Multiple sclerosis (MS) is a disease in which the nerves of the central nervous system (CNS) degenerate. The CNS is made up of the brain and spinal cord. They process information from our environment and control voluntary muscle movements to allow the body to do certain things. This neural system works efficiently, unless there is a disease process affecting the pathways in the spinal cord and brain. Multiple sclerosis is one of the diseases that can affect
What Causes Multiple Sclerosis?
The cause of multiple sclerosis is still unknown. In the last 20 years, researchers have focused on disorders of the immune system and genetics for explanations, suspecting that a foreign agent such as a virus alters the immune system so that the immune system perceives myelin as an intruder and attacks it. Definitive proof of this viral theory is still lacking. However, the attack by the body's immune system on the neural tissues that it is supposed to protect is
When Multiple Sclerosis Attacks
In multiple sclerosis, an agent such as a virus or foreign antigen, in theory, may alter or interact with the immune system so that the immune system perceives myelin as an intruder and attacks it. Inflammation occurs and causes myelin to disappear. Consequently, the electrical impulses that travel along the nerves decelerate, that is, become slower. In addition, the nerves themselves are damaged. While some of the myelin may be repaired after the assault, some of the nerves are stripped of their myelin covering (become demyelinated). Scarring also occurs, and material is deposited into the scars and forms plaques. As more and more nerves are affected, a person experiences a progressive interference with functions that are controlled by the nervous system such as vision, speech, walking, writing, and memory.
What Are the Types of Multiple Sclerosis?
In some ways, each person with multiple sclerosis lives with a different illness. Although nerve damage is always involved, the pattern is unique for each individual who has MS.
Although individual experiences with MS vary widely, doctors and researchers have identified several major types of Multiple Sclerosis. The categories are important because they help predict disease severity — and response to treatment.
What Are the Symptoms of Multiple Sclerosis?
Symptoms of multiple sclerosis may be single or multiple and may range from mild to severe in intensity and short to long in duration. These include:
- Visual disturbances (blurred vision, color distortions, loss of vision in one eye, eye pain)
- Limb weakness, loss of coordination and balance
- Muscle spasms, fatigue, numbness, prickling pain
- Loss of sensation, speech impediment, tremors, or dizziness
- Bladder and bowel dysfunction
- Mental changes (decreased concentration, attention deficit, memory loss)
- Depression
- Paranoia
- Uncontrollable laughter and weeping
How Is Multiple Sclerosis Diagnosed?
Due to the broad range and subtleties of symptoms, multiple sclerosis may not be diagnosed for months to years after the onset of symptoms. Physicians, particularly neurologists, take detailed histories and perform complete physical and neurological examinations.
- MRI
- Electrophysiological test
- Cerebrospinal fluid exam (spinal tap, lumbar puncture)
- Collectively, these three tests help the physician in confirming the diagnosis of multiple sclerosis. For a definite diagnosis of multiple sclerosis, dissemination in time (at least two separate symptomatic events or changes on MRI over time) and in anatomical space (at least two separate locations within the central nervous system, which can be demonstrated by MRI or neurological exam) is usually required. Most physicians consult a neurologist to help obtain the definitive diagnosis of multiple sclerosis.
How Is Multiple Sclerosis Treated?
There are many issues for the patient and physician to consider in treating multiple sclerosis. Goals may include:
improving the speed of recovery from attacks (treatment with steroid drugs);
reducing the number of attacks or the number of MRI lesions; or
attempting to slow progression of the disease (treatment with disease modifying drugs or DMDs).
An additional goal is relief from complications due to the loss of function of affected organs (treatment with drugs aimed at specific symptoms).
Once goals have been set, initial therapy may include medications to manage attacks, symptoms, or both. An understanding of the potential side effects of drugs is critical for the patient because sometimes side effects alone deter patients from drug therapy. Patients may choose to avoid drugs altogether or choose an alternative drug that may offer relief with fewer side effects. A continuous dialogue between the patient and physician about the medications is important in determining the needs for treatment.
Drugs known to affect the immune system have become the primary focus for managing multiple sclerosis. Initially, corticosteroids, such as prednisone (Deltasone, Liquid Pred, Orasone, Prednicen-M) or methylprednisolone (Medrol, Depo-Medrol), were widely used. However, since their effect on the immune system is non-specific (general) and they may cause numerous side effects, corticosteroids now tend to be used to manage only severe multiple sclerosis attacks (that is, attacks leading to physical disability or causing pain).
REFERENCES:
MedicineNet: "Multiple Sclerosis."
eMedicineHealth: "Multiple Sclerosis."
World Health Organization: "Atlas, Multiple Sclerosis Resources in the World 2008."
WebMD: "Understanding the Different Types of Multiple Sclerosis."
WebMD: "The Progression of Multiple Sclerosis."
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Unknown - Monday, 2 January 2012
