Multiple sclerosis is a chronic disease of the central nervous system, which includes the brain and spinal cord. It’s considered an autoimmune disorder – the body’s own immune system attacks the myelin, the fatty substance that surrounds and protects nerve fibers, disrupting nerve impulses that control motor functions. Its name reflects the fact that the damaged myelin forms scar tissue, known as sclerosis, in the locations where this happens.

In places where the myelin sheath or underlying nerve fiber is damaged or destroyed, nerve impulses traveling between the brain or spinal cord and other parts of the body are interrupted or altered, leading to a broad range of symptoms. Common symptoms seen include numbness in the extremities, dizziness, vertigo, balance and coordination problems and other motor function difficulties.

Since the locations of the damage differs with each patient, the symptoms that emerge can vary widely from person to person. Additionally, the severity of the symptoms can vary depending on the progress of the disease.

Although there is no cure for multiple sclerosis (MS) at present, much progress has been made modifying its course, treating flare-ups, managing symptoms and assisting patients in coping with the disease and living fulfilling lives.

Multiple Sclerosis Overview:

• Suspected Causes
• Classifications of Multiple Sclerosis
• Diagnostic Process
• Criteria for Diagnosis
• Symptoms
• Treatment Options
• Medications
• Rehabilitation
• For More Information

Suspected Causes

While the specific cause of MS is still unclear, it’s considered likely that a combination of factors is involved. It’s believed to be an autoimmune disorder, but the antigen that the immune system attacks isn’t clear. Some progress has been made in identifying the immune cells that are attacking.

It is clear that MS itself is not passed down genetically through families, although genetic factors may make some families more vulnerable to developing it. A range of viruses, bacteria and other infectious agents have been studied but none have been conclusively proven to be factors in the disease.

Classifications of Multiple Sclerosis

Multiple sclerosis generally takes one of four disease courses in a patient.

• Relapsing-Remitting MS – People diagnosed with this type of multiple sclerosis experience specific periods of declining neurologic function (called relapses, flare-ups or exacerbations) followed by periods of partial or complete remission. Approximately 85 percent of MS patients are initially diagnosed with this type
• Primary-Progressive MS – In this type, neurologic function slowly worsens from the initial diagnosis with no significant periods of improvement. It affects approximately 10 percent of MS patients.
• Secondary-Progressive MS – After initially being diagnosed with relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease causes a progressive decline in neurologic function. Some 50 percent of relapsing-remitting patients develop this type of the disease within 10 years of diagnosis.
• Progressive-Relapsing MS – This type of multiple sclerosis is rare (5 percent) and is characterized by a steadily worsening in neurologic function but with clear attacks or flare-ups during the course. The disease seems to progress without remission.

Diagnostic Process

Since there are no definitive symptoms or tests that specifically indicate Multiple Sclerosis, your physician relies on well-established criteria to diagnose the disease. These include a detailed medical history, a neurological examination and an MRI scan, an evoked potentials test, analysis of cerebrospinal fluid and blood tests. Since some symptoms and markers can reflect other diseases, an important concern is to rule out other diseases.

• The medical history seeks information as to family history, past and present symptoms and, perhaps, places lived and traveled to.
• The neurological evaluation focuses on mental, emotional and language functions, balance and coordination and vision and other senses.
• The MRI scan seeks to define lesions, or scarring, on the nerves and to differentiate between old and new lesions.
• Visual Evoked Potential (EP) testing studies the nervous system’s electrical response to stimulation, giving a delineation of scarring along nerve pathways.
• Cerebrospinal fluid analysis detects the levels of specific immune system proteins and the presence of indicators for an immune response within the central nervous system – present in the CSF of more than 90 percent of MS patients.
• Blood tests help to rule out other disorders that produce MS-like symptoms (such as Lyme disease and AIDs).

Criteria for Diagnosis

There are specific criteria for a diagnosis of MS to be made.

• Two separate central nervous system symptoms.
• Two separate attacks – with the onset of the two attacks separated by at least one month.
• Neurological exam is abnormal.
• All other causes have been ruled out.

Symptoms

Symptoms most commonly experienced by Multiple Sclerosis patients include:

• Fatigue.
• Altered sensation.
• Gait, balance and coordination problems.
• Bowel and bladder dysfunction.
• Visual problems.
• Pain.
• Altered cognitive function.
• Muscle stiffness and spasticity.

Treatment Options

There is no cure for multiple sclerosis but there are effective treatments available to manage the disease in terms of modifying its course, treat flare-ups and improve function, safety and quality of life. These include use of medications to help modify the disease course, use of corticosteroids to treat the inflammations associated with flare-ups, and complementary and alternative medicine strategies – including exercise, diet, food supplements, yoga, relaxation techniques and other measures – that can be employed along with or in place of medical treatments.

Medications

A range of medications have been shown to be effective for many patients in reducing disease activity:

• Avonex (interferon beta-1a)
• Betaseron (interferon beta-1b)
• Copaxone (glatiramer acetate)
• Extavia (interferon beta-1b)
• Gilenya (fingolimod)
• Novantrone (mitoxantrone)
• Rebif (interferon beta-1a)
• Tysabri (natalizumab)

Exacerbations that prove to be severe enough to interfere with a patient’s ability to function, are associated with inflammation of the central nervous system. They are often treated with high-dose corticosteroids intended to reduce the inflammation.

Rehabilitation

Physical, occupational and speech therapy treatments are very helpful throughout the course of the disease by helping patients improve their overall physical and cognitive functioning.

Portsmouth Regional Hospital’s outpatient neuroscience clinic has many services to assist people with multiple sclerosis lead fulfilling lives, including specialists in:

• Physical Therapy
• Occupational Therapy
• Speech and Language Pathology
• Social Service
• Nursing

For more information call Donna Snyder, MSW, at 603-334-2097.

For More Information:

Multiple Sclerosis Association of America
www.msassociation.org

Multiple Sclerosis Foundation
www.msfocus.org

National Institutes of Health
www.nih.gov

National Multiple Sclerosis Society
www.nationalmssociety.org