Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
Multiple sclerosis (MS) is a chronic and disabling disease of the nervous system. Symptoms can be mild, such as limb numbness, or severe, such as paralysis and loss of vision. How the disease will progress and its severity in specific individuals are difficult to predict because it progresses differently in each of its victims.
Multiple sclerosis is caused by degeneration of the nervous system. A fatty substance called myelin surrounds and protects many nerve fibers of the brain and spinal cord. Myelin is important because it speeds up signals that move along the nerve fibers. In MS, the body attacks its own tissues, termed an autoimmune reaction, and a breakdown in the myelin layer along the nerves occurs. When any part of the myelin sheathing is destroyed, nerve impulses to and from the brain are slowed, distorted, or interrupted. The disease is called “multiple” because it affects many areas of the brain. Scleroids are hardened, scarred patches that form over the damaged areas of myelin.
The initial symptoms of MS may include tingling, numbness, slurred speech, blurred or double vision, loss of coordination, and muscle weakness. Later manifestations include unusual fatigue, muscle tightness, bowel and bladder control difficulties, sexual dysfunction, and paralysis. The most common cognitive functions influenced are short-term memory, abstract reasoning, verbal fluency, and speed of information processing....
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Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
Scientists have been encouraged by advancements in MS diagnosis using the MRI brain scan. In 2002 they announced that these scans appear to detect damage around nerve fibers in patients with possible early signs of MS. This detection helps doctors predict those who will eventually develop MS and how severe one’s experience with the disease might be. In turn, this allows a drug regimen to begin earlier. In the past, doctors did not officially diagnose MS or start treatment until patients had two episodes of nerve problems in different areas of the body—reoccurrences that could come years apart while damage nonetheless continued silently. New research has found that putting patients on MS drugs at the first sign of nerve inflammation drastically slows the chances of developing MS within a few years, although most will eventually still develop the disease.
While there is no cure for MS, there are many effective treatments. In most cases, steroidal drugs are used to treat relapses or attacks of the disease. Corticotropin was the first steroidal immunosuppressant to be used widely in MS treatment. The primary effect of the drug is to shorten the duration of an attack, although it does not appear to reduce the severity of the attack. Although it is still used with patients who respond well to it, corticotropin has been supplanted by other drugs. Methylprednisolone is an immunosuppressant and steroid that has replaced...
(The entire section is 919 words.)
Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
The first written report of MS was published in 1400 when the famed Dutch skater Lydwina of Schieden was diagnosed. It was recognized initially as a wasting disease of unknown origin. The disease was described clinically by Jean-Martin Charcot in 1877. Charcot initially characterized the clinical signs and symptoms of MS. He recognized that the disease affected the nervous system and tried many remedies, without success. In 1890, the cause of MS was thought to be suppression of sweat; the treatment was electrical stimulation and bed rest. At the time, life expectancy for a sufferer was five years after diagnosis. By 1910, MS was thought to be caused by toxins in the blood, and purgatives were alleged the best treatment. In the 1930’s, poor circulation was believed to cause MS, and blood-thinning agents became the treatment of choice. In the 1950’s through the 1970’s, MS was thought to be caused by severe allergies; treatments included antihistamines. Not until the 1980’s was the basis of MS understood and effective treatment developed.
By the early twenty-first century, it was estimated that 400,000 Americans had this disorder of the brain and spinal cord, which causes disruption in the smooth flow of electrical messages from brain and nerves to the body. The progress of the disease is slow and may take decades to achieve complete nerve degeneration and paralysis. Although often considered a disease of...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Blackstone, Margaret. The First Year—Multiple Sclerosis: An Essential Guide for the Newly Diagnosed. 2d ed. New York: Avalon, 2007. Written by an MS patient, guides newly diagnosed patients step-by-step through their first year with MS and sets expectations by providing reliable and updated information on the disease. The second edition includes new research on MS, updated medications, information on support groups, and more.
