Multiple sclerosis (patient information): Difference between revisions

	Multiple sclerosis
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Multiple sclerosis?
What to expect (Outlook/Prognosis)?
Possible complications
Multiple sclerosis On the Web
Ongoing Trials at Clinical Trials.gov
Images of Multiple sclerosis
Videos on Multiple sclerosis
FDA on Multiple sclerosis
CDC on Multiple sclerosis
Multiple sclerosis in the news
Blogs on Multiple sclerosis
Directions to Hospitals Treating Multiple sclerosis
Risk calculators and risk factors for Multiple sclerosis

VisualWikitext

Latest revision as of 18:19, 24 April 2018

For the WikiDoc page for this topic, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Irfan Dotani

Overview

Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS.

What are the symptoms?

Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. The symptoms may include:

Muscle symptoms:

Loss of balance
Muscle spasms
Numbness or abnormal sensation in any area
Problems moving arms or legs
Problems walking
Problems with coordination and making small movements
Tremor in one or more arms or legs
Weakness in one or more arms or legs

Bowel and bladder symptoms:

Constipation and stool leakage
Difficulty beginning to urinate
Frequent need to urinate
Strong urge to urinate
Urine leakage (incontinence)

Eye symptoms:

Double vision
Eye discomfort
Uncontrollable eye movements
Vision loss (usually affects one eye at a time)

Numbness, tingling, or pain:

Facial pain
Painful muscle spasms
Tingling or burning feeling in the arms and legs

Other brain and nerve symptoms:

Decreased attention span, poor judgment, and memory loss
Difficulty reasoning and solving problems
Depression or feelings of sadness
Dizziness and balance problems
Hearing loss

Sexual symptoms:

Problems with erections
Problems with vaginal lubrication

Speech and swallowing symptoms:

Slurred or difficult-to-understand speech
Trouble chewing and swallowing

Fatigue is a common and bothersome symptom as MS progresses. It is often worse in the late afternoon.

What are the causes?

MS is caused by damage to the myelin sheath. This sheath is the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow or stop. The nerve damage is caused by inflammation. Inflammation occurs when the body's own immune cells attack the nervous system. This can occur in any area of the brain, optic nerve, and spinal cord.

It is unknown what exactly causes MS. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may also play a role.

You are slightly more likely to develop this condition if you have a family history of MS or you live in a part of the world where MS is more common.

Who is at highest risk?

Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40 but can be seen at any age.

Environmental factors, such as smoking and decreased light exposure have been shown to increase the risk of MS, while other factors, such as diet and hormone intake, have had inconclusive results.

Lastly, many different microbes have been proposed as potential triggers of MS, but none have been substantiated.

Diagnosis

MS can be difficult to diagnose since the symptoms are very similar to other medical problems. Clinical data alone may be sufficient for a diagnosis of MS if an individual has suffered separate episodes of neurologic symptoms characteristic of MS. Since some people seek medical attention after only one attack, another testing may hasten and ease the diagnosis. The most commonly used diagnostic tools are:

Neuroimaging,
Cerebrospinal fluid analysis
Evoked potential tests
MRI of the brain and spine shows areas of demyelination (lesions or plaques).

When to seek urgent medical care?

Call your health care provider if:

You develop any symptoms of MS
Symptoms get worse, even with treatment
The condition deteriorates to the point where home care is no longer possible

Treatment options

Although there is no known cure for multiple sclerosis (MS), several therapies for multiple sclerosis have proven helpful. Multiple sclerosis is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS).

The most common initial course of the disease is the relapsing-remitting subtype, which is characterized by unpredictable attacks (relapses) followed by periods of relative remission with no new signs of disease activity. After some years, many of the people who have this subtype begin to experience neurologic decline without acute relapses as the secondary progressive subtype. Other, less common, courses of the disease are the primary progressive (a decline from the beginning without attacks) and the progressive-relapsing (steady neurologic decline and superimposed attacks). Different therapies are used for patients experiencing acute attacks, for patients who have the relapsing-remitting subtype, for patients who have the progressive subtypes, for patients without a diagnosis of MS who have a demyelinating event, and for managing the various consequences of MS.

