Description of Multiple Sclerosis

Description of Multiple Sclerosis

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Doctors test reflexes to help diagnose MS.

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Multiple sclerosis is a neurodegenerative disorder that affects nearly 400,000 people in the United States, causing loss of function or death of nerves or nerve cells. In patients with MS, this occurs when the protective covering of the nerve, called myelin, is destroyed. This causes the appearance of myelin scars, or sclera; hence the name, multiple sclerosis. These scars, or lesions, may appear in the spinal cord, brain and optic nerve, and can be seen with magnetic resonance imaging scans.

Symptoms of MS

Myelin scarring causes faulty nerve conduction and a variety of symptoms ranging from fatigue to paralysis. Symptoms vary greatly between individuals and may be influenced by the size and location of the lesions. Patients may experience symptoms as “attacks” that gradually subside over time. This form of MS is called relapsing-remitting and occurs in approximately 85 percent of cases. Alternatively, symptoms may get worse over time without remission. This form of MS is called progressive and occurs in approximately 15 percent of cases. Some patients with relapsing-remitting MS may eventually convert to progressive MS. The more commonly reported symptoms of MS include fatigue, problems with balance and coordination, bladder, bowel and sexual dysfunction. In addition, patients may experience sleep disturbances and emotional changes, including depression and loss of cognitive function, which is the ability to learn, problem solve and plan. Twenty percent of new MS patients present with visual problems due to an inflammation of the optic nerve, called optic neuritis, and 40 percent or more may experience optic neuritis during the disease course.

Diagnosing MS

Most people with MS are diagnosed between the ages of 20 and 50. There is no definitive test for the disease, so physicians perform neurological exams and additional tests to confirm the diagnosis. MRI scans are used to find lesions in the brain, spinal cord or optic nerve. Cerebrospinal fluid is sampled to measure clonal antibodies, the excess antibodies associated with MS. Evoked potentials, which measure a nerve's response to a stimulus such as a flash of light or small amounts of electric current, are used to measure nerve conduction velocity. Positive results for one or more of these tests does not mean a diagnosis of MS, as there may be other reasons for positive test results. Therefore, the diagnosis of MS is often a diagnosis of exclusion after other diseases or causes are ruled out.

Treatment of MS

As of 2013, at least 10 FDA therapies are approved for the treatment of MS to reduce symptoms, delay progression, reduce active lesions and reduce the number of individuals who advance from relapsing-remitting to progressive MS. While therapies such as natalizumab and interferon B-1a (Rebif) decrease the recurrence of attacks of relapsing-remitting cases during the first 24 months of treatment, they are associated with long-term serious adverse effects. No therapies stop disease progression in patients with progressive MS. In individuals with mild to moderate MS, combining aerobic exercise for 30 minutes twice weekly with strength training of major muscle groups twice weekly improves aerobic capacity and muscular strength according to Canadian scientists who conducted this research at Queen's University. These studies suggest exercise may be useful for symptom relief in some patients.

Causes of MS

The causes of MS are poorly understood, but four factors are believed to contribute to the disease. First, immune system malfunction may cause immune attacks on the myelin surrounding the nerve. The reason for this is unknown. Second, environmental factors are likely involved, because MS occurs more frequently the farther individuals are from the equator. Smoking and vitamin D deficiency may further increase the risk of getting the disease. Third, genetics likely plays a role because MS occurs in most ethnic groups, but is more common in Caucasians of Northern European ancestry. While the risk of getting MS is one in 750 in the general population, the risk is one in 40 for someone with a close relative (parent or sibling) with MS, and one in four for identical twins if one twin is affected. Last, viruses may be involved as a number of viral infections are known to affect myelin. However, none have been definitively linked to MS.