MARCH IS NATIONAL MULTIPLE SCLEROSIS AWARENESS MONTH
What is Multiple Sclerosis?
Multiple sclerosis is a chronic neurological disorder that affects the central nervous system, comprised of the brain and spinal cord. In the CNS, nerve fibers or axons are surrounded by a layer of insulation called myelin. Myelin allows nerve signals to travel properly,
In MS, the myelin is destroyed (demyelination) on the brain and spinal cord. The scarring, located at multiple sites in the CNS, disrupts transmission of messages that communicate a desired action from the brain, through the spinal cord, to various parts of the body. The inflammation produced by MS damages the axons themselves and can cause permanent loss of function. In the process, the cells that produce myelin can also be damaged. This limits the ability of the brain to repair damaged myelin.
This is similar to a frayed electrical cord. The insulation assures that the electricity running along the wire reaches its destination without short-circuiting. In MS, the transmission along the nerve fibers “short-circuits,” becoming faulty or absent. This can cause problems with vision, coordination, sensation in the limbs, and other symptoms.
The course of the disease varies greatly from person to person. It is impossible to predict the severity or progression in any given individual. To better develop appropriate management plans, MS is divided into four classifications:
Relapsing-Remitting - clearly defined attacks lasting from days to weeks, with full recovery or with some remaining neurological symptoms and deficits upon recovery. Periods between relapses are stable and absent of disease progression. This is by far the most common form of the disease.
Secondary-Progressive – begins initially with a relapsing-remitting course that becomes consistently progressive and includes occasional relapses and minor remission. Deficits are accumulated without recovery between attacks.
Primary-Progressive – progression of level of disability from the onset without any distinct relapses of remissions. Temporary, minor improvements may be experienced.
Progressive-Relapsing – clear progression in disability level from the onset, but also clear acute relapses that may or may not include memory.
What Causes Multiple Sclerosis?
Currently, the exact cause of MS remains unknown, but researchers believe that a combination of several factors may be involved. Studies are ongoing in the following areas:
MS is generally believed to be an autoimmune disease. This means that the immune system, which normally protects us from disease and infection, reacts against normally occurring antigens (proteins that stimulate an immune response) as if they were foreign. In other words, the body mistakenly attacks itself. While some component of myelin is believed to be the target of that attack, the exact antigen remains unknown. In recent years, researchers have identified the immune cells causing the attack and some of the factors that cause them to do so, as well as some of the sites (or receptors) on the attacking cells that appear to be drawn to the myelin to begin the destructive process.
Viral or other Infectious Agents
Some data suggest that a common virus or other infectious agent may play a role in the cause of MS. Whether it is a persistent viral infection or an immune reaction caused by a temporary viral infection in the central nervous system or elsewhere in the body is not yet known. Environmental studies suggest that some factor – probably infectious – must be encountered before the age of 15 in order for MS to develop later in life. Several viruses and bacteria, including Epstein-Barr, Chlamydia, pneumonia, measles, canine distemper, and human herpes virus-6 have been or are being studied to determine if they may trigger MS, but none have been definitively proven to do so as of yet.
Epidemiologists – scientists who study disease patterns – have learned that MS occurs more frequently in geographic locations that are farther from the equator. In an effort to understand the puzzling disease patterns found in MS, scientists continue to examine geographic, demographic, and genetic variables. For example, studies have shown that people born in a geographic location with a high incidence of MS, who move to a geographic location with a lower incidence of MS before the age of 15, will acquire the lesser risk associated with their new location. Such data suggest that exposure to some environmental factor or factors prior to puberty, such as diet, exposure to industrial toxins, or content in water or soil may predispose a person to develop MS later in life.
Some researchers believe vitamin D, which the body produces naturally when the skin is exposed to sunlight, may be involved. People who live closer to the equator are continually exposed to greater amounts of sunlight. As a result, they tend to have higher levels of naturally produced vitamin D, which is thought to have a beneficial impact on immune function and may help protect against autoimmune disease, like MS.
Other scientists are studying MS clusters, or geographic areas in which there is a higher incidence of MS over a specific period of time. While it is hoped that such studies might offer insight into what triggers the disease, so far results have been inconclusive.
While MS is not believed to be a hereditary disease, having a family history of MS (particularly in a parent or a sibling) does make a person more likely to develop it. In a family in which one parent has MS, the risk that their children will develop the condition is estimated to be between 2 and 5 percent.
Studies have shown that there is a higher prevalence of certain genes in areas where MS seems to cluster, as well as in some families where there is more than one person with MS. It is speculated that MS develops because a person is born with a genetic tendency to react when exposed to some environmental agent that triggers an autoimmune response. New techniques are being used in an effort to identify the genes involved. Nevertheless, the genetic picture of MS remains largely unknown and is proving harder to understand than other autoimmune diseases. While some autoimmune diseases are causes by one or two malfunctioning genes, MS appears to involve defects in many genes, each with only a modest effect.
Over the years, aspartame (an artificial sweetener), allergies, physical trauma, exposure to heavy metals, and environmental toxins have also been studied as potential causes of MS. Little or no evidence has been found to substantiate these claims.
Symptoms of Multiple Sclerosis
Common symptoms of MS include fatigue, weakness, spasticity, balance problems, bladder and bowel problems, numbness, vision loss, tremors and depression.
