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What is Multiple Sclerosis?
- Multiple Sclerosis (MS) is a chronic, often disabling disease of the central nervous system (CNS) encompassing the brain, spinal cord and optic nerves. (1) (The nerve at the back of the eye that carries visual information from the eye to the brain.) In MS the body’s immune system attacks myelin, the fatty substance that surrounds and protects the nerve fibers in the CNS. The nerve fibers themselves can also be damaged. The damaged myelin forms scars ("multiple sclerosis" means "many scars") giving the disease its name. These scars interfere with communication between the brain and the rest of the body. (2)
Symptoms vary widely depending on the location and extent of the damage. They may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. MS is often difficult to diagnose early because symptoms can come and go. Symptoms of MS cause problems in signaling throughout the nervous system, which lead to symptoms such as tingling, numbness, blurred vision, and walking problems.
Presently, there is no cure for MS. However, there are treatments available to help treat attacks and symptoms and even modify the course of the disease. (3), (9)
What are the causes of Multiple Sclerosis?
Risk factors:
- Multiple Sclerosis has been considered an autoimmune disease, although this continues to be the subject of debate in the scientific community. No specific antigen has yet been identified in MS, leading many MS experts to conclude that MS cannot be classified as an autoimmune disease at this time. One indicator of MS is an abnormally high level of certain immune cells in the spinal fluid.
- Though it can occur at any age, MS most often begins between the ages of 20-40.
- Women are twice as likely to get MS as men.
- MS may be linked to the Epstein-Barr virus, which causes mononucleosis, though how Epstein-Barr increases the risk of MS is unclear.
- Caucasians, particularly those of Northern European descent, are at highest risk. Asians, Africans, and Native Americans are at lowest risk.
- Those with parents or siblings with MS have a 1-3% chance of having it themselves, compared to 0.1% of the general population. Those with an identical twin that has it, have a 30% chance of having it themselves.
- MS seems to occur more frequently in countries with temperate climates, such as Europe, the northern US, and southern Canada. Climate, however, seems to have no effect after puberty. (8)
- Thyroid disease, type 1 diabetes, and inflammatory bowel disease may increase one's chances of having MS.
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What are the characteristics of Multiple Sclerosis?
- Symptoms of MS, vary widely between people, but may include:
- Dizziness/Vertigo (feelings of spinning, whirling, falling, or tilting)
- Difficulty walking due to unsteadiness
- Fatigue
- Numbness/weakness/tingling/pain in one or more arms or legs or any combination of limbs, which typically occurs on one side of the body at a time or the bottom half of the body
- Spasticity (inability to control muscles)
- Loss of eyesight, usually in one eye at a time, with possible pain during eye movement (optic neuritis)
- Double vision or blurred vision
- "Electric shock" sensations from head movements such as brining the chin to the chest
- Lack of coordination, unsteadiness, tremors
- Bladder and Bowel Dysfunction
- Coginitive Dysfunction (5)
- Symptoms of MS come and go, sometimes disappearing for months at a time, making diagnosis more difficult. The symptoms and the severity of the condition depend on which specific nerves are damaged and the degree of the damage to them.
- Especially in the early stages of MS, symptoms appear, subside or completely vanish, then reappear.
- Appearance/worsening of symptoms may be triggered by heat.
- In extreme cases, people with MS can lose the ability to walk or speak. Other complications include bowel/bladder problems, muscle spasms and paralysis, and epilepsy.
There are four major "types" of MS:
Relapsing-Remitting MS (RRMS) -
Approximately 85% of people are initially diagnosed with relapsing-remitting MS (RRMS). RRMS is characterized by clearly defined attacks of worsening neurologic function. These attacks—which are called relapses, flare-up, or exacerbations —are followed by partial or complete recovery periods (remissions), during which no progression occurs.
Secondary-Progressive MS (SPMS) - develops in about 50% of people with RRMS. This happens gradually, often within ten years of initial diagnosis. The disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Thanks to disease modifying treatments, this number of people with SPMS is expected to decrease.
Primary-Progressive - Primary-progressive MS (PPMS) is characterized by a steady worsening of symptoms and disability without remissions. Only 10% of diagnosed cases of MS are classified as PPMS. The rate of progression may vary over time with symptoms that speed up, slow down or even improve temporarily.
Progressive-Relapsing MS (PRMS) About 5% of people with MS have progressive-relapsing MS (PRMS). In PRMS, people experience steadily worsening disease from the beginning with clear periods of attacks. These attacks may be followed by periods of recovery, but the overall disease course remains progressive. (6)
What are the statistics regarding Multiple Sclerosis?
- According to the National Multple Sclerosis Society, there are approximately 400,000 people living with MS in the United States..
- About 200 people per week are newly diagnosed.
- Worldwide, the estimate is 2.1 million people. (7)
Tests/Prognosis:
- There is still no cure for MS. There are however various treatment options that can modify the disease course, treat exacerbations, and manage symptoms.
- Blood tests and spinal taps are used to rule out diseases with similar symptoms to MS; spinal taps can also identify abnormal protein levels and white blood cell counts associated with MS. MRI's are used to see damage to the nervous system caused by MS.
