Overview of MS
How is Multiple Sclerosis Diagnosed?
What Causes MS?
Types of MS
Symptoms of MS
Treatments
Overview
 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.An estimated 400,000 Americans have MS. It generally first occurs in people between the ages of 20 and 50. The disease is twice as common in women as in men.
How is Multiple Sclerosis Diagnosed?
MS is not easy to diagnose. There is no
single conclusive test for MS. Other
conditions may need to be ruled out.
A GP should always refer a patient
to a neurologist to make or confirm the
diagnosis. The neurologist will not
usually diagnose MS until there have
been at least two occurrences of
symptoms involving different areas of
the central nervous system, at least a
month apart and each lasting for at least
24 hours. This means that there is always
a delay between the appearance of the
first symptom and a diagnosis of MS.
A clinical diagnosis, made by a doctor
after seeing you for various MS-type
symptoms over a period of time, needs
to be backed up by tests. It may be
necessary to have several different tests
to identify MS.
The following are the most commonly The following are the most commonly
used tests for MS.
Neurological examination
This tests for abnormalities in nerve
pathways involved in movement or
sensation. The neurologist looks
for changes in eye movements,
co-ordination of legs or hands, balance,
sensation, speech or reflexes, as well as
any signs of weakness.
Evoked potentials
Evoked potentials test the time it takes
for the brain to receive and interpret
messages. This is a non-invasive and
painless test. Small electrodes are placed
on the head to monitor brain waves
responding to what you see or hear. In a
healthy person, responses are virtually
instantaneous. If myelin damage has
occurred, messages may take longer to
get through.
MRI scan
The MRI (Magnetic Resonance Imaging)
scanner is used in most areas of the
country to diagnose MS. Linked to a
computer, it takes detailed pictures of the
brain and spinal cord. It is very accurate
and can pinpoint the exact location and
size of plaques.
Over 90 per cent of people with MS
have plaques that show up on MRI
scans, but some people's scans show no
myelin damage.
Lumbar puncture
This test has been used to diagnose MS
for many years. A needle is inserted into
the lower back, under local anaesthetic,
and a small sample of cerebrospinal fluid
(which flows around the brain and spinal
cord) is taken from the spinal cord. This
fluid is tested for abnormalities in
protein patterns.
Other tests
Conditions that mimic MS can be ruled
out by using MRI or other tests. These
include CAT (Computer Axial
Tomography) scans, which give a crosssectional
image of the brain; tests to
reveal certain antibodies in the blood;
and inner ear tests to check balance.
What Causes MS?
Many factors are involved in MS, but no single cause has been
identified.
Environment
An environmental agent such as a virus
or bacterial infection may be involved.
Some scientists argue that a virus
disturbs the immune system or indirectly
sets off a process whereby the immune
system attacks itself. No single virus has
been identified as being responsible for
MS, but some researchers think that a
common childhood virus may act as a
trigger.
Environmental factors seem to be
influential in the first 15 years of life.
Many people with MS have had viral
illnesses such as measles, chickenpox,
flu, herpes or glandular fever as children
or teenagers.
Genetic factors
Some people with MS seem to have
particular genes which give them a
'genetic predisposition' to MS; in other
words, they make it more likely that
they will develop the condition. These
genes are also common in the general
population, however. There is no single
gene linked to MS.
Family links
MS is not hereditary (ie passed directly
from parent to child), but it can occur in
more than one member of a family.
However, in the UK the chance of a
child having MS when a parent is
affected is very small; it is estimated to
be three in 100, which is much lower
than that for developing cancer or heart
problems. The risk of being affected by
MS for the UK population in general is
one in 800.
Climate and geography
Countries with temperate climates have
a higher incidence of MS cases, and the
condition is more common in areas in
northern latitudes such as Scotland.
No one knows why this is the case.
Some studies suggest that people who
migrate to areas with temperate climates
after the age of about 15 retain the
likelihood of taking on MS
corresponding to their country of origin,
rather than taking on the increased
likelihood associated with temperate
climates.
Are there different types of MS?
There are four main types of MS, and a great deal of variation
within each.
MS shows up differently in each person.
Some people are only mildly affected
throughout their lives. A few people
deteriorate rapidly from the beginning
and may die early. Most people with MS
experience something in between these
two extremes.
Benign MS
This type starts with a small number
of mild attacks followed by complete
recovery. It does not worsen over time
and there is no permanent disability. The
first symptoms usually affect sensation
or sight.