The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects, and many possible therapies are still under investigation. At the same time, different alternative treatments are pursued by many patients, despite the paucity of supporting, comparable, replicated scientific study.

Where to find medical care for Multiple sclerosis?

Directions to Hospitals Treating Multiple sclerosis

What to expect (Outlook/Prognosis)?

The outcome varies and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.

The following typically have the best outlook:

Females
People who were young (less than 30 years) when the disease started
People with infrequent attacks
People with a relapsing-remitting pattern
People who have limited disease on imaging studies

The amount of disability and discomfort depends on:

How often you have attacks
How severe they are
The part of the central nervous system that is affected by each attack

Most people return to normal or near-normal function between attacks. Slowly, there is a greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair.

Those with a support system are often able to remain in their home.

Possible complications

Depression
Difficulty swallowing
Difficulty thinking
Less and less able to care for self
Need for the indwelling catheter
Osteoporosis or thinning of the bones
Pressure Sores
Side effects of medications used to treat the disorder
Urinary tract infections

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000737.htm

http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html

Template:WH Template:WS

@@ Line 1: / Line 1: @@
 '''For the WikiDoc page for this topic, click [[Multiple sclerosis|here]]'''
-{{SI}}
+{{Multiple sclerosis (patient information)}}
-'''Editor-in-Chief:''' Ethan Leeman
+{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[User:Irfan Dotani|Irfan Dotani]]
-{{EJ}}
+==Overview==
+Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord.  It damages the [[Myelin sheath (patient information)|myelin sheath]], the material that surrounds and protects your [[Nerve cells (patient information)|nerve cells]]. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS.
-==What is Multiple sclerosis?==
+==What are the symptoms?==
+Multiple sclerosis [[Signs (patient information)|signs]] and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected [[Nerve fibers (patient information)|nerve fibers]]. The symptoms may include:
-'''Multiple sclerosis''', often abbreviated '''MS''', is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS. Multiple sclerosis refers to the scars (sclerosis - or legions) of white matter of the brain of the spinal cord.
+Muscle symptoms:
-No one knows what causes MS. It may be an autoimmune disease, which happens when your body attacks itself. Multiple sclerosis affects women more than men. It often begins between the ages of 20 and 40. Some people lose the ability to write, speak or walk. New symptoms can either come in discrete attacks or accumulate slowly over time. There is no cure for MS, but medicines may slow it down and help control symptoms. Physical and occupational therapy may also help.
+* Loss of balance
+* Muscle spasms
+* Numbness or abnormal sensation in any area
+* Problems moving arms or legs
+* Problems walking
+* Problems with coordination and making small movements
+* Tremor in one or more arms or legs
+* Weakness in one or more arms or legs
+Bowel and bladder symptoms:
+* Constipation and stool leakage
+* Difficulty beginning to urinate
+* Frequent need to urinate
+* Strong urge to urinate
+* Urine leakage (incontinence)
+Eye symptoms:
+* Double vision
+* Eye discomfort
+* Uncontrollable eye movements
+* Vision loss (usually affects one eye at a time)
+Numbness, tingling, or pain:
+* Facial pain
+* Painful muscle spasms
+* Tingling or burning feeling in the arms and legs
+Other brain and nerve symptoms:
+* Decreased attention span, poor judgment, and memory loss
+* Difficulty reasoning and solving problems
+* Depression or feelings of sadness
+* Dizziness and balance problems
+* Hearing loss
+Sexual symptoms:
+* Problems with erections
+* Problems with vaginal lubrication
+Speech and swallowing symptoms:
+* Slurred or difficult-to-understand speech
+* Trouble chewing and swallowing
+Fatigue is a common and bothersome symptom as MS progresses. It is often worse in the late afternoon.
-==What are the symptoms of Multiple sclerosis?==
+==What are the causes?==
-Almost any neurological symptom can occur from MS, but some of the most common symptoms include:
+MS is caused by damage to the myelin sheath. This sheath is the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow or stop. The nerve damage is caused by inflammation. Inflammation occurs when the body's own immune cells attack the nervous system. This can occur in any area of the brain, optic nerve, and spinal cord.
-*Trouble with coordination and balance, trouble walking, loss of motor coordination and trouble swallowing.
-*Sensations such as numbness, prickling, or "pins and needles"
-*Bladder problems: increased frequency, incontinence, hesitation, leaking, retention, etc. May lead to urinary tract infections
-*Cognitive: loss of memory, attention, processing speed, visual-spatial abilities and executive function.
-*Emotional: depression is most common but may also include anger, anxiety, frustration. Suicide is the causes 15% of deaths.
-*Fatigue
-*Visual: Nystagmus (involuntary eye movement), optic neuritis (inflamation of optic nerve), double vision.
-*Pain: Most often form headaches, but also dysesthetic limb pain, back pain, spasms. Acute pain is often from optic neuritis.
-*Sexual dysfunction
-Symptoms of MS usually appear in episodic acute periods of worsening (called relapses, exacerbations, bouts, attacks, or "flare-ups"), in a gradually progressive deterioration of neurologic function, or in a combination of both.[6] Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors with a rate rarely above 1 and a half per year.[1] Some attacks, however, are preceded by common triggers. Relapses occur more frequently during spring and summer.[14] Viral infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse.[1] Stress may also trigger an attack.[15] Pregnancy affects the susceptibility to relapse, with a lower relapse rate at each trimester of gestation. During the first few months after delivery, however, the risk of relapse is increased.[1] Overall, pregnancy does not seem to influence long-term disability. Many potential triggers have been examined and found not to influence MS relapse rates. There is no evidence that vaccination and breast feeding,[1] physical trauma,[16] or Uhthoff's phenomenon[14] are relapse triggers.
+It is unknown what exactly causes MS. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may also play a role.
-==Causes==
+You are slightly more likely to develop this condition if you have a family history of MS or you live in a part of the world where MS is more common.
-Most likely MS occurs as a result of some combination of genetic, environmental and infectious factors.[1] Epidemiological studies of MS have provided hints on possible causes for the disease. Theories try to combine the known data into plausible explanations, but none has proved definitive.
+==Who is at highest risk?==
-MS is not a hereditary disease, but some genetic variations can increase the risk of developing MS. Specifically differences in the human leukocyte antigen system, a group of genes on chromosome 6, are linked to MS. MS is more common in some ethnic groups than in others.
+Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40 but can be seen at any age.
 Environmental factors, such as smoking and decreased light exposure have been shown to increase the risk of MS, while other factors, such as diet and hormone intake, have had inconclusive results.
@@ Line 34: / Line 62: @@
 Lastly, many different microbes have been proposed as potential triggers of MS, but none have been substantiated.
-===Diagnosis===
+==Diagnosis==
 MS can be difficult to diagnose since the symptoms are very similar to other medical problems.
-Clinical data alone may be sufficient for a diagnosis of MS if an individual has suffered separate episodes of neurologic symptoms characteristic of MS.[29] Since some people seek medical attention after only one attack, other testing may hasten and ease the diagnosis. The most commonly used diagnostic tools are neuroimaging, analysis of cerebrospinal fluid and evoked potentials. Magnetic resonance imaging of the brain and spine shows areas of demyelination (lesions or plaques).
+Clinical data alone may be sufficient for a diagnosis of MS if an individual has suffered separate episodes of neurologic symptoms characteristic of MS. Since some people seek medical attention after only one attack, another testing may hasten and ease the diagnosis. The most commonly used diagnostic tools are:
+*Neuroimaging,
+*Cerebrospinal fluid analysis
+*Evoked potential tests
+*MRI of the brain and spine shows areas of demyelination (lesions or plaques).
+==When to seek urgent medical care?==
+Call your health care provider if:
+*You develop any symptoms of MS
+*Symptoms get worse, even with treatment
+*The condition deteriorates to the point where home care is no longer possible