Halbreich, Uriel. Multiple Sclerosis: A Neuropsychiatric Disorder. Boston: American Psychiatric Press, 1993. Describes the psychological conditions that often accompany multiple sclerosis.
Iams, Betty. From MS to Wellness. Chicago: Iams House, 1998. An autobiography of an MS sufferer who outlines treatments that have helped her overcome the disease.
Kalb, Rosalind, ed. Multiple Sclerosis: The Questions You Have, the Answers You Need. 4th ed. New York: Demos Vermande, 2008. A guide for everyone concerned about multiple sclerosis.
Litin, Scott C., ed. “Multiple Sclerosis.” In Mayo Clinic Family Health Book. 4th ed. New York: HarperResource, 2009. A chapter in a text that discusses both muscles and bones, underscoring the intimate relationship between disorders in the two systems. The text and illustrations are complete and easy to understand.
Matthews, Bryan. Multiple Sclerosis: The Facts. 4th ed. New York:...
(The entire section is 369 words.)
Multiple Sclerosis (Encyclopedia of Medicine)
Multiple sclerosis (MS) is a chronic autoimmune disorder affecting movement, sensation, and bodily functions. It is caused by destruction of the myelin insulation covering nerve fibers (neurons) in the central nervous system (brain and spinal cord).
MS is a nerve disorder caused by destruction of the insulating layer surrounding neurons in the brain and spinal cord. This insulation, called myelin, helps electrical signals pass quickly and smoothly between the brain and the rest of the body. When the myelin is destroyed, nerve messages are sent more slowly and less efficiently. Patches of scar tissue, called plaques, form over the affected areas, further disrupting nerve communication. The symptoms of MS occur when the brain and spinal cord nerves no longer communicate properly with other parts of the body. MS causes a wide variety of symptoms and can affect vision, balance, strength, sensation, coordination, and bodily functions.
Multiple sclerosis affects more than a quarter of a million people in the United States. Most people have their first symptoms between the ages of 20 and 40; symptoms rarely begin before 15 or after 60. Women are almost twice as likely to get MS as men, especially in their early years. People of northern European heritage are more likely to be affected than people...
(The entire section is 3663 words.)
Multiple Sclerosis (Encyclopedia of Neurological Disorders)
Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system. The disease results in injury to the myelin sheath (the fatty matter that covers the axons of the nerve cells), the oligodendrocytes (the cells that produce myelin) and, to a lesser extent, the axons and nerve cells themselves. The symptoms of multiple sclerosis vary, depending in part on the location of plaques (areas of thick scar tissue) within the central nervous system. Common symptoms include weakness and fatigue, sensory disturbances in the limbs, bladder or bowel dysfunction, problems with sexual function, and ataxia (loss of coordination). Although the disease may not be cured or prevented at this time, treatments are available to reduce severity and delay progression.
Multiple, or disseminated, sclerosis (MS) is a slowly progressive disease of the central nervous system (CNS), that comprises the brain and spinal cord. In 1868, French physician Jean-Martin Charcot (1825893) produced his lectures on "Sclerose en plaques," providing the first detailed clinical description of the disease. The cause of multiple sclerosis is unknown, and it cannot be prevented or cured. Great progress, however, is being made in treating and identifying underlying mechanisms that trigger the disease. The primary...
(The entire section is 3177 words.)
Multiple Sclerosis (Encyclopedia of Alternative Medicine)
Multiple sclerosis is a chronic, degenerative disease of the central nervous system (CNS). The CNS is comprised of the brain and the spinal cord. In the CNS, the nerves are covered by a protective layer called the myelin sheath. Myelin helps keep the nerve healthy. It also improves nerve conduction. In multiple sclerosis, inflammation causes the nerves to gradually lose this myelin cover. This repeated inflammation and erosion leads to scarring (sclerosis), which impairs the nerve's ability to conduct impulses. Eventually, even the nerves themselves are affected. Because the nervous system controls and coordinates a number of body functions, patients with MS gradually lose a variety of functions, including memory and the ability to see, speak or walk.
