Multiple sclerosis or MS is a neurologic autoimmune disease where the immune system attacks the myelin sheath that covers our nerves. It can be a potentially disabling disorder that involves the brain and spinal cord, our central nervous system, and therefore has wide range of effects over the entire body. The damage that MS causes to the myelin sheath slows down and/or blocks the nervous system’s message along the nerves. The disease can progress to permanent nerve damage and deterioration.
There is no single test to detect MS, so doctors use several criteria to determine its diagnosis. These include evidence of damage in at least two separate areas of the central nervous system or CNS that occurred at different points in time and ruling out all other possible diagnoses. There is no known cause or cure, but there are several therapies that can aid in slowing the progression of this disease and the accompanying symptoms. It is still not known why MS develops in some persons and not others. There are theories that genetics and environment may play a role. Risk factors associated with MS include:
- Age. MS can occur at any age, but usually affects people somewhere between the ages of 16 and 55.
- Sex. Women are more than two to three times as likely as men to have relapsing-remitting MS.
- Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
- Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
- Race. Caucasian people, particularly those of Northern European descent, are at highest risk for developing MS. People of Asian, African or Native American descent have the lowest risk.
- Climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia, and Europe.
- Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of MS.
- Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes, or inflammatory bowel disease.
- Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.
Symptoms can vary widely from person to person over the course of the disease and depend on the area of nerves that are affected.
Some symptoms include: numbness, weakness of limbs (typically occurring on one side of the body), and “pins and needles” sensations (especially with neck movement) known as Lhermitte’s Sign. Visual changes are also common, including: partial or complete loss of vision and double or blurry vision. Other symptoms include thinking and memory disturbances, fatigue, slurred speech, dizziness, as well as bladder, bowel, and sexual dysfunction.
There are four different types of MS, with varying degrees of symptoms.
Relapsing-remitting MS is the most common, with symptoms that relapse over days or weeks and remissions that may last months or even years with very little or no symptoms.
Secondary Progressive MS typically occurs in the relapsing-remitting MS population, who will then continue to have symptoms without remission. Typical symptom progression usually occurs with mobility and walking.
Primary Progressive MS is not very common and has a gradual progressive onset of symptoms without any remissions.
Progressive-Relapsing MS is a rare form of MS that steadily worsens from the beginning, with acute relapses but no remissions.
Treatments vary but focus on speeding recovery from attacks, slowing the progression of the disease, and managing symptoms.
During an attack, steroids may be used intravenously or by mouth to decrease nerve inflammation. There is also another procedure known as plasmapheresis where the patient’s blood is filtered to decrease symptoms of MS if steroids prove ineffective.
There are several disease-modifying medications dealing with the immune response early in the disease’s progression to hopefully impede it’s progress, stop it completely, and/or decrease damage to nerves, preventing the growth of new lesions along the nerves. Many of the disease-modifying drugs have serious side effects. The severity of the disease, patient health, childbearing status, and response to other therapies need to be taken into consideration when deciding to use one of these medications.
Beta interferons are disease-modifying medications for relapsing-remitting MS and are one of the most common classes of drugs used. They can be injected under the skin or into a muscle to reduce the frequency and severity of relapses. The main side effect is flu-like symptoms.
Glatiramer acetate also known as Copaxone or Glatopa is another injectable disease-modifying medication that has been shown to block the immune system’s attack on the myelin sheath. This medication is injectable under the skin as well. Side effects include irritation at the injection site.
There are a few newer IV drugs that can be administered to modify disease progression and decrease symptoms; however, they all come with serious side effects. Risk-benefit considerations and prior therapy response should be considered when thinking about using these medications. Examples include: Natalizumab also known as Tysabri, Alemtuzumab also known as Campath or Lemtrada, and Ocrelizumab (Ocrevus).
There are also supportive therapies to treat the signs and symptoms of MS:
Physical therapy and occupational therapy can be used to help with mobility, strengthening, and stretching. Muscle relaxants for muscle stiffness or spasms and medications for fatigue can be prescribed.
Some lifestyle modifications include: getting enough sleep, exercise, eating a well-balanced diet, lowering stress, and keeping the body cool.
Some alternative therapies such as yoga, massage, and acupuncture have brought some patients mental and physical well being benefits.
Coping with MS, a chronic illness, and the fear associated with it is an important part of disease management. Affected patients should seek out support groups, stay connected to friends and family, discuss their feelings and concerns with a counselor or physician, and try to maintain their activities of daily living as best as they can.
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