Multiple sclerosis

What is multiple sclerosis?

Multiple sclerosis (MS) is a slow progressive disease of the central nervous system. It is the most common cause of neurologic disability in young adults. In MS, local areas of myelin, the fatty substance that surrounds nerve processes, is lost. This demyelination can cause slowed or blocked nerve impulse conduction and can occur at any site where "white matter" (nerves encased in myelin) occurs. Because it can disrupt function in any area of the central nervous system (CNS), symptoms are varied and numerous.

Although the exact cause of multiple sclerosis is unknown, it is considered to be an autoimmune disease (condition in which the body's defense system reacts against its own tissue). There seems to be a genetic factor as well, since relatives of affected people are eight times more likely than others to contract the disease. Since it is five times more common in temperate zones (such as the US and Europe) than in the tropics, environment may also play a part. Spending the first fifteen years of life or more in a particular area seems to increase the risk. This suggests that a virus picked up during this early period of life may be responsible for a susceptible person to later develop the disease MS generally occurs between 20 and 40 years of age. In high-risk areas, the incidence is about one in every 1,000 people. Women outnumber the men at a ratio of three to two.

How is it diagnosed?

Signs and symptoms: Multiple sclerosis can have many different signs and/or symptoms. Approximately 50% of individuals will present with visual problems (usually the loss of vision in one eye).

Although painless, the symptoms can last from several days to weeks. Remission (period of time during which the symptoms of a disease lessen or disappear) may be partial or complete. The next attack may come with new symptoms and may not occur until years later.

In females, relapses are common in the first two to three months following pregnancy. Diagnosis is often a considerable challenge because of the potential for an infinite array of signs and symptoms. After exclusion of all other causes, criteria for diagnosis is generally that there must be at least two neurologic events, separate in time (by at least a month), and separate in location within the central nervous system.

Physical exam are variable depending on which region of the CNS is involved. Clumsiness, muscle weakness, and unsteady gait may be due to damage to the white matter in the brain. When the inflammation occurs in the portion of the brain involved with vision, the eye's pupillary response to light is often diminished. Inflammation of the spinal cord can cause extremity weakness or stiffness (spasticity). Urinary incontinence indicates that the nerve fibers to the bladder may be involved.

Tests: There is no specific diagnostic test for MS. But the accuracy of the diagnosis can be improved with three indicators. A spinal tap to obtain a sample of cerebrospinal fluid may be used to confirm the presence of an inflammatory lesion or to rule out other possible CNS diseases or infections. Recording of nerve responses to various stimuli (evoked potential) are routinely employed. Absence of response or an abnormality in a response is useful in detecting and localizing lesions in the CNS. MRI is used to both diagnose and monitor the disease. It can also be helpful in excluding other CNS disorders.

How is Multiple sclerosis treated?

Search for a cure is still in progress. Treatment is designed to suppress the disease, to lessen the symptoms, and/or to improve day-to-day lifestyle.

Treatment is directed at modification of the course of the disease and primarily includes the use of corticosteroids (anti-inflammatory), immunosuppressant drugs (which interfere or suppress the body's immune response), or a combination of corticosteroid with immunosuppressant drugs. Treatment may include the use of beta-interferon (anti-inflammatory) and plasmapheresis (immunosuppressant). The symptoms of multiple sclerosis are treated with drugs to address muscle weakness and muscle spasticity, physical therapy to strengthen weakened muscles, and occupational therapy to teach individuals how to deal with stress in the workplace and at home. Treatment also targets bladder dysfunction and pain management.

One of the most difficult aspects for the individual with multiple sclerosis is the sense of uncertainty about the course of the disease. Psychiatric or psychological counseling may be necessary to provide support.

Medications

Information

Brand

Generic

Label

Elavil

Amitriptyline

Lioresal

Baclofen

Neurontin

Gabapentin

Trileptal (Oxcarbazepine), Zofran (Ondansetron), Pamelor (Nortriptyline), Prozac (Fluoxetine), Tofranil (Imipramine), Nydrazid (Isoniazid), Symmetrel (Amantadine), Imuran (Azathioprine), Zocor (Simvastatin), Decadron (Dexamethasone), Medrol (Methylprednisolone), Tegretol (Carbamazepine), Topamax (Topiramate), Klonopin (Clonazepam), Soma (Carisoprodol), Valium (Diazepam), Aricept (Donepezil)

Activity

• A regular program of physical exercise and mental activity is essential. Obtain physical therapy and muscle retraining with mechanical devices (wearing braces, use of a cane or walker) to overcome physical handicaps.
• Take regular rest periods.
• Remain sexually active, if possible. Sexual counseling may be helpful.

What might complicate it?

The course of the disease and the rate of disability varies considerably from person to person. Approximately twenty percent of individuals experience long symptom-free periods throughout life with a few mild relapses and very few permanent effects. Others may have a series of flare-ups, leaving some residual disability, but further deterioration ceases.

While most individuals at least partially recover from the first attack, there are others who gradually become more disabled, becoming bedridden and incontinent by early middle life. A small group of individuals suffer gross disability within the first year. Although MS is not in itself fatal, those who are disabled may die from the complications of being bedridden or from recurrent infections.

Predicted outcome

The course of the disease and the rate of disability varies considerably from person to person. Approximately twenty percent of individuals experience long symptom-free periods throughout life with a few mild relapses and very few permanent effects. Others may have a series of flare-ups, leaving some residual disability, but further deterioration ceases. While most individuals at least partially recover from the first attack, there are others who gradually become more disabled, becoming bedridden and incontinent by early middle life. A small group of individuals suffer gross disability within the first year. Although multiple sclerosis is not in itself fatal, those who are disabled may die from the complications of being bedridden or from recurrent infections.

Alternatives

Conditions with similar symptoms include neoplasms (tumors) or infections (labyrinthitis, meningovascular syphilis, or encephalitis).

Appropriate specialists

Neurologist, urologist, ophthalmologist, psychiatrist, psychologist and physical therapist.

Last updated 4 April 2018