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What Is Multiple Sclerosis?

The name multiple sclerosis refers to scars (scleroses—better known as plaques or lesions) particularly in the white matter of the brain and spinal cord, which is mainly composed of myelin. According to Wikipedia, Multiple sclerosis (abbreviated to MS, known as disseminated sclerosis or encephalomyelitis disseminata) is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms.

There are three main types of MS:

• relapsing remitting MS
• secondary progressive MS
• primary progressive MS

This disease affects the brain and spinal cord resulting in loss of muscle control, vision, balance, and sensation (such as numbness). MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other effectively. Nerve cells communicate by sending electrical signals called action potentials down long fibers called axons, which are contained within an insulating substance called myelin.  When some one surfer MS, the nerves of the brain and spinal cord are damaged by one’s own immune system. In MS, the body’s own immune system attacks and damages the myelin. Thus, the condition is called an autoimmune disease.

Multiple sclerosis symptoms generally appear between the ages of 20 and 40. MS is two to three times as common in females as in males and its occurrence is unusual before adolescence. A person has an increased risk of developing the disease from the teen years to age 50 with the risk gradually declining thereafter. MS is a lifelong condition, but it is not terminal. Most people with MS can expect to live as long as someone without the condition. However, a minority of patients (about 20%) with MS have a considerably shortened life.

What Causes Multiple Sclerosis?

In the last 20 years, researchers have focused on disorders of the immune system and genetics for explanations. No one is sure what causes the body’s immune system to go awry in multiple sclerosis, but there are interesting data that suggest that genetics, a person’s environment, and possibly even a virus may play a role, and possibly other factors like vascular problems. The risk of acquiring MS is higher in relatives of a person with the disease than in the general population, especially in the case of siblings, parents, and children.

Studies show that MS is more common in certain parts of the world, but if you move from an area with higher risk to one of lower risk, you acquire the risk of your new home if the move occurs prior to adolescence. Such data suggest that exposure to some environmental agent encountered before puberty may predispose a person to MS. Moreover, MS is a disease of temperate climates. In both hemispheres, its prevalence increases with distance from the equator.

Many microbes have been proposed as potential infectious triggers of MS, but none have been substantiated.

Multiple sclerosis symptoms

A person with MS can suffer almost any neurological symptom or sign. Symptoms of multiple sclerosis vary from person to person and can change over time in the same person. The most common early symptoms include:

• Tingling
• Numbness
• Loss of balance
• Weakness in one or more limbs
• Blurred or double vision

Less common symptoms of MS may include:

• Slurred speech
• Sudden onset of paralysis
• Lack of coordination
• Cognitive difficulties

As the disease progresses, other symptoms may include muscle spasms, sensitivity to heat, fatigue, changes in thinking or perception, and sexual disturbances.

• Fatigue. This is a characteristic and common symptom of MS. It is typically present in the midafternoon and may consist of increased muscle weakness, mental fatigue, sleepiness, or drowsiness. Physical exhaustion is not related to the amount of work performed; and many patients with MS complain of extreme fatigue even after a good night’s sleep.
• Heat sensitivity. Heat sensitivity (the appearance or worsening of symptoms when exposed to heat, like a hot shower) occurs in most people with MS.
• Spasticity. Muscle spasms are a common and often debilitating symptom of MS. Spasticity usually affects the muscles of the legs and arms, and may interfere with a persons ability to move those muscles freely.
• Dizziness. Many people with MS complain of feeling “off balance” or lightheaded. Occasionally they may experience the feeling that they or their surroundings are spinning; this is called vertigo. These symptoms are caused by damage in the complex nerve pathways that coordinate vision and other inputs into the brain that are needed to maintain balance.
• Impaired thinking. Impaired thinking. Problems with thinking occur in about half of people with MS. For most, this means slowed thinking, decreased concentration, or decreased memory. Approximately 10% of people with the disease have severe impairment that significantly impairs their ability to carry out tasks of daily living.
• Vision problems. Vision problems are relatively common in people with MS. In fact, one vision problem, optic neuritis, occurs in 55% of people with the condition.This can result in blurring or graying of vision or blindness in one eye.  However ,most vision problems in MS do not lead to blindness.
• Abnormal sensations. Many people with MS experience abnormal sensations such as “pins and needles,” numbness, itching, burning, stabbing, or tearing pains. Fortunately, most of these symptoms, while aggravating, are not life-threatening or debilitating and can be managed or treated.
• Speech and swallowing problems. People with MS often have swallowing difficulties. In many cases, they are associated with speech problems as well. They are caused by damaged nerves that normally aid in performing these tasks.
• Tremors. Fairly common in people with MS, tremors can be debilitating and difficult to treat.
• Difficulty walking. Gait disturbances are amongst the most common symptoms of MS. Mostly this problem is related to muscle weakness and/or spasticity, but having balance problems or numbness in your feet can also make walking difficult.

