Multiple Sclerosis

What is Multiple Sclerosis?

Multiple sclerosis, otherwise known as MS, affects thousands of people across the world. The disease can be debilitating and progressive. Targeting the central nervous system, multiple sclerosis can make a sudden appearance or may cause a steady, gradual decline in health. Involving the brain, spinal cord, and optic nerves, multiple sclerosis is a disease that certainly should be studied and investigated. It is very important to learn more about this disease, especially if you or a loved one has been diagnosed with multiple sclerosis.

What Multiple Sclerosis Does

People suffering from MS often have problems with muscle control, balance, strength, and vision. They may also have problems with sensation and mental functions. The central nervous system is composed of nerves and nerve fibers. Multiple sclerosis works to attack the protective protein called myelin that surrounds nerve fibers. This process is called demyelination. This occurs when the protective protein is inflamed or destroyed because of multiple sclerosis. When the myelin protecting vulnerable nerve cells has been destroyed, the communication between the nerve cells is jumbled. This interrupts the normal flow of nerve impulses throughout the central nervous system and results in the symptoms experienced by people with multiple sclerosis.

There may be lesions or plaques in areas of the body where demyelination has occurred. When the cells that help to create and restore myelin are destroyed, the body cannot restore function or heal the damaged tissues. This results in damage to the nerve fibers, known as axons. Thus, the body is further damaged and disabled. People with multiple sclerosis may experience periods of relapse and recurrence, or they may experience a progression and worsening of the disease from the first onset of symptoms. The severity of the symptoms someone with multiple sclerosis might experience varies from person to person.

Many people who develop multiple sclerosis can get around unassisted, but eventually as many as 25 percent of those people will need some form of assistance, including a wheelchair. If you are caring for someone who has been diagnosed with multiple sclerosis or you have been diagnosed yourself, finding out as much information about the disease as possible will make understanding the battle easier.

The Types of Multiple Sclerosis

Not every patient who develops multiple sclerosis, or MS, will experience the same progression of symptoms. There are four different paths the disease may follow, varying from person to person. Each path has its own progression of symptoms and again varies in severity from person to person. The progression of the disease may be more or less steady, depending on the path that a particular patient’s disease follows.

Relapsing-Remitting Multiple Sclerosis:

The first type of multiple sclerosis occurs initially in the majority of patients diagnosed with the disease. In this case, symptoms may fade and then reappear periodically for many years. The recurrence and remission of symptoms is completely random and varies among patients. During remissions, the disease does not advance in severity. However, after relapses, symptoms may grow to be more severe.

Secondary-Progressive Multiple Sclerosis:

Secondary-progressive multiple sclerosis usually begins as relapsing-remitting multiple sclerosis does. Patients may experience a relapse, remission stage or stages of the disease. Then the disease will begin to slowly and steadily progress with damage to the spinal cord and brain. Some attacks and remissions may still occur. However, the patient’s symptoms will generally become constant and may continue to grow worse.

Primary-Progressive Multiple Sclerosis:

In this form of multiple sclerosis, the patient’s symptoms progress from the onset of the disease, becoming steadily worse over time. Brain and nerve function deteriorate gradually and there are no periods of remission. This type of the disease occurs in small numbers of people with multiple sclerosis.

Progressive-Relapsing Multiple Sclerosis:

Progressive-relapsing multiple sclerosis involves the more steady deterioration of nerve function that begins as soon as the first symptoms of multiple sclerosis appear. The patient can experience relapses and flare-ups in which the nerve damage continues to worsen. In this case, symptoms may worsen and become disabling even without an attack. This is a more rare course for the disease to take, however.

Once a patient has been diagnosed with multiple sclerosis, it is important to try to determine which path the disease will take. Since many forms of the disease can have relapses and remissions, it is important to be closely monitored by a doctor to see if progression of damage remains the same or continues to worsen over time.

What are the Causes of Multiple Sclerosis?

Unfortunately, scientists do not know the specific origins of multiple sclerosis, or MS. Yet while they don’t completely understand the exact causes of the disease, they can point to a number of factors that may hold the keys to the development of the disease in most people.

