Multiple Sclerosis

Crohn's Disease | Diabetes | Lupus | Multiple Sclerosis | Myasthenia Gravis-Als | Rheumatoid Arhritis | Scleroderma

In multiple sclerosis, patches of myelin and underlying nerve fibers in the eyes, brain, and spinal cord are damaged or destroyed.

• The cause is unknown but may involve an attack by the immune system against the body's own tissues (autoimmune reaction)
• Usually, periods of relatively good health alternate with episodes of worsening symptoms
• People may have vision problems and abnormal sensations, and movements may be weak and clumsy
• Usually, doctors base the diagnosis on symptoms and results of a physical examination and magnetic resonance imaging (MRI)
• Treatment includes corticosteroids, drugs that help keep the immune system from attacking the body, and drugs to relieve symptoms
• Often, the disorder slowly worsens, disabling some people, but life span is unaffected unless the disorder is very severe.

The term “multiple sclerosis” refers to the many areas of scarring (sclerosis) that result from destruction of the tissues that wrap around nerves (myelin sheath). This destruction is called demyelination. Sometimes the nerve fibers that send messages (axons) are also damaged. Over time, the brain may shrink in size because axons are destroyed.

In the United States, about 400,000 people, mostly young adults, have multiple sclerosis. Most commonly, it begins between the ages of 20 and 40. It is more common among women. Most people have periods of relatively good health (remissions) alternating with periods of worsening symptoms (flare-ups or relapses). Relapses can be mild or debilitating. Recovery during remission is good but incomplete. Thus, the disorder worsens slowly over time.

Causes

The cause unknown, but a likely explanation is that people are exposed early in life to a virus (possibly a herpesvirus or retrovirus) or some unknown substance that somehow triggers the immune system to attack the body's own tissues (autoimmune reaction). The autoimmune reaction results in inflammation, destruction of myelin, and damage to the myelin sheath and the underlying nerve fiber.

Heredity seems to have a role in multiple sclerosis. About 5% of people with the disorder have a brother or sister who is affected, and about 15% have a close relative who is affected. Also, multiple sclerosis is more likely to develop in people with certain genetic markers on the surface of their cells called human leukocyte antigens. These markers help the body to distinguish self from nonself and thus know which substances to attack.

Environment also has a role in multiple sclerosis. Where people spend the first 15 years of life affects their chance of developing multiple sclerosis. It occurs in 1 of 2,000 people who grow up in a temperate climate but in only 1 of 10,000 people who grow up in a tropical climate. Multiple sclerosis almost never occurs in people who grow up near the equator. These differences may be related to vitamin D levels. When the skin is exposed to sunlight, the body forms vitamin D. Thus, people who grow up in temperate climates may have a lower vitamin D level. People with a low level of vitamin D are more likely to develop multiple sclerosis. But how vitamin D may protect against the disorder is unknown. The climate in which later years are spent does not change the chances of developing the disorder.

Cigarette smoking also appears to increase the chances of developing the disorder. The reason is unknown.

Symptoms

Symptoms of multiple sclerosis vary greatly, from person to person and from time to time in one person, depending on which nerve fibers are demyelinated. If nerve fibers that carry sensory information become demyelinated, problems with sensations (sensory symptoms) result. If nerve fibers that carry signals to muscles become demyelinated, problems with movement (motor symptoms) result. Symptoms often come and go, affecting one or several parts of the body. The fluctuating symptoms result from damage to myelin sheaths, followed by repair, followed by more damage. Symptoms may become more severe when people are exposed to high temperatures, such as in very warm weather, a hot bath or shower, or during a fever.

Multiple sclerosis may progress and regress unpredictably. However, there are several patterns of ms symptoms:

• Relapsing-remitting pattern: Relapses (when symptoms worsen) alternate with remissions (when symptoms are stable). Remissions may last months or years. Relapses can occur spontaneously or can be triggered by an infection such as influenza
• Primary progressive pattern: The disease progresses gradually with no remissions or obvious relapses, although there may be temporary plateaus during which the disease does not progress
• Secondary progressive pattern: This pattern begins with relapses alternating with remissions, followed by gradual progression of the disease
• Progressive relapsing pattern: The disease progresses gradually, but progression is interrupted by sudden relapses. This pattern is rare.

Vague symptoms of demyelination in the brain sometimes begin long before the disorder is diagnosed. For example, tingling, numbness, pain, burning, and itching may occur in the arms, legs, trunk, or face. The sense of touch may be reduced. People may lose strength or dexterity in a leg or hand, which may become stiff.