People are only classified as having
benign MS when they have little sign of
disability 10 to 15 years after the first
onset of symptoms. However, disability
may occasionally develop after many
years in which the disease has been
inactive. Around 20 per cent of people
with MS have the benign form.
Relapsing-remitting MS
For most people MS starts as the
relapsing-remitting type. This means
they have relapses (a flare-up of
symptoms), followed by remissions
(periods of recovery).
Relapses (also known as attacks or
exacerbations) tend to be unpredictable
and their causes are unclear. They can
last for hours, days, weeks or months,
and vary from mild to severe. During
a relapse new symptoms may occur,
previous symptoms may return. At their
worst, acute relapses may need hospital
treatment.
Remissions can last any length
of time - even years. No one knows
exactly what makes MS go into
remission. Even during remission
there may still be plaques visible on
MRI scans.
In the early stages of relapsingremitting
MS, symptoms usually disappear during remissions. However,
after several attacks there may be some
residual damage to myelin, resulting in
the person being slightly more affected
than before the relapse. Around 25 per
cent of people with MS have the
relapsing-remitting form.
Secondary progressive MS
Many people who start out with
relapsing-remitting MS later develop
a form known as secondary progressive.
This means that disability does not go
away after a relapse and progressively
worsens between attacks, or that the
cycle of attack followed by remission
is replaced by a steady progression of
disability.
Around 40 per cent of people with
MS develop the secondary progressive
form, usually about 15 to 20 years after
the initial onset of MS.
Primary progressive MS
Some people with MS never have
distinct relapses and remissions. From
the start they experience steadily
worsening symptoms and progressive
disability. This may level off at any time
or may continue to get worse.
Around 15 per cent of people with
MS have the primary progressive form
of the disease, which is also known as
chronic progressive.
Symptoms of MS?
MS varies from person to person. No one experiences every symptom.
MS can cause a wide variety of
symptoms. Many people only experience
a few symptoms and no one has all of
them. People can have different
symptoms at different times, and
although some are very common, there
is no typical set that applies to everyone.
Symptoms vary in severity and
duration. They can range from mild and
short-lived to severe and longer-lasting.
Some symptoms are obvious to other
people. Others (such as pain or fatigue)
are hidden or "silent", and may be harder
for people unfamiliar with MS to
understand.
Certain triggers can seem to make
symptoms worse. The most common
triggers tend to be overdoing things,
exercise which raises core body
temperature, fever, heat and humidity.
Symptoms may start with double or
blurred vision, pain at the back of the eye
or nerve pain in the face. Some people experience ringing in the ears or hearing
problems, tingling ("pins and needles") or
numbness in the legs, feet, arms or hands.
Others experience giddiness and loss of
balance, especially in the dark.
Some people may find it hard to
concentrate, become forgetful, or
experience anxiety, depression or mood
swings.
Other symptoms may include fatigue
(especially in hot weather), pain,
weakness or difficulty in walking. Some
people experience problems with speech
or bladder or bowel control. Sexual
function or sensation can be affected,
and a person with MS may need more
stimulation to become or stay aroused.
These problems can come and go, like
any other MS symptom.
Symptoms are not necessarily unique
to MS, and can be associated with other
conditions.
Effective treatments are available for most MS symptoms, and in some
cases can reduce relapses. They should
be discussed with your doctors or an
MS nurse.
Help and support
You may feel upset at being told that
you have MS. It may be hard to believe
that the good health you had before has
been taken away from you.
You may feel a sense of loss or
bereavement, which may take some time
to understand. You may experience
shock or bewilderment and feel angry
and want to deny the diagnosis, carrying
on as though nothing has happened.
All these reactions are normal, but
some people will experience them more
acutely than others. See our booklet
Making the most of life with MS for
more information on coping with these
reactions.
Talking through your emotions and questions with someone else can be
helpful. The freephone MS Helpline,
telephone counselling lines and local
contacts are there to support you.
Details are included on the back page.
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. The Food and Drug Administration (FDA) has approved beta interferons only for people with relapsing forms of MS who can still walk. Beta interferons don't reverse damage and haven't been proved to prevent permanent disability.
Some people develop antibodies to beta interferons, which may make them less effective. Other people can't tolerate the side effects, which may include symptoms similar to those of the flu (influenza).Mayo Clinic neurologists generally recommend beta interferons for people who have more than one attack of MS a year and for those who don't recover well from flare-ups. The treatment may also be used for people who have a significant buildup of new lesions as seen on an MRI scan, even when there may not be major new symptoms of disease activity.
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.
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.
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