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Awareness:
- Become aware of the affect on daily activities.
- MS symptoms vary widely between people and there are many hidden symptoms such as fatigue, cognitive dysfunction and visual problems.
- Fear of workplace discrimination causes many people to not disclose thier condition until absolutely necessary.
- Multiple Sclerosis Awareness week takes place annually during the first part of March and is sponsored by the National Multiple Sclerosis Society. They raise millions of dollars for research by sponsoring walks, bike runs and much more from MS chapters throughout the United States.
- People First Language from disabilityisnatural.com by Kathie Snow offers insight into society's use of language when using the term disability. The term disability is a societal construct to identify characteristics related to a medical condition that may entitle an individual for services or legal protections. The use of this language encourages freedom, respect and inclusion for all, and recognizes forms of language that can isolate, create negative stereotypes and place attitudinal barriers for individuals. "Using People First Language, putting the person before the disability—and eliminating old, prejudicial, and hurtful descriptors, can move us in a new direction. People First Language is not political correctness; instead, it demonstrates good manners, respect, the Golden Rule, and more—it can change the way we see a person, and it can change the way a person sees themself!" For more articles by Kathie Snow to "help us begin to use more respectful and accurate language and create positive change," visit People First Language and More
Viewpoint
- Each person's journey with Multiple Sclerosis is unique; symptoms should not be generalized or predicted.
On-Line Discussion
Visit our NHU Community Forum on Multiple Sclerosis for more insight, awareness, viewpoints, experiences, needs and solutions.
Treatments and Rehabilitation
- Because symptoms vary so greatly, it is best to work closely with a physician well versed in MS to develop a personalized treatment plan.
- Medications can reduce future disease activity for many individuals with relapsing forms of MS.
- Corticosteroids (a hormone) can lessen the severity of and/or shorten "flare ups."
- Rehabilitation can be useful in restoring function after flare ups.
- Corticosteroids (a hormone) can lessen the severity of and/or shorten "flare ups". Examples include oral prednisone and intravenous methylprednisolone.
- Interferons, which include drugs such as Betaseron, Avonex and Rebif, slow the rate at which MS symptoms worsen, but carry the risk of serious liver damage.
- Glatiramer (Copaxone), injected once daily, is believed by doctors to block damage to myelin by the immune system. Flushing and shortness of breath may occur after injection.
- Tysabri interferes with the movement of immune system cells from the blood to the brain and spinal cord. This drug is generally reserved for patients who see no results from other treatments or for whom other treatments aren't an option, as it increases the risk of progressive multifocal leukoencephalopathy, a fatal brain disease.
- Mitoxantrone (Novantrone) suppresses the immune system. This drug is generally reserved for patients with severe MS, as it can cause heart damage.
- Therapists can teach stretching/strengthening exercises to lessen the muscle-related symptoms of MS and demonstrate use of devices to make daily tasks easier.
- Plasma exchange, a procedure similar to dialysis, is sometimes used to combat severe MS symptoms, particularly if intravenous steroid treatments are not working.
Learn More about Multiple Sclerosis
Organizations and websites that provide information about Multiple Sclerosis.
- National Multiple Sclerosis Society offers this section on their website About MS, What is MS, Causes, Symptoms, Do I have MS?, Diagnosis information, Treatments, FAQs, and a glossary.
- 7 Multiple Sclerosis Facts You Should Know
written by Erica Roth,
Medically Reviewed by George T. Krucik, MD, MBA on July 18, 2013. This article has an overview of 9 points: Chronic Condition, Symptoms, Relapses, Cognitive Skills, Silent Progression, Stay cool, Vitamin D and Outlook. This is an informative article to assist those with MS.
- What Do You Want to Know About Multiple Sclerosis? on Healthline Networks written by June Halper, MSN, APN-C, FAAN, MSCN, Medically Reviewed on October 22, 2013 by George Krucik, MD, MBA offers comprehensive easy to read articles to understand, diagnose and treat your
Multiple Sclerosis with 7 Must-Know MS Facts, What Are the Early Signs of MS, A Closer Look: MRI Images of the MS Brain, 8 Common MS symptoms in Women, and more including taking control of MS, new treatments, natural remedies, and inspiration, coping strategies from people with MS. Be sure to check out Breaking News! New 3D Imaging Technique Shows Myelin Damage, Helps Diagnose MS
- Multiple Sclerosis Health Center by WebMD
References
1. “What Is MS?” National MS Society, © 1995-2011.
2. “Multiple Sclerosis-Causes,” Mayo Clinic, ©1998-2012.
3. “Multiple Sclerosis-Definition,” Mayo Clinic, ©1998-2012.
4. “What Causes MS?” National MS Society, ©1995-2011.
5. “Symptoms” National MS Society,
6. “Types of MS” MS Active Source-Biogen/Idec,©2012,
7. “FAQs About MS” National MS Society,
8. “Risk Factors,” Mayo Clinic.
9. Mayo Clinic: Multiple Sclerosis
10. National Multiple Sclerosis Society
11. WebMD: Multiple Sclerosis Health Center
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