Multiple sclerosis is a chronic debilitating disease that affects as many at 350,000 in the United States alone (2.5 million worldwide). Most patients are first diagnosed of the disease at age 20-40. However, the disease may appear as early as age 12 or as late as age 50. MS strikes women earlier in life. Women are also affected more frequently than men and whites more often than other races.
Causes & symptoms
The causes of multiple sclerosis are still unknown, although many factorsare suspected. In the United...
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Multiple Sclerosis (Encyclopedia of Nursing & Allied Health)
Multiple sclerosis (MS) is a chronic autoimmune disorder affecting movement, sensation, and bodily functions. It is caused by destruction of the myelin sheath (insulation) covering nerve fibers (neurons) in the central nervous system (brain and spinal cord).
MS is a nerve disorder caused by destruction of the insulating layer surrounding neurons in the brain and spinal cord. This insulation, called myelin, helps electrical signals pass quickly and smoothly between the brain and the rest of the body. When the myelin is destroyed neuronal messages are sent more slowly and less efficiently. Patches of scar tissue, called plaque, form over the affected areas, further disrupting neuronal communication. The symptoms of MS occur when the brain and spinal cord nerves no longer communicate properly with other parts of the body. MS causes a wide variety of symptoms and can affect vision, balance, strength, sensation, coordination, and bodily functions.
Multiple sclerosis affects more than a quarter of a million people in the United States. Most people have their first symptoms between the ages of 20 and 40 years; symptoms rarely begin before 15 years or after 60 years of age. Women are almost twice as likely as men to get MS, especially in their early years. People of northern European heritage are more likely to be affected than people of other racial backgrounds, and MS rates are higher in the United States, Canada, and Northern Europe than in other parts of the world. MS is very rare among Asians, North and South American natives, and Eskimos. Between 10% and 20% of people with MS have a benign type, meaning their symptoms progress very little over the course of their lives.
Causes and symptoms
Multiple sclerosis is an autoimmune disease, meaning its cause is due to an attack by the body's own immune system. For unknown reasons immune cells attack and destroy the myelin sheath that insulates neurons in the brain and spinal cord. This myelin sheath, created by other brain cells called glia, speeds transmission and prevents electrical activity in one cell from short-circuiting to another cell. Disruption of communication between the brain and other parts of the body prevents normal passage of sensations and control messages, leading to the symptoms of MS. The demyelinated areas appear as plaques, small round areas of gray neurons without the white myelin covering. The progression of symptoms is correlated with development of new plaques in the portion of the brain or spinal cord controlling the affected areas. Because there appears to be no pattern in the appearance of new plaques, the progression of MS is unpredictable.
Despite considerable research the trigger for this autoimmune destruction is still unknown. At various times evidence has pointed to genes, environmental factors, viruses, or a combination of these factors.
The risk of developing MS is higher if another family member is affected, suggesting the influence of genetic factors. In addition, the higher prevalence of MS among people of northern European ancestry suggests some genetic susceptibility.
The role of an environmental factor is suggested by studies of the effect of migration on the risk of developing MS. Age plays an important role in determining this change in risk. Young people in low-risk groups who move into countries with higher MS rates display the risk rates of their new surroundings, while older migrants retain the risk of their original home country. One interpretation of these studies is that an environmental factor, either protective or harmful, is acquired in early life. The risk of disease later in life reflects the effects of the early environment.
These same data can be used to support the involvement of a slow-acting virus, one that is acquired early on but begins its destructive effects much later. Slow viruses are known to cause other diseases, including Creutzfeldt-Jakob disease and bovine spongiform encephalopathy ("mad cow" disease). In addition, viruses have been implicated in other autoimmune diseases. Many claims have been made for the role of viruses, slow or otherwise, as the trigger for MS; however, as of 2001, no strong candidate has emerged.
