Multiple Sclerosis

Overview

Multiple sclerosis affects around 2.5 million people worldwide; it is one of the most common neurological disorders and cause of disability of young adults, especially in Europe and North America.

Multiple Sclerosis is an unpredictable disease of the central nervous system; marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted.

Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerves. The exact antigen — or target that the immune cells are sensitized to attack — remains unknown, which is why MS is considered by many experts to be “immune-mediated” rather than “autoimmune.”

Types of Multiple Sclerosis

Clinically Isolated Syndrome (CIS)

Clinically isolated syndrome (CIS) is one of the MS disease courses. CIS refers to a first episode of neurologic symptoms that lasts at least 24 hours and is caused by inflammation or demyelination (loss of the myelin that covers the nerve cells) in the central nervous system (CNS). CIS can be either monofocal or multifocal:

The episode usually has no associated fever or infection and is followed by a complete or partial recovery.

Like MS, CIS is two to three times more common in women than men. Seventy percent of people diagnosed with CIS are between the ages of 20 and 40 years (average 30 years) but people can develop CIS at older or younger ages.

Relapsing-remitting MS (RRMS)

RRMS – the most common disease course – is characterized by clearly defined attacks of new or increasing neurologic symptoms. These attacks – also called relapses or exacerbations – are followed by periods of partial or complete recovery (remissions). During remissions, all symptoms may disappear, or some symptoms may continue and become permanent. However, there is no apparent progression of the disease during the periods of remission.
At different points in time, RRMS can be further characterized as either active (with relapses and/or evidence of new MRI activity) or not active, as well as worsening (a confirmed increase in disability over a specified period of time following a relapse) or not worsening. An increase in disability is confirmed when the person exhibits the same level of disability at the next scheduled neurological evaluation, typically 6 to 12 months later.Approximately 85 percent of people with MS are initially diagnosed with RRMS.
Relapsing-remitting MS is defined by inflammatory attacks on myelin (the layers of insulating membranes surrounding nerve fibers in the central nervous system (CNS)), as well as the nerve fibers themselves. During these inflammatory attacks, activated immune cells cause small, localized areas of damage which produce the symptoms of MS. Because the location of the damage is so variable, no two people have exactly the same symptoms.

Primary-Progressive Multiple Sclerosis (PPMS)

PPMS is characterized by worsening neurologic function (accumulation of disability) from the onset of symptoms, without early relapses or remissions. PPMS can be further characterized at different points in time as either active (with an occasional relapse and/or evidence of new MRI activity) or not active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapse or new MRI activity) or without progression. Approximately 15 percent of people with MS are diagnosed with PPMS.

Although there is a lot of variability among people with PPMS, we know that as a group, they differ in several ways from people with relapsing forms of MS:

Secondary-progressive MS (SPMS)

SPMS follows an initial relapsing-remitting course. Most people who are diagnosed with RRMS will eventually transition to a secondary progressive course in which there is a progressive worsening of neurologic function (accumulation of disability) over time. SPMS can be further characterized at different points in time as either active (with relapses and/or evidence of new MRI activity) or not active, as well as with progression (evidence of disease worsening on an objective measure of change over time, with or without relapses) or without progression.

SPMS occurs in people who initially had a relapsing-remitting disease course. In other words, SPMS occurs as a second phase of the disease for many individuals. Primary progressive MS (PPMS) is the first — and only — phase of the illness for approximately 15 percent of people with MS.

In SPMS, people may or may not continue to experience relapses caused by inflammation; the disease gradually changes from the inflammatory process seen in RRMS to a more steadily progressive phase characterized by nerve damage or loss.

Symptoms of Multiple Sclerosis

Common Symptoms

Less Common but Possible Symptoms

Secondary Symptoms that results from the primary symptoms

Tertiary Symptoms

Tertiary symptoms are the “trickle down” effects of the disease on your life. These symptoms include social, vocational and psychological complications. For example, if you are no longer able to drive or walk, you may not be able to hold down your usual job. The stress and strain of dealing with MS often alters social networks and sometimes fractures relationships. Problems with bladder control, tremor or swallowing may cause people to withdraw from social interactions and become isolated.

Causes for Multiple Sclerosis

The worldwide distribution of MS can be only an indirect refl ection of its cause, implicating some environmental factor that varies with latitude, and can be interpreted in at least three different ways in the search for clues to a specific etiology. a), an environmental risk factor may be more common in temperate than tropical climates, b), such a factor may be more common in tropical climates, where it is acquired at an earlier age and consequently has less impact c), this factor may be equally common in all regions, but the chance of its acquisition or of the manifestation of symptoms is either increased by some enhancing factor present in temperate climates or reduced by a protective factor present in tropical areas.

Among those factors that have been most closely scrutinized are:

It is now generally accepted that the etiology of MS involves some interplay of genetic and environmental factors. Evidence of racial or ethnic resistance, the increased risk among MS family members, and elevated monozygotic twin concordance rate all favor a genetic contribution to acquisition of the disease. The studies from which this evidence is derived, however, also indicate that heredity cannot entirely explain the occurrence of MS. This is underlined by the fact that no population-based study of monozygotic twins has found a concordance rate in excess of 30%. Some environmental factor, such as a virus or toxin, must still play a role.

Regardless; of any factor, the demyelination occurs in all subjects suffering from Multiple Sclerosis.

The latest research identifies that the chloride-channel protein anoctamin 2 (ANO2) as a new target for autoantibody production in multiple sclerosis (MS) patients.

Diagnosing MS

Your doctor will need to perform a neurological exam, a clinical history, and a series of other tests to determine if you have MS.

Diagnostic testing may include the following:

The diagnosis of MS requires evidence of demyelination in more than one area of the brain, spinal cord, or optic nerves. That damage must have occurred at different times.

It also requires ruling out other conditions that have similar symptoms. This includes Lyme disease, lupus, and Sjogren’s syndrome.

Treatment for Multiple Sclerosis

No cure is available for MS, but multiple treatment options exist.

If you have relapsing-remitting MS (RRMS), you can choose one of the disease-modifying drugs. These medications are designed to slow disease progression and lower your relapse rate.

Self-injectable disease-modifying drugs include glatiramer (Copaxone, Glatopa) and beta interferons, such as:

Oral medications for RRMS include:

Intravenous infusion treatments for RRMS include:

Disease-modifying drugs aren’t effective in treating progressive MS.

Your doctor can prescribe corticosteroids, such as methylprednisolone (Medrol) and prednisone (Deltasone) to treat relapses.

Other treatments may ease your symptoms and improve your quality of life. Because the disease is different for everybody, treatment depends on your specific symptoms. For most people, a flexible approach is necessary.

Risk factors

These factors may increase your risk of developing multiple sclerosis:

Complications

People with multiple sclerosis also may develop:

Statistics about MS

If you are facing any of the above symptoms, then it’s always a better idea to get yourself check with an expert neurologist. Alabama Clinics have one of the leading neurologists that specializes in treating patients with Multiple Sclerosis.