Environmental Factors

Multiple sclerosis affects different populations and ethnic groups across the world. Surprisingly, the disease has the highest prevalence in Scotland, Scandinavia, and Northern Europe. In the United States, the prevalence of the disease is higher in whites. According to statistics, African blacks and Japanese citizens rarely get the disease, if ever. However, interestingly enough, African Americans and Japanese Americans do develop multiple sclerosis.

Research has also revealed another fascinating piece of information about multiple sclerosis. Studies show that if you move to a new environment, you acquire the risk of that environment –whether higher or lower—if your move is prior to adolescence. This reveals that some type of environmental agent may influence the development of the disease prior to adolescence. Prevalence of multiple sclerosis also increases with the distance from the equator, and there have been epidemics of the disease. These factors contribute to the theory that the disease may be influenced by the actual environment.

Genetic Factors

Multiple sclerosis may also be inherited. Scientists believe multiple sclerosis may be influenced by multiple genes, however. A sibling to an multiple sclerosis patient has a two to five percent risk of developing the disease. Scientists also believe that some people may be genetically predisposed to developing multiple sclerosis and are then influenced by an environmental factor or virus that triggers an autoimmune response.

Viruses and Hormones

There have also been theories that viruses such as the flu, herpes, and measles may trigger some response in the body that can lead to multiple sclerosis. Sex hormones like estrogen, which may suppress the immune system, have also been blamed. This particular theory gains some credibility due to the fact that many women with multiple sclerosis who become pregnant –thus lowering estrogen and progesterone levels—may experience relief of symptoms, and the progression of their disease may slow.

Each theory may hold part of the key to the development of multiple sclerosis, and each one is an interesting point to consider when studying the disease.

What are the Symptoms of Multiple Sclerosis?

The symptoms of patients suffering from multiple sclerosis (MS) can vary dramatically. One patient may be hit suddenly like a sledge hammer. Another patient may experience a gradual onset of symptoms and a steady weakening of nerve function and communication. The disease generally occurs between the ages of 20 and 40, and there are a few different symptoms to note when studying the onset of multiple sclerosis.

What Happens

In the early stages of multiple sclerosis, a person may experience a few different symptoms. These symptoms include numbness, tingling, loss of balance, weakness in one or more limbs, and blurred or double vision. Symptoms that can also be experienced but are less common include slurred speech, lack of coordination, and the sudden onset of paralysis.

As the disease progresses, patients will begin to experience more debilitating symptoms depending on the rapidity of progression and the severity of their condition. These symptoms can include sensitivity to heat, fatigue, muscle spasms, and changes in perception or thinking impairment. Patients may also experience some sexual disturbances. Statistics reveal that as many as 10 percent of people with multiple sclerosis experience a form of thinking impairment. Approximately 55 percent of patients with the disease experience optic neuritis, a painful eye condition.

Patients may also experience tremors, which can be hard for doctors to treat effectively and which patients may find to be debilitating. Extremely rare symptoms of multiple sclerosis as the disease progresses can include breathing problems and seizures.

There are different types of symptoms, as well.

Primary Symptoms

These symptoms result directly from the demyelination process, including tremors, paralysis, loss of balance, and other symptoms.

Secondary Symptoms

Secondary symptoms, on the other hand, result from the primary symptoms. For example, a patient experiencing paralysis may spend a large amount of time immobile and may develop pressure sores (or bed sores), an example of a secondary symptom.

Tertiary Symptoms

These symptoms are the results of the primary and secondary symptoms, and they are also the result of having the disease itself. They include the social and psychological impact the disease has on its victim. One major tertiary symptom experienced is depression.

What Are the Tests for Multiple Sclerosis?

Patients who suspect they may have multiple sclerosis, or MS, may want to consider a few different tests to determine if they have multiple sclerosis. While there is no single definitive test for the disease, there are a few different criteria one must meet as well as different tests available to determine if multiple sclerosis is present.