How a virus could trigger the autoimmune reaction is also unclear. There are two main models of virally induced autoimmunity. The first suggests the immune system is actually attacking a virus (one too well hidden for detection in the laboratory), and the myelin damage is an unintentional consequence of fighting the infection. The second model suggests the immune system mistakes myelin for a viral protein encountered during a prior infection. Primed for the attack, the immune system destroys myelin because it resembles the previously recognized viral invader.
Either of these models allows a role for genetic factors, since certain genes can increase the likelihood of autoimmunity. Environmental factors, as well, might change the sensitivity of the immune system or interact with myelin to provide the trigger for the secondary immune response. Possible environmental triggers that have been invoked in MS include viral infection, trauma, electrical injury, and chemical exposurelthough controlled studies have not supported a causative role.
The symptoms of multiple sclerosis may occur in one of three patterns:
- The most common pattern is the "relapsing-remitting" pattern, in which there are clearly defined symptomatic attacks lasting 24 hours or more, followed by complete or almost complete improvement. The period between attacks may be a year or more at the beginning of the disease, but may shrink to several months as the disease progresses. This pattern is especially common among younger people who develop MS.
- In the "primary progressive" pattern, the disease progresses without remission, or with occasional plateaus or slight improvements. This pattern is more common among older people.
- In the "secondary progressive" pattern, the person with MS begins with relapses and remissions, followed by more steady progression of symptoms.
Because plaques may form in any part of the central nervous system, the symptoms of MS vary widely from person-to-person and from stage-to-stage of the disease. Initial symptoms often include:
- muscle weakness causing difficulty walking
- loss of coordination or balance
- numbness, "pins and needles," or other abnormal sensations
- visual disturbances, including blurred or double vision
Later symptoms may include:
- muscle spasticity and stiffness
- speech or swallowing difficulty
- loss of bowel and bladder control
- sexual dysfunction
- changes in cognitive ability
Weakness in one or both legs is common, and may be the first symptom noticed by a person with MS. Muscle spasticity, or excessive tightness, is also common and may be more disabling than weakness.
Double vision (diplopia) or eye tremor (nystagmus) may result from involvement of the nerve pathways controlling movement of the eye muscles. Visual disturbances result from involvement of the optic nerves (optic neuritis) and may include development of blind spots in one or both eyes, changes in color vision, or blindness. Optic neuritis usually involves only one eye at a time and is often associated with movement of the effected eye.
More than half of all people affected by MS have pain during the course of their disease. Many experience chronic pain, including pain from spasticity. Acute pain occurs in about 10% of cases. This pain may be a sharp, stabbing pain especially in the face, neck, or down the back. Facial numbness and weakness are also common.
Cognitive changes, including memory disturbances, depression, and personality changes, are found in people affected by MS, though it is not entirely clear whether these changes are due primarily to the disease or to the psychological reaction to it. Depression may be severe enough to require treatment in up to 25% of those with MS. A smaller number of people experience diseaserelated euphoria, or abnormally elevated mood, usually after a long disease duration and in combination with other psychological changes.
Symptoms of MS may be worsened by heat or increased body temperature including fever; intense physical activity; or exposure to sun, hot baths, or showers.
There is no single test that confirms the diagnosis of multiple sclerosis and there are a number of other diseases with similar symptoms. While one person's diagnosis may be immediately suggested by symptoms and history, another's may not be confirmed without multiple
tests and prolonged observation. The distribution of symptoms is important, as MS affects multiple areas of the body over time. The pattern of symptoms is also critical, especially evidence of the relapsing-remitting pattern. Thus, a detailed medical history is one of the most important parts of the diagnostic process. A thorough search to exclude other causes of a person's symptoms is especially important if the following features are present:1) family history of neurologic disease, 2) symptoms and findings attributable to a single anatomic location, 3) persistent back pain, 4) age of onset over 60 or under 15 years of age, or 5) progressively worsening disease.
