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MULTIPLE SCLEROSIS (MS)
By peace | May 5, 2006
An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. Many investigators believe MS to be an autoimmune disease — one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus.
Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or “pins and needles” sensations. Some may also experience pain. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. Depression is another common feature of MS.
Causes
The cause of MS is still unknown. In the last 20 years, researchers have focused on disorders of the immune system and genetics for explanations. The immune system is the body’s defender and is highly organized and regulated. If triggered by an aggressor or foreign object, the immune system mounts a defensive action which identifies and attacks the invader and then withdraws. This process depends upon rapid communication among the immune cells and the production of cells that can destroy the intruder. In MS, researchers suspect that a foreign object such as a virus or an abnormal gene alters myelin or the immune system so that the immune system perceives myelin as an intruder and attacks it. While some of the myelin may be repaired after the assault, some of the myelin disappears and nerves become stripped of this covering (demyelinated). Scarring also occurs, and material is deposited into the scars forming plaques.
Symptoms
Symptoms of MS may be single or multiple and may range from mild to severe in intensity and short to long in duration. Complete or partial remission from symptoms occurs early in about 70% of MS patients. Visual disturbances often are the first symptoms of MS, but they usually subside. A patient may notice blurred or double vision, red-green distortion, or sudden blindness. Muscle weakness leading to difficulties with coordination and balance commonly is noticed early. Muscle spasms, fatigue, numbness, and prickling pain are common symptoms. There may be a loss of sensation, speech impediment, tremors, dizziness or occasionally hearing loss. 50% of patients experience mental changes such as decreased concentration, attention deficits, some degree of memory loss, or impairment in judgment. Other symptoms may include depression; manic depression, paranoia or an uncontrollable urge to laugh and weep called laughing-weeping syndrome. As the disease worsens, patients may experience sexual dysfunction or reduced bowel and bladder control. Heat appears to intensify MS symptoms for about 60% of patients, and relief is found with cold baths or swimming. Pregnancy seems to reduce the number of attacks.
Diagnosis
Due to the broad range and subtleties of symptoms, MS 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. If patients have minor complaints but no definite clues of MS or abnormal examinations, they may be diagnosed with “possible” MS. Further testing helps to diagnose “probable” or “definite” MS. MRI (magnetic resonance imaging) with intravenous gadolinium or MRS (magnetic resonance scanning) help to identify, describe, and date lesions in the brain (plaques).
Another electro-physiological test, evoked potentials, examines the impulses traveling through the nerves to determine if the impulses are moving normally or too slowly. Finally, examining the cerebro-spinal fluid that surrounds the spinal cord may identify abnormal chemicals or cells floating in the brain or spinal cord that suggest the presence of MS.
Collectively, these three tests strengthen the diagnosis of MS. If criteria for definite MS are not met, the patient is diagnosed with probable MS. Definite MS is diagnosed when the patient’s age is within the range for MS, at least one attack affecting more than one organ has occurred or there has been a progression of symptoms over a long time, and the MRI or MRS, cerebro-spinal fluid abnormalities, and evoked potentials suggest MS.
Treatment: The drug baclofen is used to suppress muscle spasticity, and corticosteroids help reduce inflammation. Interferons also are being used to treat this disease.
Multiple Sclerosis At A Glance
- Multiple sclerosis (MS) is a disease which progressively injures the nerves of the brain and spinal cord.
- Injury to the nerves in MS may be reflected by alterations of virtually any sensory or motor (muscular) function in the body.
- The cause of MS is unknown, but genetic and immunological factors probably are important.
- Interferon is the primary drug treatment for MS.
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