The Basics

People with multiple sclerosis generally meet certain criteria for having the disease. However, not everyone who is diagnosed with multiple sclerosis will meet these criteria, and your doctor may diagnose you with the disease even if you do not. For example, people who develop multiple sclerosis are generally between 15 and 60, but the ages can vary. They may also have two or more lesions on the brain as multiple sclerosis develops, but this is not always the case, as well. To diagnose multiple sclerosis, your doctor will take a thorough medical history and then perform a neurological exam. Blood tests can also be performed to rule out other causes. In fact, as many as 10 percent of people have been misdiagnosed with multiple sclerosis when they had a disorder that mimicked the disease instead.

The Tests

Besides blood tests, your doctor may order an MRI, or magnetic resonance imaging. An MRI is the most convenient way for doctors to investigate any changes to the brain that could be caused by MS, including lesions and scar tissue on the brain and spinal cord. Your doctor may also wish to perform a spinal tap in order to examine the cerebrospinal fluid. This procedure can be very useful in analyzing this fluid but is no longer deemed necessary or vital to perform.

Your doctor may also try a test called evoked potentials. During this test, wires attached to the scalp test the brain’s response to certain electrical stimulations to determine if any visual, sensory, or auditory pathways are impaired.

Sometimes people may be diagnosed with multiple sclerosis when there is no other explanation for their symptoms, but the tests available can help to rule out any other potential health problems and make the diagnosis more definite.

Drug Treatment Overview for Multiple Sclerosis

Fortunately for patients suffering from multiple sclerosis (MS), there are numerous prescription drugs on the market today used to fight the disease. These drugs have been shown to be effective in quelling the symptoms of multiple sclerosis. The medications help to slow the progression of the debilitating disease and help to lessen the disabling effects of multiple sclerosis.

Disease-Modifying Drugs

Most of the drugs available to treat multiple sclerosis are known as disease-modifying drugs. These drugs include the prescriptions Avonex, Betaseron, and Rebif. These medications are examples of interferon drugs. Interferons are proteins in the immune system that work to control the immune system’s activity. They also have antiviral properties. These drugs are administered by injection, some simply beneath the skin, others by vein, and others into the muscle of the patient.

These medications work by suppressing the activity of the body’s immune system. This assumes the scientific theory that multiple sclerosis may develop as a result of an abnormal immune system response in the body that causes the body’s immune system to attack the myelin, or protective nerve coating, in the body.

These drugs work to reduce the severity of attacks multiple sclerosis patients experience and also to reduce their frequency. The drugs have also been shown to slow the progression of the disease and to reduce the disabling affects of the disease. Patients who are considering taking such drugs should consider each drug’s side effects and benefits with their doctor.

Other Treatments

There are other treatments available as well, such as the use of chemotherapy drugs. There are several therapies that have been developed to take more drastic action in the case of patients with severe symptoms that appear to be quickly progressing. These types of drugs can work well for patients who have failed to respond to other medications. While these drugs may have strong side effects, they may often be the only hope for patients living with severely progressing multiple sclerosis. The risks associated with taking these drugs may be well worth it if they are the patient’s only remaining option. Talk to your doctor to determine which category of treatment is best for your condition.

Chemotherapy for Patients with Multiple Sclerosis

For patients suffering from symptoms of multiple sclerosis, or MS, that appear to be worsening each day, there may be few options remaining. These is especially true if the patient has failed to respond to more conventional forms of medication. There are forms of treatment available now that involve the use of chemotherapy to assist in restoring the body’s healthy immune system by basically starting from scratch.

A Last Resort

This particular use of chemotherapy to treat multiple sclerosis is considered a last resort. It is reserved for patients whose symptoms grow progressively worse each day and do not appear to be getting better at all. These people have also failed to respond to other medications and thus a more drastic approach is needed. This particular treatment calls for a radical measure: the total elimination of the body’s immune system so that it may be replaced and allowed to be healthy again. Patients will be administered high-dose whole body irradiation after which they will have their bone marrow completely wiped out. Bone marrow is where immune system and other cells are produced. Then, patients will be administered special antibodies to ensure the death of any remaining cells in the blood.