In addition to a medical history and a standard neurological exam, several lab tests are used to help confirm or rule out a diagnosis of MS:
- Magnetic resonance imaging (MRI) can reveal plaques on the brain and spinal cord. Gadolinium enhancement can distinguish between old and new plaques, allowing a correlation of new plaques with new symptoms. Plaques may be seen in several other diseases as well, including encephalomyelitis, neurosarcoidosis, and cerebral lupus. Plaques seen on an MRI may, however, be difficult to distinguish from damage caused by small strokes, areas of decreased blood flow, or changes seen with trauma or normal aging.
- A lumbar puncture, or spinal tap, is done to measure levels of immune proteins, which are usually elevated in the cerebrospinal fluid of a person with MS. This test may not be necessary if other diagnostic tests are positive.
- Evoked potential tests, electrical tests of conduction speed in the neurons, can reveal reduced speeds consistent with the damage caused by plaques. These tests may be done with small electrical charges applied to the skin (somatosensory evoked potential), with light patterns flashed on the eyes (visual evoked potential), or with sounds presented to the ears (auditory evoked potential).
A clinician making the diagnosis, usually a neurologist, may classify the disease in one of three ways:
- "Definite MS" means that the symptoms and test results all point toward MS as the cause.
- "Probable MS" and "Possible MS" reflect less certainty and may require more time for observing the progression gression of the disease and the distribution of symptoms.
As of 2001 three drugs shown to affect the course of the disease have been approved for the treatment of MS. None of these drugs is a cure, but they can slow disease progression in many cases.
Avonex and Betaseron are forms of the immune system protein beta interferon, while Copaxone is glatiramer acetate (formerly called copolymer-1). All three have been shown to reduce the rate of relapse in the relapsing-remitting form of MS. Different measurements from tests of each drug have demonstrated other benefits as well. Avonex may slow the progress of physical impairment, Betaseron may reduce the severity of symptoms, and Copaxone may decrease disability. All three drugs are administered by injection. Copaxone is given daily, Betaseron every other day, and Avonex weekly. Betaseron, however, is know to lead to the development of neutralizing antibodies, which reduce the effectiveness of treatment.
Immunosuppressant drugs have been used for many years to treat acute exacerbations (relapses). These drugs include corticosteroids such as prednisone and methylprednisolone, the hormone adrenocorticotropic hormone (ACTH), and azathioprine. Recent studies indicate that several days of intravenous methylprednisolone may be more effective than other immunosuppressant treatments for acute symptoms. This treatment may require hospitalization.
MS causes a large variety of symptoms, and the treatments for these are equally diverse. Most symptoms can be treated and complications avoided with good care and attention from medical professionals. Good health and nutrition remain important preventive measures. Vaccination against influenza can prevent respiratory complications and, contrary to earlier concerns, is not associated with worsening of symptoms. Preventing complications such as pneumonia, bed sores, injuries from falls, or urinary infection requires attention to the primary problems that may cause them. Shortened life spans with MS are almost always due to complications rather than primary symptoms themselves.
Physical therapy helps a person with MS to strengthen and retrain affected muscles; to maintain range of motion to prevent muscle stiffening; to learn to use assistive devices such as canes and walkers; and to learn safer and more energy-efficient ways of moving, sitting, and transferring. Exercise and stretching programs are usually designed by a physical therapist and taught to patients and their caregivers for use at home. Exercise is an important part of maintaining function for a person with MS. Swimming is often recommended, not only because it is a low-impact workout, but also because it allows strenuous activity without overheating.
Occupational therapy helps a person with MS adapt to the local environment and adapt the environment. An occupational therapist may suggest alternate strategies and assistive devices for activities of daily living, such as dressing, feeding, and washing, and may evaluate both home and work environments for safety and efficiency improvements.
