Multiple Sclerosis (MS)

What Is MS?

MS is a chronic, unpredictable, and often difficult to diagnose disease which affects the central nervous system (the brain, optic nerves, and spinal cord). It is believed to be an autoimmune disorder (a disease in which the body’s immune system attacks the person’s own tissue).

What Happens in Multiple Sclerosis?

The short answer is the destruction of myelin. Myelin is a complex substance that surrounds and insulates nerve fibers and is essential for nerves to perform their function and conduct electricity. When the myelin is damaged, nerves in the brain and spinal cord lose their ability to transmit signals. Think about a cable that should bring a clear signal to your TV but has interference due to damage or corrosion.
With MS, the immune system that normally defends against viruses and bacteria acts atypically and actually attacks the central nervous system, damaging the myelin and creating interference in normal nerve functionality and communication to various parts of the body.

Risk Factors

Despite being discovered in 1868, there is still much mystery surrounding the causes of the disease. We do know there are several factors that may increase your risk for developing multiple sclerosis, including:

There are 4 Types of MS

PRMS

Progressive-Relapse

RRMS

Relapsing-Remitting

PPMS

Primary-Progressive

SPMS

Secondary-Progressive

Pediatric Multiple Sclerosis

Although MS occurs most commonly in adults, it is unfortunately also diagnosed in children and adolescents. Estimates suggest that 8,000-10,000 children (up to 18 years old) in the United States have MS and another 10,000-15,000 have experienced at least one symptom suggestive of MS. Studies suggest that two to five percent of all people with MS have a history of symptom onset before age 18.

Diagnosis

Diagnosing MS in children is more challenging than in adults due to shorter medical histories, the frequency of other childhood disorders with similar symptoms and characteristics, and certain diagnostic limitations in criteria and equipment. Pediatricians may not be familiar with MS because they are not expecting to see it in children. Children with MS benefit from comprehensive care through multidisciplinary teams that include pediatric and adult MS experts.
Estimates in the US:

Related Conditions

There is no single test that is proof-positive for diagnosing multiple sclerosis. However, there are accepted criteria for making the diagnosis, but even this system is imperfect.
Since diagnosing MS can be very difficult, a neurologist familiar with treating MS should evaluate your symptoms. As many as 10% of people diagnosed with multiple sclerosis actually have some other conditions that mimic MS. Examples of other conditions that masquerade as MS include inflammation in the blood vessels, multiple strokes, vitamin deficiency, lupus, or a brain infection. Sometimes, stress-related disorders can lead to a misdiagnosis of MS.
Conditions that mimic symptoms of MS include: Sjogren’s Syndrome, Vitamin B12 Deficiency, Inflammation of the Blood Vessels, Lupus, Lyme Disease, Multiple Strokes, Brain Infection, Stress-Related Disorders, Sarcoidosis.

Diagnostic Methods

Magnetic Resonance Imaging

Evoked Potential Testing

Visual

Audio

Sensory

Lumbar Puncture

Treating Attacks

MS relapses are caused by inflammation in the central nervous system that damages the myelin coating around nerve fibers. This damage slows or disrupts the transmission of nerve impulses and causes the symptoms of MS. For relapses that interfere with a person’s mobility, safety, or overall ability to function, most neurologists recommend treatment with corticosteroids.
The most common treatment regimen is a three-to-five-day course of high-dose, intravenous corticosteroids to reduce inflammation and end the relapse more quickly. This regimen may or may not be followed with a slow taper of oral prednisone. Corticosteroids are not believed to have any long-term benefit on the disease.

Slowing Down MS

To alter the course of the disease, a number of disease-modifying therapies (DMTs) are available which are designed to help slow down the long-term progression of MS. These treatments, or disease-modifying agents, have been shown in clinical trials to be effective in decreasing the frequency of relapses and the number of lesions in the brain or spinal cord. Some of these medications have also been shown to slow down the rate at which a person with MS accumulates disability.

Manage Your Symptoms

Symptom management is a very important consideration in the overall treatment of MS. Symptoms vary greatly from one individual to another and each symptom needs to be addressed by healthcare professionals who specialize in MS.

How To Manage

A wide variety of medications are used to help manage the symptoms of MS.
In addition to medications prescribed for a specific symptom, there are also other treatment therapies available.

Rehabilitation in MS Care

Rehabilitation is an essential component of comprehensive MS care throughout the disease course. The goal of rehabilitation is to improve and maintain function. From the time of diagnosis onward, rehabilitation specialists provide education and treatment strategies designed to promote good health and overall conditioning, reduce fatigue, and help you feel and function your best at home and at work.
If symptoms begin to interfere with everyday activities, the rehabilitation team can address problems with mobility, dressing and personal care, role performance at home and work, and participation in leisure activities.