Not all symptoms affect all MS patients. No two persons have the same complaints; no one develops all of the symptoms.
Symptoms may be persistent or may cease from time to time. Most patients have episodic patterns of attacks and remissions throughout the disease course. Symptoms may remit completely, leaving no residual damage, or partially leaving degrees of permanent impairment.
Because the symptoms that define the clinical picture of MS are the result of nerve lesions causing disturbances in electrical conduction in one or more areas of the CNS, the nature of the symptoms that occur is determined by the location of the lesion. For example: an optic nerve lesion may cause blurred vision; a brain stem lesion may cause dizziness or double vision; a spinal cord lesion may cause coordination/balance problems.
Depending on the location of the lesion, the MS patient may experience the following signs and symptoms:
The following list of symptoms followed by typical courses of treatment, are not the only symptoms to affect those with MS. These symptoms may be intermittent or persistent. Not all of these symptoms affect all patients.
Fatigue: The most common complaint of MS patients is fatigue. Occurs in as many as 78 percent of patients, usually in the late afternoon and often subsides in the early evening.
Modifying activities, occupational therapy, and medications.
Numbness, Tingling, Burning Sensations: Sensory complaints occur in up to 55 percent of patients and are often the earliest symptoms of MS. Disturbances of feeling in the extremities or the trunk such as tingling, crawling sensations, feelings of swelling or numbness. Numbness also depends upon its cause. If severe neurological damage to the myelin sheath takes place, then numbness may remain.
Medication, exercise, healthy diet, body cooling, acupuncture, or pointed pressure therapy.
Tremors: Shaking or trembling of a limb or occasionally the head. Up to 50 percent report extremity ataxia (shaky movements or unsteady gait) or tremors. Tremors may come and go. This symptom of MS impairs mobility and often is associated with difficulty in balance and coordination.
Exercises, physical therapy, occupational therapy, adaptive equipment, and medications.
Balance/Coordination: Gait and balance disturbances are common with MS. Balance problems without vertigo may be more constant, causing the person to sway or stagger.
Exercises, physical therapy, occupational therapy.
Depression: As in most cases with the onset of an illness, depression is a frequent reaction. MS-related lethargy and fatigue may also be mistaken for depression or heighten its effects.
Medications, counseling, and alternative treatment options.
Spasticity: Occurs with the initial attack of MS in up to 41 percent of patients and is present in about 62 percent of patients with progressive disease. Occurs when opposing groups of muscles contract and relax at the same time. When spasticity is present, the increased stiffness in the muscles means that a great deal of energy is required to perform daily activities.
Exercise, stretching, physical therapy, mechanical aids, and medications.
Bladder: Increased frequency of urination, urgency, dribbling, hesitancy, and incontinence.
Modifying activities, catheterization, and medications.
Bowel: Constipation, diarrhea and incontinence. Dysfunction occurs in almost two thirds of patients during the disease course.
Diet management, adequate fluid intake, and medications.
Vision Loss: Rarely involves both eyes simultaneously, usually starts with blurred vision followed by vision loss from 20/20 to 20/30 to 20/40.
Medications, eye patch.
Cognitive and Emotional Dysfunction: Affects approximately 50 percent of MS patients. Involves memory, reasoning, verbal fluency and speed of information processing. Emotional changes include euphoria, depression. Memory problems are fairly common among people with MS. Memory and reasoning problems may affect between two thirds and three fourths of those diagnosed with MS to varying degrees.
Consider other issues that may lead to memory problems such as depression, other illnesses, and normal absent-mindedness. If memory loss is a constant problem, there are certain "mnemonic" exercises that may help or, consult a physician. Some treatments may be available to enhance cognitive functioning.
Sexual Difficulties: More than 90 percent of men and 70 percent of women with MS report some change in their sexual life after the onset of the disease. Some problems include decreased sexual drive, impaired sensation, diminished orgasmic response, and loss of sexual interest.
Good communication between partners, counseling, medications.
Treatments for Multiple Sclerosis
The year 1993 saw the release of the first disease-modifying drug, Betaseron®, for multiple sclerosis. By the turn of the century, three other disease-modifying drugs had also been approved. Now with more than 10 products are available, patients not only have treatments but treatment options. It is important to note that none of the currently approved disease-modifying agents are not a cure for MS. However, all of these products can alter the course of the disease by decreasing the number and severity of relapses, by slowing the progression of the disease, and by reducing the accumulation of new lesions.
MS Treatment Guidelines
Research demonstrates that potentially irreversible axonal damage may occur early in relapsing-remitting MS. These therapies appear to be more effective in preventing new lesions than in repairing old lesions. Based on these findings, it is the consensus of researchers and clinicians with expertise in MS that the following treatment guidelines be followed:
• Therapy with a disease-modifying drug should be initiated as early in the disease course as possible. Such treatment may also be considered for those who have experienced a first attack and are at high risk of developing MS. (This is known as clinically isolated syndrome or CIS.)
• Treatment should be continued indefinitely except in the case of clear lack of benefit, intolerable side effects, new data, or if a better treatment becomes available.
• Individuals should be allowed to change therapies.
• Treatment should not be interrupted for insurance purposes.
• None of these medications are approved for use in women who are pregnant, nursing, or may become pregnant.
If you have any questions about MS or any other health related issue please call and speak to one of our Providers at (719) 438-2251.
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