Training in bowel and bladder care may be needed to prevent or compensate for incontinence. If the urge to urinate becomes great before the bladder is full, some drugs may be helpful, including propantheline bromide (Probanthine), oxybutynin chloride (Ditropan), or imipramine (Tofranil). Baclofen (Lioresal) may relax the sphincter muscle, allowing full emptying. Intermittent catheterization is effective in controlling bladder dysfunction. In this technique, a catheter is used to periodically empty the bladder.
Spasticity can be treated with oral medications, including baclofen and diazepam (Valium), or by injection with botulinum toxin (Botox). Spasticity relief may also bring relief from chronic pain. Other more acute types of pain may respond to carbamazepine (Tegretol) or diphenylhydantoin (Dilantin). Low back pain is common from increased use of the back muscles to compensate for weakened legs. Physical therapy and over-thecounter pain relievers may be helpful.
Fatigue may be partially avoidable with changes in the daily routine to allow more frequent rests. Amantadine (Symmetrel) and pemoline (Cylert) may improve alertness and lessen fatigue. Visual disturbances often respond to corticosteroids. Other symptoms that may be treated with drugs include seizures, vertigo, and tremor.
Myloral, an oral preparation of bovine myelin, has recently been tested in clinical trials for its effectiveness in reducing the frequency and severity of relapses. Preliminary data indicate no difference between it and placebo.
Bee venom has been suggested as a treatment for MS, but no studies or objective reports support this claim.
In British studies marijuana has been shown to have variable effects on the symptoms of MS. Improvements have been documented for tremor, pain, and spasticity, and worsening for posture and balance. Side effects have included weakness, dizziness, relaxation, and lack of coordination, as well as euphoria. As a result marijuana is not recommended as an alternative treatment. As of 2001 the use of marijuana for medical purposes was still illegal in most states of the United States.
Some studies support the value of high doses of vitamins, minerals, and other dietary supplements for controlling disease progression or improving symptoms. Alpha-linoleic and linoleic acids, as well as selenium and vitamin E, have shown effectiveness in the treatment of MS. Selenium and vitamin E act as antioxidants. In addition, the Swank diet (low in saturated fats), maintained over a long period of time, may retard the disease process.
Removal of mercury fillings has been touted as a possible cure, but is of no proven benefit.
It is difficult to predict how multiple sclerosis will progress in any one person. Most people with MS will be able to continue to walk and function at their work for many years after their initial diagnosis. The factors associated with the mildest course of MS are being female, having the relapsing-remitting form, having the first symptoms at a younger age, having longer periods of remission between relapses, and initial symptoms of decreased sensation or vision rather than of weakness or lack of coordination.
Approximately 5% of people with MS have the severe progressive form that leads to death from complications within five years. At the other extreme, 10-20% have a benign form, with very slow or no progression of their symptoms. The most recent studies show that about seven out of 10 people with MS are still alive 25 years after their diagnosis, compared to about nine out of 10 people of similar age without the disease. On average, MS shortens the lives of affected women by about six years and men by about 11 years. Suicide is a significant cause of death in MS, especially in younger persons.
The degree of disability a person experiences five years after onset is, on average, about three-quarters of the expected disability at 10-15 years. A benign course for the first five years usually indicates the disease will not cause marked disability.
Health care team roles
Physicians provide initial diagnoses. Neurologists may support diagnoses and monitor disease progression. Physical and occupational therapists provide exercise and environmental support for relief from muscle strains and weakness. Radiologists are important in documenting disease progression. Psychiatrists, psychologists, and other therapists may be helpful in treating depression that may accompany MS. Nurses provide bedside care, education for the patient and caregiver, preparation for home management of the disease, and home safety assessment.
There is no known way to prevent MS. Until its cause is discovered, this situation is unlikely to change. Good nutrition; adequate rest; avoidance of stress, heat, and extreme physical exertion; and good bladder hygiene may improve quality of life and reduce symptoms for those who are affected by the disease.
