Multiple sclerosis (patient information)
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What is Multiple sclerosis?
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. 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.
What are the symptoms of Multiple sclerosis?
Almost any neurological symptom can occur from MS, but some of the most common symptoms include:
- 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.
Causes
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.
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.
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.[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).
Treatment options
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.
Management of acute attacks
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] [edit] Disease modifying treatments 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]
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]
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]
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] [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 [edit] Therapies under investigation
Main article: therapies under investigation for multiple sclerosis
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. [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]
Where to find medical care for Multiple sclerosis
Directions to Hospitals Treating Multiple sclerosis