Other rare symptoms include breathing problems and seizures.

Early diagnosis is important, since treatment can slow the disease. In these articles, learn about testing to diagnose MS — and questions to ask your doctor.

Diagnosing Multiple Sclerosis

There is no single test that is proof-positive for diagnosing multiple sclerosis. An accurate diagnosis of multiple sclerosis is based on your medical history and a neurological exam (an exam of the function of the brain and spinal cord) using various tests. A lot depends on the skill of the doctor in asking the right questions to uncover information and to properly evaluate the signs and symptoms of a malfunctioning brain or spinal cord.

In addition to a thorough medical history and exam, a variety of specialized procedures are helpful — although not always necessary — to accurately diagnose MS. These include imaging techniques, such as MRI, spinal taps or lumbar punctures (examination of the cerebrospinal fluid that runs through the spinal column), evoked potentials (electrical tests to help determine if MS has affected a person’s nerve pathways), and lab analysis of blood samples.

Tests

1. MRI: Magnetic Resonance Imaging - It’s not the sole test used to diagnose MS, but MRI is a giant step in confirming a diagnosis.MRI is the best test to view the changes caused by multiple sclerosis. The precise image produced by MRI gives the neurologist clear evidence of scar tissue in the deep parts of the brain or spinal cord that is characteristic of MS.However, abnormal spots on the brain MRI can be caused by other conditions, so before making a diagnosis your doctor will consider all information including your symptoms and scan results. Similar lesions can be seen in elderly people or people with migraine headaches or high blood pressure.Also, a normal MRI does not absolutely rule out a diagnosis of MS. About 5% of patients who are confirmed to have MS on the basis of other criteria, do not have lesions in the brain on MRI. These people may have lesions in the spinal cord or may have lesions that cannot be detected by MRI.
2. The Spinal Tap & Multiple Sclerosis – Spinal fluid analysis holds important clues in diagnosis. Performing a spinal tap to examine the cerebrospinal fluid may be helpful in diagnosing MS in some people, but it is no longer considered necessary in all instances.
3. Evoked Potential Tests for Multiple Sclerosis - This painless test measures electrical activity in the brain to help diagnose MS. There are three main types of evoked potential tests:
   • Visual Evoked Potentials (VEP): You sit in front of a screen on which an alternating checkerboard pattern is displayed.
   • Brainstem Auditory Evoked Potentials (BAEP): You hear a series of clicks in each ear.
   • Sensory Evoked Potentials (SEP): Short electrical impulses are administered to an arm or leg.

Multiple Sclerosis Treatment

A. Drug Therapy

A number of drugs have been shown to slow the progression of MS in some people.

A number of drugs have been shown to slow the progression of MS in some people. All of these drugs work by suppressing, or altering, the activity of the body’s immune system. Thus, these therapies are based on the theory that MS is, at least in part, a result of an abnormal response of the body’s immune system that causes it to attack the myelin surrounding nerves. These are called the disease modifying drugs.

They include: Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (glatiramer acetate), Novantrone (mitoxantrone), Rebif (interferon beta-1a), Tysabri (natalizumab), Gilenya (fingolimod).