Evoked potentialsests that measure the brain's electrical response to stimulation of sensory organs (eyes or ears) or peripheral nerves (skin).
Myelin layer of fatty cells that surrounds many nerve fibers in the brain and spinal cord. The myelin sheath acts as insulation that channels electrical impulses.
Nystagmusncontrollable movements of the eye.
Plaqueatches of scar tissue that form where a layer of myelin covering the nerve fibers is destroyed by the multiple sclerosis disease process.
Primary progressive pattern of symptoms of multiple sclerosis in which the disease progresses without remission, or with occasional plateaus or slight improvements.
Relapsing-remitting pattern of symptoms of multiple sclerosis in which symptomatic attacks last 24 hours or more, followed by complete or almost complete improvement.
Secondary progressive pattern of symptoms of multiple sclerosis in which there are relapses and remissions, followed by more steady progression of symptoms.
Adams, Raymond D., Maurice Victor, and Allan H. Ropper. Adam's & Victor's Principles of Neurology, 6th ed. New York: McGraw Hill, 1997.
Burks, Jack S. and Kenneth P. Johnson. Multiple Sclerosis: Diagnosis, Medical Management, and Rehabilitation. New York: Demos Medical Publishing, 2000.
Cook, Stuart D. Handbook of Multiple Sclerosis, 3rd ed. New York: Marcel Dekker, 2001.
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Nichols, Judith L., and Lily Jung. Living Beyond Multiple Sclerosis: A Woman's Guide. Alameda: Hunter House, 2000.
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American Academy of Neurology. 1080 Montreal Avenue, St. Paul, Minnesota 55116, (651) 695-1940. <<a href="http://www.aan.com">http://www.aan.com>.
Multiple Sclerosis Foundation. 6350 North Andrews Ave., Fort Lauderdale, Fl 33309-2130, (800) 441-7055. <<a href="http://www.msfacts.org">http://www.msfacts.org>.
National Multiple Sclerosis Society. 733 Third Avenue, New York, NY 10017, (800) 344-4867. <<a href="http://www.nmss.org">http://www.nmss.org>.
Computer Literate Advocates for Multiple Sclerosis. <<a href="http://www.clams.org">http://www.clams.org>.
International Multiple Sclerosis Support Foundation. <<a href="http://www.msnews.org">http://www.msnews.org>.
MS World. <<a href="http://www.msworld.org">http://www.msworld.org>.
Multiple Sclerosis International Federation. <<a href="http://www.ifmss.org.uk">http://www.ifmss.org.uk>.
Multiple Sclerosis Society of UK. <<a href="http://www.mssociety.org.uk">http://www.mssociety.org.uk>.
Multiple Sclerosis Society of Canada. <<a href="http://www.mssociety.ca">http://www.mssociety.ca>.
National Institute of Neurological Disorders and Stroke. <<a href="http://ninds.nih.gov/health_and_medical/disorders/multiple_sclerosis.htm">http://ninds.nih.gov/health_and_medical/disorders/multiple_... >.
L. Fleming Fallon, Jr., M.D., Dr.P.H.
Multiple Sclerosis (Encyclopedia of Public Health)
Multiple sclerosis (MS) is a disorder that affects primarily the myelinated white matter of the central nervous system (CNS), the brain, optic nerves, and spinal cord. There is no known cause. Myelin is the fatty sheath that insulates nerve fibers (axons). Partial or complete loss of myelin due to MS impairs nerve conduction through affected axons, producing symptoms and functional impairment referable to them. Thus, MS may produce mild to severe weakness, lack of coordination, disordered sensations, partial loss of vision, impaired control of bladder and bowel function, impaired cognition, or any combination of these effects.
