Multiple Sclerosis - Symptoms & Treatment

Multiple sclerosis (MS) is caused by demyelination of the white matter of the brain and spinal cord and damage to nerve fibers and their targets. In MS, sporadic patches of axon demyelination and nerve fiber loss occur throughout the central nervous system, inducing widely disseminated and varied neurologic dysfunction. Characterized by exacerbations and remissions, MS is a major cause of chronic disability in young adults.

Roughly 400,000 people in the United States have MS. Women are more likely than men to have this disease. MS is most common in Northern Europe, the United States, and Canada. People with a family member with MS are at a greater risk for developing this disease.

Causes

There are many possible causes of MS, including the following:

• viruses
• autoimmune disorders
• environmental factors
• genetic factors

Signs and symptoms information

Clinical findings in MS depend on the extent and site of myelin destruction, the extent of remyelination, and the adequacy of subsequent restored synaptic transmission.

Signs and symptoms in MS may be transient, or they may last for hours or weeks. They may wax and wane with no predictable pattern, vary from day to day, and be bizarre and difficult for the patient to describe.

In most patients, visual problems and sensory impairment, such as burning, pins and needles, and electrical sensations, are the first signs that something may be wrong.

Other characteristic changes include the following:

• ocular dismrbances-optic neuritis, diplopia, ophthalmoplegia, blurred vision, and nystagmus
• muscle dysfunction - weakness, paralysis ranging from monoplegia to quadriplegia, spasticity, hyperreflexia, intention tremor, and gait ataxia
• urinary dismrbances - incontinence, frequency, urgency, and frequent infections
• bowel disturbances - involuntary evacuation or constipation
• fatigue-often the most debilitating symptom.
  Associated signs and symptoms include poorly articulated or scanning speech and dysphagia. Clinical effects may be so mild that the patient is unaware of them or so intense that they are debilitating.

Diagnosis

The following tests may be performed:

• Magnetic resonance imaging may detect MS lesions.
• EEG is abnormal in one-third of patients.
• Lumbar puncture shows an elevated gamma globulin fraction of immunoglobulin G but normal total cerebrospinal fluid (CSF) protein levels. An elevated CSF gamma globulin level is significant only when serum gamma globulin levels are normal; it reflects hyperactivity of the immune system due to chronic demyelination. In addition, the WBC level in CSF may be elevated.
• Electrophoresis can detect oligoclonal bands of immunoglobulin in CSF. Present in most patients, they can be foundeven when the percentage of gamma globulin in CSF is normal.

Treatment information

The aim of treatment is threefold: to treat the acute exacerbation, the disease process, and the related signs and symptoms.

Acute exacerbation

I.V. methylprednisone followed by oral prednisone has been shown to be effective for speeding recovery for acute attacks. Other drugs, such as azathioprine (Imuran) or methotrexate and cytoxin, may be used.

Treating the disease

Three drugs (Betaseron, Avonex, and glatiramen [Copaxone]) may reduce the frequency and severity of relapses and slow central nervous system damage. Betaseron and Avonex (both interferon
B) and Copaxone (a combination of four amino acids) are currently available for relapsing-remitting MS.

In addition to medications, these treatments may also be helpful:

• Physical and occupational therapy. A physical or occupational therapist can teach you strengthening exercises and show you how to use devices that can ease daily tasks. This can help preserve your independence.
• Counseling. Individual or group therapy may help you cope with MS and relieve emotional stress. Your family members or caregivers may also benefit from seeing a counselor.

Self-care tips

Researchers have not yet discovered a way to prevent MS. If you have been diagnosed with MS, it is extremely important to have a good support system among your family, friends, and health care team. Maintaining a healthy lifestyle, including a nutritious diet, a medically approved program of physical activity, and plenty of rest, goes a long way toward keeping you in the best health possible. Although it may be difficult, you can reduce your symptoms by keeping stress to a minimum and avoiding spending too much time outdoors in extremely hot weather. Also avoid hot showers, saunas, or hot tubs, which can make symptoms worse.