Avonex (interferon beta-1a)

Betaseron (interferon beta-1b)

Glatiramer acetate (Copaxone)

Glatiramer acetate (Copaxone) is another DMD that is approved for reducing the frequency of relapses in RR-MS. Glatiramer acetate is a synthetic (man-made) amino acid mixture that may resemble a protein component of myelin. It is thought that the immune system reaction against myelin in multiple sclerosis may be blocked or diminished by glatiramer acetate. A reaction occurring immediately after the injection of glatiramer acetate is common, affecting one out of 10 patients. The reaction may involve flushing, chest pain or tightness, palpitations, anxiety, shortness of breath, tightness in the throat, or hives. The reaction usually resolves within 30 minutes and requires no treatment. Some patients may be at risk of developing lipoatrophy, inflammation and destruction of fat tissue beneath the skin at the site of injection.

Natalizumab (Tysabri®)

Natalizumab (Tysabri®) is a drug approved by the FDA to treat relapsing multiple sclerosis. Natalizumab is a monoclonal antibody against VLA-4, a molecule required for immune cells to adhere to other cells, and penetrate into the brain. It is administered via monthly intravenous infusions. It carries a warning for a potentially fatal disease, progressive multifocal leukoencephalopathy (PML), a viral infection of the brain that usually leads to death or severe disability. For this reason only patients who have signed up for treatment under a controlled drug distribution program can receive treatment with natalizumab.

Natalizumab is used alone for the treatment of patients with relapsing forms of multiple sclerosis to delay the progression of physical disability and reduce the frequency of clinical relapses. The safety and efficacy of natalizumab beyond two years are unknown. The risk of PML may increase with prolonged exposure to natalizumab. Because natalizumab increases the risk of PML, it is generally recommended only for patients who have had an inadequate response to, or are unable to tolerate an alternate multiple sclerosis therapy.

Mitoxantrone (Novantrone®)

Mitoxantrone (Novantrone®) is approved by the FDA for the treatment of multiple sclerosis (SP-MS, PR-MS, and worsening RR-MS). Mitoxantrone is a chemotherapy drug that carries the risk of serious cardiac side effects or cancer (leukemia). Because of these serious side effects, physicians tend to reserve its use for more advanced or worsening cases of multiple sclerosis, and there is a limit to the total amount of mitoxantrone that can be administered. Cardiac monitoring prior to each dose and yearly following the last dose of mitoxantrone also is necessary.

Mitoxantrone is used for reducing neurologic disability and/or the frequency of clinical relapses in patients with SP-MS, PR-MS, or worsening RR-MS (for example, patients whose neurologic status is significantly abnormal between relapses). Mitoxantrone is not used in the treatment of patients with PP-MS.

Fingolimod (Gilenya®)

Fingolimod (Gilenya®) is a daily oral medication to treat MS that was approved by the US FDA in September 2010 as the first oral medication to treat MS. Although the exact mechanism of action of fingolimod is unclear, it appears to work by reducing the number of lymphocytes (a type of white blood cell that is important for immunity and the inflammation process) in the blood. Fingolimod is taken daily in capsule form. It is not a cure for MS, but it has been shown to decrease the number of MS flares and slow down the development of physical disability caused by MS. Like many injectable therapies for MS, the long-term safety of fingolimod is unknown. The most common side effects of fingolimod are headache, flu, diarrhea, back pain, elevations of liver enzymes in the blood, and cough. Other side effects are also possible including eye problems, so those taking this drug should have regular ophthalmologic evaluations.

Rebif (interferon beta-1a)

Tysabri (natalizumab)

Use: Treatment of relapsing forms of MS
How administered: Intravenous (in the vein)
Frequency of use: Every 4 weeks
Common side effects: Headache, feeling tired, and joint pain

B. Alternative treatments

Many patients use complementary and alternative medicine. Depending on the treatments, the evidence is weak or absent. Examples are a dietary regimen, herbal medicine (including the use of medical cannabis), hyperbaric oxygenation and self-infection with hookworm (known generally as helminthic therapy).

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