Early in the course of the disorder, symptoms are often brief and transientmpaired function caused by a particular episode, or relapse, tends to improve, in what is called a "remission." Remissions may be partial or total. However, over the course of years, incomplete recovery from relapses may occur, leading to the accumulation of impaired function and producing some degree of disability in about 70 percent of affected individuals. Among those who become disabled, some do not experience improvement from the beginning. However, it is important to realize that, although it is a common cause of disability among young to middle-aged individuals, MS is very unpredictable in a particular person; it does not necessarily disable and it does not necessarily shorten life span appreciably.
The average age of occurrence of the first symptom(s) is thirty-three, but MS may show itself as early as childhood or as late as age sixty or beyond. It affects almost twice as many women as men, and primarily in men and women of predominantly or mixed Caucasian parentage. Approximately 350,000 people in the United States have MS, and it is estimated to affect about 3 million people worldwide. However, MS is rare among South and East Asians, and among blacks in Africa. These differences suggest that susceptibility to develop MS may be genetically determined. However, among identical twins where one has MS, no more than 50 percent of the unaffected twins will go on to develop MS. This lends support to the concept that an environmental trigger, perhaps a viral infection, acts in concert with the genetic setting to produce MS. Siblings and children of those with MS have a somewhat greater chance of developing MS, but no specific genetic pattern has been identified. It is likely that multiple genes are involved in conferring susceptibility.
The frequency of MS has been studied closely since the 1930s. However, despite improved diagnostic methods (and improved treatment), the incidence (number of new cases per year in the population) does not appear to have increased.
Even after many years of intensive research, the cause of MS remains elusive, and it is a challenging subject for research. The most widely accepted hypothesis at this time is that an infection triggers an autoimmune response in genetically susceptible individuals. Autoimmunity implies that the body's immune-defense system erroneously and inappropriately attacks normal tissues, in this case the myelin and/or the cell that synthesizes and supports myelin, the oligodendrocyte.
Diagnosing MS is often very challenging. To do so involves documenting the occurrence of two or more episodes of impaired function, occurring at different times, that are referable to CNS white matter, while excluding all other possible causes of the problems. The fact that MS affects primarily the CNS white matter makes it possible to visualize very accurately areas of inflammation and demyelination via magnetic resonance imaging (MRI). MRI is an invaluable aid to diagnosis, although the MRI picture alone is not sufficient to be certain of the diagnosis. MRI is also used to identify new relapses, and to quantify the number and size of past episodes. Similarly, the cerebrospinal fluid typically shows alterations that may support a diagnosis, but a diagnosis cannot be made without appropriate clinical history and neurological examination.
Even though its cause is still mysterious, treatments have been developed that have reduced the number of relapses by more than 30 percent. These agents include recombinant interferon beta (IFN particular brand names include Avonex, Betaseron, and Rebif) and glatiramer acetate (Copaxone), each of which is widely used. Laboratory and clinical studies of many other possible treatments are underway, which is a very hopeful indicator of more effective therapies to come in the future. In addition to these disease-modifying agents, treatment often includes the use of medications intended for purely symptomatic relief, as well as physical therapy and occupational therapy. The challenges posed by an uncertain clinical course, and by chronic disability among some individuals, makes psychological support a key part of management.
The National Multiple Sclerosis Society (http://nmss.org/), similar organizations in other countries, and the International Federation of Multiple Sclerosis Societies (http://www.who.int/ina-ngo/ngo/ngo076.htm) are excellent sources of further information about the disorder, ongoing research, and treatment.
DONALD H. SILBERBERG
(SEE ALSO: Environmental Determinants of Health; Genes; Genetic Disorders; Genetics and Health)
Burks, J. S., and Johnson, K. P., eds. (2000). Multiple Sclerosis: Diagnosis, Medical Management, and Rehabilitation. New York: Demos.
Paty, D. W., and Ebers, G. C., eds. (1998). Multiple Sclerosis. Philadelphia, PA: F. A. Davis.