need training in bowel and bladder control. Drugs are sometimes used to deal with these problems. They help the patient to empty his or her bowel and bladder on a more consistently schedule.

Spasticity can be treated with drugs as well. Baclofen and diazepam (trade name Valium) are given by mouth, while botulin toxin (Botox) is given by injection. These drugs can help relieve the pain caused by spasticity. Back pain can be treated with over-the-counter pain relievers such as aspirin or acetaminophen (trade name Tylenol), or with physical therapy.

Fatigue can be treated by having the patient plan and follow a regular daily routine. The routine should allow for plenty of rest periods. Drugs such as amantadine (trade name Symmetrel) and pemoline (trade name Cylert) is able to improve alertness while lessen the effects of fatigue. Corticosteroids are used to treat visual problems. Other types of drugs can be used to treat seizures, vertigo, and tremor.

Alternative Treatment
A variety of alternative treatments have been recommended for multiple sclerosis. So far, there is insufficient scientific data to support most of these claims. For example, bee venom has been suggested as a treatment for MS. However, studies have not supported this claim. Marijuana has also been recommended for the relief of certain symptoms associated with MS including tremor, pain, and spasticity. However the drug contains side effects of its own. It is not widely recommended in the United States for the treatment of MS.

Some practitioners suggest that high doses of vitamins, minerals, and other dietary supplements can help slow the progress of MS. Specific nutrients recommended include linoleic (pronounced lin-uh-LEE-ik) acids, selenium, vitamin E, and a diet low in saturated fats.

Prognosis
The prognosis for MS differs significantly between one individual to the other. Most individuals with the disease can continue walking and functioning at home and work for many years after their diagnosis. Some conditions that favour a promising diagnosis include being female, having the relapsing-remitting form of the disease, having the first symptoms at an early age, having long periods of remission between relapses, and having vision and touch symptoms rather than muscular problems.

Less than 5 percent of individuals with MS have a severe progressive form of the disease that leads to death within five years. At the other extreme, 10 percent to 20 percent have a benign (relatively harmless) form with very slow or no progression of symptoms. On average, MS shortens the lives of women with the disease by about six years and men by about eleven years. Suicide is a significant cause of death in people with MS, especially among younger patients.

Most people experience the the most severe disabilities associated with MS within five years of diagnosis. After that point, disabilities do not continue to worsen significantly. If no disabilities appear within the first five years, they are unlikely to occur at all.

Prevention
There is no known way to prevent multiple sclerosis. Until the cause of the disease is discovered, that will continue to be the case. The symptoms of the disease can be reduced, however, by good nutrition; adequate rest; avoidance of stress, heat, and extreme physical exercise; and good bladder hygiene.

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