Multiple Sclerosis

What is Multiple Sclerosis ?

Multiple sclerosis (MS) is a chronic disease caused by progressive demyelination of the white matter of the brain and spinal cord. These sporadic patches of demyelination in the central nervous system (CNS) cause widespread and varied neurologic dysfunction.

MS is a major cause of chronic disability in young adults ages 20 to 40. Exacerbations and remissions characterize it.MS may progress rapidly, causing death within months or disability by early adulthood. The prognosis varies; about 70% of patients lead active, productive lives with prolonged remissions.

The incidence of MS is highest in women and among people in northern urban areas and higher socioeconomic groups. Incidence is low in Japan. A family history of MS increases the risk, as does living in a cold, damp climate.

Causes of Multiple Sclerosis

The exact cause of MS is unknown but may be a slowly acting viral infection, an autoimmune response of the nervous system, or an allergic response. Other possible factors include trauma, anoxia, toxins, nutritional deficiencies, vascular lesions, and anorexia nervosa, all of which may help destroy axons and the myelin sheath.

Signs & Symptoms of Multiple Sclerosis

The most common early symptoms include sensory abnormalities (e.g., tingling, numbness, itching, tightness, burning, shooting pain in the back and limbs [called Lhermitte's sign]) difficulty walking, eye pain, and vision loss.

Symptoms of the disease vary, depending on where the damage occurs, and range from minor physical annoyances to major disabilities. Common symptoms include the following:

• Cognitive abnormalities
• Decreased memory
• Decreased spontaneity
• Decreased judgment
• Depression
• Facial pain
• Fatigue
• Extremity pain
• Euphoria
• Tingling

Diagnostic Tests

This difficult diagnosis may require years of testing and observation. The following tests help diagnose MS:

EEG shows abnormalities in one-third of patients.

Blood tests may be used to help rule out other conditions that cause similar symptoms.

Cerebrospinal fluid analysis reveals elevated immunoglobulin G (lgG) levels but normal total protein levels. Elevated IgG levels are significant only when serum gamma globulin levels are normal, and they reflect hyperactivity of the immune system due to chronic demyelination. The white blood cell count may be slightly increased.

Magnetic resonance imaging is the most sensitive method of detecting MS lesions. More than 90% of patients with MS show multifocal white matter lesions when this test is performed. It's also used to evaluate disease progression. Computed tomography scanning also may disclose lesions within the brain's white matter.

Evoked potential test. This test measures the electrical signals sent by the brain in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which short electrical impulses are applied to the legs or arms

Treatment

The goal of treatment is threefold: to treat acute exacerbations, the disease, and its related signs and symptoms.

Acute exacerbations are treated with I. V. methylprednisolone followed by oral prednisone. This is effective for speeding recovery from acute attacks. Other drugs, such as azathioprine (Imuran) or methotrexate and cytotoxin may be used.

Three drugs are used for treating the disease: Betaseron (interferon beta -1b),Avonex (interferon beta­1a), and glatiramer(Copaxone or Copolymer-1), which may reduce the frequency and severity of relapses and slow CNS damage. Copaxone is a combination of four amino acids and all the medications are immunomodulating agents, targeting the autoimmune response. They are all currently used for relapsingremitting MS.

Prevention Tips

There is no known way to prevent multiple sclerosis. Until the cause of the disease is discovered, this is unlikely to change. Good nutrition; adequate rest; avoidance of stress, heat, and extreme physical exertion; and good bladder hygiene may improve quality of life and reduce symptoms.