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Healthcare: Neurology

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Master
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About Multiple Sclerosis

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Multiple sclerosis is a chronic, often disabling, neurological disease that affects the central nervous system (the brain, optic nerves and the spinal cord). The disease most commonly causes relapses, which are episodes of neurologic symptoms, followed by periods of improvement (remission).

As the disease progresses, recovery from each relapse may become less and less complete, and permanent neurologic deficits may build up. Although the cause of MS is not yet known, whatever it is appears to create abnormalities in the immune system, which normally provides protection from illnesses and viruses. Most scientists attribute this pathology to altered immunity possibly triggered by a virus in a genetically susceptible individual. With MS, cells that should fight off viruses begin to turn against healthy tissue and attack the protective coating of the central nervous system. A fatty covering or myelin sheath insulates each nerve fiber that makes up the central nervous system, much like insulation covering electrical wires. This myelin sheath helps transmit messages or nerve impulses to and from the brain and other parts of the body. These nerve impulses give instructions that control motor functions such as walking or writing. They also relay information back to the brain from other parts of the body. When the nerve loses part of its myelin coating or becomes demyelinated, the message being transmitted is short-circuited or distorted. Patches of myelin are replaced with scar tissue. As the scar tissue hardens or thickens, it begins to permanently interfere with messages sent by the nerve impulses, and permanent neurologic symptoms can result. The location of this scar tissue within the central nervous system determines which specific systems will develop. This is why symptoms of the disease, or combinations of symptoms, are unique to each person with MS.

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Symptoms

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Symptoms may be mild such as numbness in the limbs or severe such as paralysis or loss of vision. Most people with MS are diagnosed between the ages of 20 and 40, but the unpredictable physical and emotional effects of MS can be lifelong. The peak age of onset is 30 years. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are giving hope to those affected by the disease. MS affects women more often than men, by a ratio of about three to one. MS is one of the major causes of neurologic disability in adults under age 65. In its early stages, MS tends to follow a relapsing-remitting pattern. Symptoms flare up when inflammation hits a part of the brain. This is known as a relapse. Relapses are usually followed by a return to normal function, which is known as remission. The process is progressive in some individuals and periodically active and inactive in others. Rare individuals may have an initial attack and never experience a recurrence.

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Diagnosis

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Due to the nature of the symptoms of MS, it may be a difficult disease to diagnose initially. In addition, MS symptoms may mimic many other neurologic disorders. A history of at least two attacks separated by a period of reduced or no symptoms may indicate the pattern of attack/remission seen with MS. The increased use of MRIs has resulted in more timely diagnosis of MS in many cases.

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Treatment

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Currently there is no medication to absolutely prevent or cure MS but a number of anti-inflammatory type treatments and experimental autoimmune treatments are being used. There are two equally important approaches to treating MS. One approach attempts to slow down or halt the course of the disease by using medication to reduce the underlying inflammation and autoimmune attack against the nervous system. It is best to start on such a disease modifying treatment (DMT) as early after diagnosis as possible.  The other approach involves relieving or controlling the symptoms of MS and managing acute relapses. The variety of available treatment options in a clinical setting causes most patients to feel more comfortable seeking treatment at a comprehensive care center.

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