Strategize new treatment tactics that improve and maintain function.

Feel and function your best when you’re at home or at work.

Promote good health and overall conditioning.

Address problems with mobility, personal care, and role performance.

Alternative Therapies in MS Care

Many people with MS use complementary and alternative medicine (CAM), which refers to unconventional medical practices that are not part of mainstream medicine. The term complementary medicine refers to therapies that are used in addition to conventional medicine, while the term alternative medicine is used to describe treatment that is used instead of conventional medicine.
Surveys have shown that approximately 90% of people who use CAM also use conventional medicine. Thus, a small fraction of people who use CAM do so in a truly alternative manner.

Frequently Asked Questions

Multiple sclerosis is a chronic, unpredictable disease of the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. It is thought to be an immune-mediated disorder, in which the immune system incorrectly attacks healthy tissue in the CNS. MS can cause many symptoms, including blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, extreme fatigue, problems with memory and concentration, paralysis, blindness, and more.

Anyone may develop MS but there are some patterns. More than two to three times as many women as men develop MS and this gender difference has been increasing over the past 50 years. Studies suggest that genetic risk factors increase the risk of developing MS, but there is no evidence that MS is directly inherited. Environmental factors, such as low Vitamin D and cigarette smoking have also been shown to increase the risk of MS. MS occurs in most ethnic groups, including African Americans, Asians, and Hispanics/Latinos, but is most common in Caucasians of Northern European ancestry.

More than 2.3 million people are affected by MS worldwide. Because the Centers for Disease Control and Prevention (CDC) does not require U.S. physicians to report new cases, and because symptoms can be completely invisible, the prevalence of MS in the U.S. can only be estimated. Efforts are underway for the establishment of a national registry that will track the number of people living with MS.

Because MS causes damage in the CNS, nearly any function can be adversely affected. However, the most common symptoms are overwhelming fatigue, visual disturbances, altered sensation, and difficulties with mobility. Symptoms of MS are unpredictable and vary in type and severity from one person to another and in the same person over time. Symptoms may disappear or remit completely or they may persist and worsen over time.

MS symptoms occur when the immune-system produces inflammation within the CNS. The inflammatory attack damages myelin, (the protective insulation surrounding nerve fibers), oligodendrocytes (cells that make CNS myelin), and sometimes the underlying nerve fiber. The damage caused by inflammation can produce symptoms that resolve over weeks to months or symptoms that are permanent.

In general, MS is not considered a fatal disease, and most people with MS have a normal or near-normal life expectancy. In rare cases, complications of MS can shorten life—though many complications are preventable or manageable. Very rare instances of MS that progress rapidly from disease onset can be fatal.

No. Moreover, the majority of people with MS do not become severely disabled. Two-thirds of people who have MS remain able to walk, though many will need an aid, such as a cane or crutches, and some will use a scooter or wheelchair because of fatigue, weakness, balance problems, or to assist with conserving energy.

No. MS is not contagious or directly inherited. Studies do indicate that genetic factors and certain environmental factors may make certain individuals more susceptible to the disease.

Not yet. There are now FDA-approved medications that have been shown to “modify” the course of MS by reducing the number of relapses and delaying the progression of disability to some degree. In addition, many therapeutic and technological advances are helping people manage symptoms. Advances in treating and understanding MS are made every year, and progress in research to find a cure is very encouraging.

The doctors at ANI recommend that a person consider treatment with one of the FDA-approved “disease-modifying” drugs as soon as possible following a definite diagnosis of MS with active or relapsing disease. These medications help to reduce inflammation in the CNS, reduce the frequency and severity of MS attacks and the numbers of lesions in the CNS, and may slow the progression of disability. In addition, these medications that address the disease process, there are many medications and other strategies to manage MS symptoms such as spasticity, pain, bladder problems, fatigue, sexual dysfunction, weakness, and cognitive problems. People should consult a knowledgeable MS care provider to develop a comprehensive plan to manage their MS.

Diagnosing MS can be a challenging process. In early MS, symptoms may be non-specific and suggestive of several disorders of the nervous system. Early symptoms that come and go may be ignored. While no single laboratory test is yet available to prove or rule out MS, Magnetic Resonance Imaging (MRI) is a great help in reaching a definitive diagnosis. Diagnostic criteria that incorporate MRI findings have been developed and revised by experts in the field and have helped providers make an accurate and timely diagnosis.

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