Multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the central nervous system, or brain and spinal cord.


Causes/associated factors
When you have MS, plaques (patches of inflammation) randomly develop in parts of your central nervous system. This inflammatory process causes autoantibodies (proteins your body makes and targets against itself) to form, which are thought to destroy the myelin sheath (the protective coating of the nerves that help transmit signals between your brain, spinal cord and the rest of your body). MS can cause diminished or lost function in any area of your body that's served by nerve fibers. Most people living with MS have a nearly normal life span.
The cause of MS is unclear, but a number of factors may play a role. Some experts suspect it may be caused by a virus or some form of environmental trigger causing an autoimmune disorder (when the body produces antibodies that attack its own tissues) that results in destruction of myelin sheath. Research indicates that genetics may also be a factor.

Here are few statistics about MS:

Although MS can appear at any age, it often strikes people between ages 20 and 40. MS is rare before age 16 or after age 60.
Women are more likely than men to develop MS.
MS affects Caucasians more than twice as often as people of other ethnic backgrounds.
MS occurs more often among people who have a family history of the disease.
MS is five times more common in areas with a moderate climate, such as the northern United States, Canada and Europe, than tropical areas.

Signs/symptoms
Symptoms of MS vary and may mimic other neurological diseases. They can involve different parts of the central nervous system, range in severity, develop quickly and resolve rapidly, or last for a long time and possibly progressively worsen. Initially, symptoms may include visual problems, such as blurred or double vision and difficulty with red/green color distortion. Sometimes, blindness develops in one eye.
Depending on what part of the nervous system is affected, other symptoms may include:

moderate to severe pain
weakness in the arms and/or legs
intermittent numbness or prickling sensations
tremors
muscle spasticity
coordination problems
speech problems
dizziness
impaired concentration or memory
depression
sexual dysfunction
bowel and bladder problems
fatigue after physical activity that improves with rest
chronic fatigue
Symptoms often worsen when body heat increases, either through exercise or environment. Symptoms may also be triggered by fever or stress. About 20 percent of people who have MS have an initial attack and then a remission, followed by only mild or no further symptoms. For these people, MS has very little lasting effects. For others, MS causes progressive or chronic flare-ups, remissions and relapses. Sometimes, symptoms progress or worsen without remissions.


Types of multiple sclerosis
There are four types of multiple sclerosis, determined by the specific symptoms:
Relapsing-remitting: Symptom flare-ups are followed by remissions, or periods when symptoms are less noticeable. During clear recovery times, the disease doesnf MS, accounting for about 85 percent of cases.

Primary progressive: In this case, symptoms steadily worsen. Only about 10 percent of people develop this type of MS.

Secondary progressive: With this type of MS, someone who was first diagnosed with relapsing-remitting MS experiences a steady worsening of symptoms, with or without flare-ups. About 50 percent of people who have relapsing-remitting MS develop secondary progressive MS within 10 years.

Progressive-relapsing: In this case, steadily worsening symptoms are accompanied by clear flare-ups. This is the rarest type of MS, accounting for only about 5 percent of cases.

Diagnosis
Your doctor will ask questions about your symptoms and medical history. This will be followed by a physical and neurological exam. Because there is no single test that specifically confirms the diagnosis of MS, you may need a series of tests. These tests will also be used to rule out other conditions that may mimic MS.
Magnetic resonance imaging (MRI, an imaging technique based on computer analysis of the body's response to a magnetic field) can show damage to the myelin sheath. Lesions can also be caused by other disorders, however.
An evoked potential test records electrical responses in your brain when vision, hearing or other senses are stimulated.
A lumbar puncture (taking a sample of cerebrospinal fluid) can provide another clue. People who have MS often have more white blood cells and protein in this fluid than normal.
Even if your doctor suspects MS, the recommendation may be watchful waiting and close monitoring of your symptoms.


Treatment
There is no cure for MS. Treatment depends on the type of MS you have. For some people, symptoms disappear without treatment. For others, treatment can help relieve troublesome symptoms and maintain quality of life.
Medication
Your doctor may prescribe steroids such as prednisone, dexamethasone or methylprednisolone to treat relapses or attacks. These medications donnd severity of attacks or relapses. Because of side effects, these medications are not recommended for long-term use.

Certain medications can also be used to treat specific symptoms.

Spasticity can affect the legs, especially at night. Muscle relaxants or tranquilizers can be helpful.
Visual problems may be relieved with short-term steroid use.
Aspirin or acetaminophen may help relieve muscle and back pain.
Anticonvulsant medications can help relieve facial pain. Sometimes, surgery may be recommended.
Antidepressants or electrical stimulation may relieve nerve pain in other areas. Narcotic pain medications may be prescribed in certain cases.
Other medications can treat bladder spasms or incontinence.
Antidepressants or antianxiety medications can reduce the intensity of fatigue, pain and sexual dysfunction caused by depression.
Fatigue may be treated with the antiviral medication amantadine.
The U.S. Food and Drug Administration (FDA) has approved interferon beta-1a (Avonex or Rebif) and interferon beta-1b (Betaseron) to reduce the number of relapses and slow the development of physical disabilities. Beta interferon may reduce damage to the myelin sheath. When relapses occur, they're often shorter and less severe.

Glatiramer (Copaxone) is another medication used to reduce the frequency of relapses. It's thought to work by altering the immune response that produces MS. More recently, the chemotherapy medication mitoxantrone (Novantrone) was approved by the FDA for use with MS when the illness continues to worsen despite treatment with other medications.

Lifestyle changes
Although there is no evidence that changes in diet prevent or improve MS, proper nutrition provides energy and helps your body fight infections. To keep your urine diluted and reduce the risk of a bladder infection, drink plenty of fluids. Your doctor may recommend vitamin C supplements or cranberry juice.

Following an exercise program recommended by your doctor can help you maximize and maintain muscle tone, bone strength and respiratory function. Staying in good shape may limit or prevent further symptoms. (Remember to plan exercise so you avoid times when you're fatigued or it's too hot.) If you're weak or uncoordinated, physical therapy, exercise or walking aids (such as canes, walkers or foot braces) may help you remain independent. Physical therapy can also help relieve muscle and back pain.

Avoid humidity and overheating. Remember, symptoms can become worse with humidity or when your body heat increases through exercise, environmental factors or fever. Symptoms usually improve after cooling down. For some people with MS, becoming cold also worsens symptoms.

On the research front
Researchers are considering the development of an MS vaccine. They're also studying experimental therapies, including:

immunotherapy (exposing the body to increasing amounts of an allergen)
therapies to improve the conduction of nerve impulses
other drugs that may prevent damage to the myelin sheath

Complications
The symptoms of MS can worsen progressively or change character. Medication changes may be needed. Physical therapy and/or other treatments may be necessary. If you have frequent relapses, disability may become permanent.

Pregnancy-specific information
Pregnancy may actually trigger multiple sclerosis in some women. However, there is no evidence that pregnancy changes or causes the progression of MS. The disease appears to have no adverse effects on pregnancy, labor or delivery. In fact, natural changes in the immune system during pregnancy often cause symptoms to temporarily improve. Many new mothers experience a relapse of MS symptoms in the three months after delivery, however. If you have MS and are planning to become pregnant, discuss the situation with your doctor. Many medications commonly used to treat MS may be harmful to a developing fetus.

Senior-specific information
Multiple sclerosis rarely develops after age 60. Remissions for older adults who have the disease are less common during the later years.

Prevention
Currently, there is no way to prevent multiple sclerosis.