 ==Treatment options==
+Although there is no known cure for multiple sclerosis (MS), several therapies for multiple sclerosis have proven helpful. Multiple sclerosis is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS).
-Although there is no known cure for multiple sclerosis, several therapies have proven helpful. The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects. Alternative treatments are pursued by some patients, despite the shortage of supporting, comparable, replicated scientific study.
+The most common initial course of the disease is the relapsing-remitting subtype, which is characterized by unpredictable attacks (relapses) followed by periods of relative remission with no new signs of disease activity. After some years, many of the people who have this subtype begin to experience neurologic decline without acute relapses as the secondary progressive subtype. Other, less common, courses of the disease are the primary progressive (a decline from the beginning without attacks) and the progressive-relapsing (steady neurologic decline and superimposed attacks). Different therapies are used for patients experiencing acute attacks, for patients who have the relapsing-remitting subtype, for patients who have the progressive subtypes, for patients without a diagnosis of MS who have a demyelinating event, and for managing the various consequences of MS.
-Management of acute attacks
+The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects, and many possible therapies are still under investigation. At the same time, different alternative treatments are pursued by many patients, despite the paucity of supporting, comparable, replicated scientific study.
-During symptomatic attacks administration of high doses of intravenous corticosteroids, such as methylprednisolone,[141][142] is the routine therapy for acute relapses.The aim of this kind of treatment is to end the attack sooner and leave fewer lasting deficits in the patient. Although generally effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery.[143] Potential side effects include osteoporosis[144] and impaired memory, being the latter reversible[145]
+==Where to find medical care for Multiple sclerosis?==
-[edit] Disease modifying treatments
+[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Multiple sclerosis}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Multiple sclerosis]
-Disease-modifying treatments are expensive and require frequent injections.
-Disease-modifying treatments are expensive and require frequent injections.
-The earliest clinical presentation of relapsing-remitting MS (RRMS) is the clinically isolated syndrome (CIS). Several studies have shown that treatment with interferons during an initial attack can decrease the chance that a patient will develop MS.[146][147][131]
+==What to expect (Outlook/Prognosis)?==
+The outcome varies and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.
-As of 2007, six disease-modifying treatments have been approved by regulatory agencies of different countries for relapsing-remitting MS. Three are interferons: two formulations of interferon beta-1a (trade names Avonex and Rebif) and one of interferon beta-1b (U.S. trade name Betaseron, in Europe and Japan Betaferon). A fourth medication is glatiramer acetate (Copaxone). The fifth medication, mitoxantrone, is an immunosuppressant also used in cancer chemotherapy. Finally, the sixth is natalizumab (marketed as Tysabri). All six medications are modestly effective at decreasing the number of attacks and slowing progression to disability, although they differ in their efficacy rate and studies of their long-term effects are still lacking.[148][149][150][151] Comparisons between immunomodulators (all but mitoxantrone) show that the most effective is natalizumab.[152] Mitoxantrone is probably the most effective of them all;[153] however, its use is limited by severe cardiotoxicity.[154]
+The following typically have the best outlook:
-Treatment of progressive MS is more difficult than relapsing-remitting MS. Mitoxantrone has shown positive effects in patients with a secondary progressive and progressive relapsing courses. It is moderately effective in reducing the progression of the disease and the frequency of relapses in patients in short-term follow-up.[151] On the other hand no treatment has been proven to modify the course of primary progresive MS.[155]
+* Females
+* People who were young (less than 30 years) when the disease started
+* People with infrequent attacks
+* People with a relapsing-remitting pattern
+* People who have limited disease on imaging studies
