Multiple Sclerosis

General

MS Lesions

Multiple Sclerosis (MS) is a common disabling neurologic disorder of young adults, affecting at least 300,000 Americans. The average age of diagnosis is 30, but it typically starts anywhere between the ages of 15 and 50. Occasionally, the disease begins in children or in older adults. Women are affected at least twice as often as men. It is more common in persons of Northern European heritage, and people with MS are distributed in a remarkable geographic pattern. The highest density occurs in those living furthest from the equator, that is, in temperate zones.

There are several types of MS. Most people with MS begin with relapsing remitting disease-that is, it starts with an abrupt onset of neurological problems like numbness or tingling, weakness, or unsteady gait, that either improve spontaneously, visual disturbances or with treatment of the symptoms-only to come back again or "relapse." Until recently, when the first treatment became available, most people with relapsing remitting MS eventually developed a secondary or chronic progressive from of the disease. Ultimately, over one half of people with MS will experience a progressive course.

In general, MS is not life threatening. The life expectancy of those with MS is only slightly less than the general population. When premature death occurs, it is usually the result of complications such as pneumonia or other infections.

The disease is not contagious, and its course is very unpredictable. There is tremendous variation between patients and in patients in various stages of the disease.

What Is Multiple Sclerosis?

Myelin

Multiple sclerosis (MS) is thought to be an autoimmune disease, which means that your own immune system mistakenly attacks normal tissues in your body. In MS, these attacks are aimed at the brain and spinal cord, or the central nervous system.

The central nervous system is made up of nerves that act as the body's messenger system. Each nerve is covered by a fatty substance called myelin, which insulates the nerves and helps in the transmission of nerve impulses, or messages between the brain and other parts of the body.

MS gets its name from the buildup of scar tissue located in more than one area of the brain and/or spinal cord. Plaques form when the protective myelin sheath is destroyed, a process called demyelination. Without the myelin, signals transmitted throughout the central nervous system are disrupted or halted. The brain then becomes unable to send and receive messages.

Although the nerves can regain myelin, this process is not fast enough to outpace the deterioration that occurs. The types of symptoms, severity of symptoms, and the course of MS vary widely, partly due to the location of the scar tissue and the extent of demyelination.






MS Pathology MS Pathology

What causes multiple sclerosis?

There is no known cause of MS; the disease is probably related to a number of factors. While symptoms show up in the central nervous system, MS appears to be the result of problems in the immune system. The ultimate consequence of MS is that immune cells enter the brain and spinal cord, attack the myelin and eventually cause myelin loss and scarring. The entire process results in the failure of nerve impulses to be sent or received properly.

How does MS progress?

The course of multiple sclerosis varies for each person. Because of this, people are told by their doctor that they "probably" or "possibly" have MS. Your diagnosis is based on the combination of problems, patterns of recurrence, which systems are impaired, and your lab results. There is no way to predict how each person's condition will progress.

Four basic types of MS have been defined:

  • Relapsing-remitting: characterized by acute attacks, called exacerbations, followed by full recovery or some neurological symptoms after recovery. The disease does not worsen in the periods between relapses.
  • Primary progressive: characterized by a gradual but steady progression of disability, without any obvious relapses and remissions.
  • Secondary progressive: initially begins with a relapsing-remitting course, but later evolves into progression at a variable rate.
  • Progressive relapsing: characterized by a steady progression in disability with acute attacks that may or may not be followed by some recovery.

What does my future hold?

One of the greatest challenges of MS is the unpredictability and uncertainty of what is to come. A good plan for coping with your concerns about the future is to:

  • Educate yourself about possible changes.
  • Work with your doctor and other healthcare professionals to manage your symptoms.
  • Communicate openly with your family and others.
  • Keep your life satisfying and fulfilling.

How Is MS Diagnosed?

There is no single diagnostic test that is proof-positive for multiple sclerosis. There is a set of accepted criteria for MS diagnosis, but even this system is imperfect. Since diagnosing MS can be very difficult, it must be done by a neurologist who specializes in treating MS. As many as 10% of people diagnosed with multiple sclerosis actually have some other condition that mimics MS.

Examples of other conditions that masquerade as MS include inflammation in the blood vessels, multiple strokes, vitamin deficiency, or brain infection. Sometimes stress-related disorders can lead to a misdiagnosis of MS.

What are the accepted criteria for diagnosis?

  • Onset usually between 10 and 60 years of age
  • Symptoms and signs indicating lesions of central nervous system white matter
  • Evidence of two or more lesions upon examination by MRI scan

How will I be diagnosed?

