Overview and Facts
Multiple sclerosis (MS) is a potentially debilitating disease in which your body's immune system eats away at the protective sheath that covers your nerves. This interferes with the communication between your brain and the rest of your body. Ultimately, this may result in deterioration of the nerves themselves, a process that's not reversible.
MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve impulses are slowed down or stopped.
MS is a progressive disease, meaning the nerve damage (neurodegeneration) gets worse over time. How quickly MS gets worse varies from person to person.
The nerve damage is caused by inflammation. Inflammation occurs when the body's own immune cells attack the nervous system. Repeated episodes of inflammation can occur along any area of the brain and spinal cord. Researchers are not sure what triggers the inflammation. The most common theories point to a virus or genetic defect, or a combination of both.
Symptoms and Facts
Symptoms vary widely, depending on the amount of damage and which particular nerves are affected. People with severe cases of multiple sclerosis may lose the ability to walk or speak. Multiple sclerosis can be difficult to diagnose early in the course of the disease, because symptoms often come and go — sometimes disappearing for months.
Although multiple sclerosis can occur at any age, it most often begins in people between the ages of 20 and 40. Women are more likely to develop multiple sclerosis than are men.
MS is more likely to occur in northern Europe, the northern United States, southern Australia, and New Zealand than in other areas. Geographic studies indicate there may be an environmental factor involved.
People with a family history of MS and those who live in a geographical area with a higher incidence rate for MS have a higher risk of the disease.
Diagnosis
Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions.
People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.
The health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times.
A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. This may include:
- Abnormal nerve reflexes
- Decreased ability to move a part of the body
- Decreased or abnormal sensation
- Other loss of nervous system functions
An eye examination may show:
- Abnormal pupil responses
- Changes in the visual fields or eye movements
- Decreased visual acuity
- Problems with the inside parts of the eye
- Rapid eye movements triggered when the eye moves
Tests to diagnose multiple sclerosis include:
- Cerebrospinal fluid tests, including CSF oligoclonal banding
- Head MRI scan
- Lumbar puncture (spinal tap)
- Nerve function study (evoked potential test)
- Spine MRI
Treatment and Care
There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.
Medications used to slow the progression of multiple sclerosis may include:
- Immune modulators to help control the immune system, including interferons (Avonex, Betaseron, or Rebif), monoclonal antibodies (Tysabri), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), methotrexate, azathioprine (Imuran), cyclophosphamide (Cytoxan), and natalizumab (Tysabri)
- Steroids may be used to decrease the severity of attacks
Medications to control symptoms may include:
- Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine
- Cholinergic medications to reduce urinary problems
- Antidepressants for mood or behavior symptoms
- Amantadine for fatigue
The following may help MS patients:
- Physical therapy, speech therapy, occupational therapy, and support groups
- Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
- A planned exercise program early in the course of the disorder
- A healthy lifestyle, with good nutrition and enough rest and relaxation
- Avoiding fatigue, stress, temperature extremes, and illness