-As with any medical treatment, these treatments have several adverse effects. One of the most common is irritation at the injection site. Interferons also produce symtoms similar to influenza; [156] while some patients taking glatiramer experience a post-injection reaction manifested by flushing, chest tightness, heart palpitations, breathlessness, and anxiety, which usually lasts less than thirty minutes.[149]. More dangerous are liver damage of interferons and mitoxantrone,[157][158][159] [160] the immunosuppressive effects and cardiac toxicity of the latter; [160] or the relation between natalizumab and some cases of progressive multifocal leukoencephalopathy in patients who had taken it in combination with interferons.[161][162]
+The amount of disability and discomfort depends on:
-[edit] Management of the effects of MS
-Disease-modifying treatments only reduce the progression rate of the disease but do not stop it. As multiple sclerosis progresses, the symptomatology tends to increase. The disease is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Management of these deficits is therefore very important. Both drug therapy and neurorehabilitation have shown to ease the burden of some symptoms, even though neither influence disease progression.[163] As for any patient with neurologic deficits, a multidisciplinary approach is key to limiting and overcoming disability; however there are particular difficulties in specifying a ‘core team’ because people with MS may need help from almost any health profession or service at some point.[59] Similarly for each symptom there are different treatment options. Treatments should therefore be individualized depending both on the patient and the physician
+* How often you have attacks
-[edit] Therapies under investigation
+* How severe they are
+* The part of the central nervous system that is affected by each attack
-    Main article: therapies under investigation for multiple sclerosis
+Most people return to normal or near-normal function between attacks. Slowly, there is a greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair.
-Scientists continue their extensive efforts to create new and better therapies for MS. There are a number of treatments under investigation that may curtail attacks or improve function. Some of these treatments involve the combination of drugs that are already in use for multiple sclerosis, such as the combination of mitoxantrone and glatiramer acetate (Copaxone).[164] However most treatments already in clinical trials involve drugs that are used in other diseases or medications that have been designed specifically for MS. Finally, there are also many basic investigations that try to understand better the disease and in the future may help to find new treatments.
+Those with a support system are often able to remain in their home.
-[edit] Alternative treatments
-Different alternative treatments are pursued by many patients, despite the paucity of supporting, comparable, replicated scientific study. Examples are dietary regimens,[165], herbal medicine, including the use of marijuana to help alleviate symptoms,[166][167] or hyperbaric oxygenation.[168] On the other hand the therapeutic practice of martial arts such as tai chi, relaxation disciplines such as yoga, or general exercise, seem to mitigate fatigue and improve quality of life.[169]
+==Possible complications==
-==Where to find medical care for Multiple sclerosis==
+* [[Depression]]
-[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Multiple sclerosis}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating Multiple sclerosis]
+* Difficulty swallowing
+* Difficulty thinking
+* Less and less able to care for self
+* Need for the indwelling catheter
+* [[Osteoporosis]] or thinning of the bones
+* Pressure Sores
+* Side effects of medications used to treat the disorder
+* [[Urinary tract infections]]
 ==Sources==
-*[http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html Medline]
+http://www.nlm.nih.gov/medlineplus/ency/article/000737.htm
-*[http://en.wikipedia.org/wiki/Multiple_sclerosis Wikipedia]
+http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html
+[[Category:Patient information]]
+[[Category:Autoimmune diseases]]
+[[Category:Neurological disorders]]
+[[Category:Multiple sclerosis]]
+[[Category:Neurology]]
+[[Category:Neurology patient information]]
+[[Category:Overview complete]]
+[[Category:Template complete]]
+[[Category:Orthopedics]]
+[[Category:Orthopedics patient information]]
-==References==
+{{WH}}
-{{reflist}}
+{{WS}}
-{{SIB}}
-[[Category:Patient Information]] {{WH}} {{WS}}