Vision may become dim or blurred. Mainly, people lose the ability to see when looking straight ahead (central vision). Peripheral (side) vision is less affected. In some people, one eye becomes weaker than the other, causing double vision when looking from one side to the other. This disorder is called internuclear ophthalmoplegia. The stronger eye may move involuntarily, rapidly and repetitively moving in one direction, then slowly drifting back (a symptom called nystagmus). Partial blindness may develop in one eye, and pain occurs when the eye is moved.

These symptoms result from inflammation of the optic nerve (optic neuritis). Some people with multiple sclerosis have only optic neuritis.

When the back part of the spinal cord in the neck is affected, bending the neck forward may cause an electrical shock or a tingling sensation that shoots down the back, down both legs, down one arm, or down one side of the body (a response called Lhermitte's sign). Usually, the sensation lasts only a moment and disappears when the neck is straightened. Often, it is felt as long as the neck remains bent.

Kidney Problems: Kidney involvement may be minor and without symptoms or may be relentlessly progressive and fatal. The most common result of this impairment is protein in the urine that leads to swelling (edema) in the legs.

As the disorder progresses, movements may become shaky, irregular, and ineffective. People may become partially or completely paralyzed. Weak muscles may contract involuntarily (called spasticity), sometimes causing painful cramps. Muscle weakness and spasticity may interfere with walking, eventually making it impossible, even with a walker or another assistive device. Speech may become slow, slurred, and hesitant.

Late in the disorder, dementia and mania (excessive elation) may develop. The nerves that control urination or bowel movements can be affected, leading to frequent and strong urges to urinate, retention of urine, constipation, and, occasionally, urinary and fecal incontinence. If relapses become more frequent, people become increasingly disabled, sometimes permanently.

Diagnosis

Because symptoms vary widely, doctors may not recognize the disorder in its early stages. Doctors suspect multiple sclerosis in younger people who suddenly develop blurred vision, double vision, or movement problems and abnormal sensations in various unrelated parts of the body. Fluctuating symptoms and a pattern of relapses and remissions support the diagnosis.

When doctors suspect multiple sclerosis, they thoroughly evaluate the nervous system during a physical examination. They examine the back of the eye (retina) with an ophthalmoscope. The optic disk (the spot where the optic nerve joins the retina) may be inflamed or unusually pale, indicating inflammation of the optic nerve.

Magnetic resonance imaging (MRI) is the best imaging test for detecting multiple sclerosis. It usually detects areas of demyelination in the brain and spinal cord. Before MRI, doctors may inject gadolinium, a paramagnetic contrast agent, into the bloodstream. Gadolinium helps distinguish areas of recent demyelination and active inflammation from areas of long-standing demyelination.

The multiple sclerosis diagnosis may be clear based on the physical examination and MRI. If not, other tests are done to obtain additional information:

• Spinal tap (lumbar puncture): A sample of cerebrospinal fluid is removed. The protein content of the fluid may be higher than normal. The concentration of antibodies may be high, and a specific pattern of antibodies is detected in up to 90% of people with multiple sclerosis.
• Evoked responses: For this test, sensory stimuli, such as flashing lights, are used to activate certain areas of the brain, and the brain's electrical responses are recorded. In people with multiple sclerosis, the brain's response to stimuli may be slow because signal conduction along demyelinated nerve fibers is impaired. This test can also detect slight damage to the optic nerve.

Other tests can help doctors distinguish multiple sclerosis from disorders that cause similar symptoms, such as AIDS, vasculitis, arthritis of the neck, Guillain-Barré syndrome, hereditary ataxias, lupus, Lyme disease, rupture of a spinal disk, syphilis, and a cyst in the spinal cord (syringomyelia). For example, blood tests may be done to rule out Lyme disease, syphilis, and lupus, and imaging tests can help rule out arthritis of the neck, rupture of a spinal disk, and syringomyelia.

Prognosis

What effects multiple sclerosis has and how quickly it progresses vary greatly and unpredictably. Remissions can last months up to 10 years or more. However, some people, particularly men who develop the disorder during middle age, have frequent attacks and are rapidly incapacitated. Nonetheless, about 75% of people who have multiple sclerosis never need a wheelchair, and for about 40%, normal activities are not disrupted. Unless the disorder is very severe, life span is usually unaffected.

Treatment

Individual multiple sclerosis treatment of multiple sclerosis may vary depending upon the patient and their desire to receive tradition treatment, alternative treatment or integrative treatment for the disease.  It is vital that persons diagnosed with, or suspected of having multiple sclerosis consult with their health care provider to assure proper evaluation, treatment and interpretation of information contained on this site.

Fight this Disease

Donate Online or Donate by Mail today to help fund new treatments, patient resources and medical research that will impact finding a cure for those battling multiple sclerosis.