An accurate diagnosis is based on your medical history and neurological examination using tests of nervous system function or MRI. A lot depends on the skill of the physician in asking the right questions to uncover information and to properly evaluate the signs and symptoms of a malfunctioning nervous system. In addition to a thorough medical history and neurological examination, a variety of specialized procedures are helpful -- although not always necessary -- in accurately diagnosing MS. These include imaging techniques such as MRI, spinal taps (examination of the cerebrospinal fluid that runs through the spinal column), evoked potentials (electrical tests to help determine if MS has affected a person's sensory nerve pathways), and laboratory analysis of blood samples.

What does an MRI show?

MS Hemisphere MS Hemisphere


The precise image produced by magnetic resonance imaging (MRI) gives the neurologist clear evidence of scar tissue in the deep parts of the brain or spinal cord that is characteristic of MS.

However, abnormal spots on the brain MRI can be caused by other conditions, so these images must be interpreted by the neurologist in light of all information about the patient. Similar lesions can be seen in elderly people or people with migraine headaches or high blood pressure. Confirming a diagnosis of MS and ruling out other possible causes requires expert interpretation of the MRI scan.

Will I need a spinal tap?

Performing a spinal tap to examine the cerebrospinal fluid may be helpful in diagnosing MS in some people, but it is no longer considered necessary in all instances.

An experienced MS team will be able to determine if you need this test to confirm a suspected diagnosis of MS, particularly if your history and physical examination suggest the presence of the disease. Abnormalities that may appear in the cerebrospinal fluid can be very helpful in establishing a diagnosis but, like other tests, spinal taps are not foolproof in diagnosing MS.

What other tests might be done?

Electrical tests of the nerve pathways, known as evoked potentials, are very helpful in confirming whether MS has affected the visual, auditory, or sensory pathways. These tests are done by placing wires on the scalp to test the brain's response to certain types of stimulation, such as watching a pattern on a video screen, hearing a series of clicks, or receiving electrical impulses in your arm or leg.

Your doctor may order a blood test to help rule out conditions that imitate multiple sclerosis, but the presence of MS cannot be detected in the blood.

Treatment

There is no known cure for multiple sclerosis, but there are many types of treatments.

The interventions prescribed by your doctor and other healthcare professionals are not designed to make MS disappear. Instead, the various treatments -- including medications, exercises, adaptive aids, and self-care strategies -- are designed to help manage symptoms, prevent unnecessary complications, control disease progression, and minimize disability.

The medical management of your MS involves an ongoing collaboration between you and your healthcare team. Decisions about treatment must be made on an individual basis.

The treatment of MS can be grouped into three categories: disease-modifying treatments, management of acute attacks, and management of symptoms.

Stress and MS

Multiple sclerosis is an unpredictable, frustrating disease. As such, its emotional impact can be as great as its physical impact.

The prolonged stress of living with a chronic illness can lead to frustration, anger, hopelessness and, at times, depression. People with multiple sclerosis are especially at risk for becoming depressed. And you are not the only person affected. Family members are also influenced by the persistent health changes of a loved one. It is important to recognize the triggers, signs and solutions that are associated with stress so that you can effectively manage it.

What causes stress for people with MS?

  • Uncertainty of diagnosis (living with symptoms and no diagnosis)
  • Unpredictability of the disease
  • The emergence of symptoms and having visible signs of the disease, such as the need of a cane or wheelchair
  • Concerns about finances and job situation
  • Having to depend on others, and not being able to care for others (such as spouses and children) like you used to
  • Modifying your activities and your surroundings to accommodate your MS
  • Symptoms that are unexplainable and not understandable

What are the warning signs of stress?

  • Your body sends out physical, emotional, and behavioral warning signs of stress.
  • Emotional warning signs include anger, an inability to concentrate, unproductive worry, sadness, and frequent mood swings.
  • Physical warning signs include stooped posture, sweaty palms, chronic fatigue, and weight gain or loss.
  • Behavioral warning signs include overreacting, acting on impulse, using alcohol or drugs, and withdrawing from relationships.

What can I do to reduce stress?

  • Keep a positive attitude.
  • Accept that there are events that you cannot control.
  • Be assertive instead of aggressive. Assert your feelings, opinions, or beliefs instead of becoming angry, combative, or passive.
  • Learn relaxation techniques.
  • Exercise regularly. Your body can fight stress better when it is fit.
  • Eat well-balanced meals.
  • Rest and sleep. Your body needs time to recover from stressful events.
  • Don't rely on alcohol or drugs to reduce stress.