When treatment begins, patients will receive an immune boosting injection that fills the blood with stem cells. These stem cells are drawn from the patient and then injected again to help kick start new growth in the immune system. Some results have shown that many patients did not need to continue taking multiple sclerosis drugs after this drastic form of treatment. Many patients who have undergone this type of therapy remain stable. However, some patients do need to continue drugs, and some patients have actually gotten worse. It is worth discussing with your doctor, however, especially if you are suffering from chronic symptoms with no response to normal medications.

Novantrone is a drug also prescribed to patients with multiple sclerosis. Novantrone is a chemotherapy drug that may work alone or in combination with other drugs. Patients that have been taking another popular drug –Betaseron—with no response may combine the drug with Novantrone to see results. Eventually, less Novantrone will be used, and patients can return to taking doses of Betaseron or another drug. Some side effects to consider include hair thinning, loss of menstruation, and stomach and intestinal problems. Women who plan to become pregnant during the course of treatment should not take this medicine.

COX-2 Drugs and Multiple Sclerosis

COX-2 drugs work similarly to popular anti-inflammatory pain relievers like naproxen and ibuprofen. Although the makers of COX-2 drugs have not advertised these types of drugs as being more effective than naproxen or ibuprofen, the drugs do carry a lower risk of stomach and intestinal side effects.

The Benefits

COX-2 drugs help to relieve pain and inflammation in patients suffering from multiple sclerosis, or MS. As the disease progresses in patients with MS, they may experience pain or inflammation in certain areas of their bodies. While COX-2 drugs are part of a group of medications called non-steroidal anti-inflammatory drugs that are most popularly prescribed for arthritis patients, they can also be beneficial to patients living with multiple sclerosis. These drugs are particularly beneficial to patients with a tendency toward intestinal problems or stomach bleeding. The COX-2 drugs may be less irritating and toxic to the stomach and gastro-intestinal lining than the other anti-inflammatory drugs such as naproxen and ibuprofen.

Precautions

While these drugs do hold benefits for people living with multiple sclerosis, they should be taken with caution just as other prescription drugs are. There is evidence that these drugs increase the risk of heart problems in patients 65 and over. Examples of these drugs include Bextra and Celebrex. However, the concern for heart problems also extends to anyone with a history of heart problems or anyone who carries an underlying risk of heart disease or stroke. In these patients, COX-2 drugs should be used with caution.

Patients who have a history of edema, or fluid retention, and high blood pressure should be monitored, as well. The COX-2 drugs may make high blood pressure and fluid retention worse. Also, patients with a history of kidney problems should take these drugs with caution as they may carry a risk for kidney problems, as do many anti-inflammatory drugs.

One piece of good news concerning the side effects associated with COX-2 drugs is that the risk of heart disease and stroke does not continue after patients have stopped taking the drugs. Studies have shown no adverse effects on the hearts of patients once they discontinue use of the medications. However, it is still a good idea for patients to maintain regular visits with their doctor for monitoring of any future concerns.

Caring for People with Multiple Sclerosis

People who have been diagnosed with multiple sclerosis, or MS, face a variety of physical and emotional challenges during the course of their disease. The caregivers and loved ones of patients diagnosed with multiple sclerosis also face the challenge of dealing with the diagnosis. Spouses, children, and relatives may face difficult times as both they and their loved one deal with the progression of the disease. There are a few important steps these people can take in caring for a person with multiple sclerosis.

The Importance of Attitude

People who have a loved one who has just been diagnosed with multiple sclerosis will experience a range of emotions, just as the patient will. Although the initial shock and denial of the diagnosis will eventually fade, the emotional rollercoaster many patients and their loved ones experience may continue through the progression of the disease, following its ups and downs. Children of people diagnosed with multiple sclerosis may have an especially hard time adjusting to the diagnosis. They may feel resentment, fear, anger, and embarrassment. All of these emotions are normal in the moderate sense of the word, but sometimes children may need counseling of their own, as they may also experience depression and other emotions of concern.

The most important thing people caring for a person with multiple sclerosis can do is to keep a positive attitude. While this is just as important for the patient battling multiple sclerosis, the loved ones of a person with the disease must remain equally strong and supportive. With a disease like multiple sclerosis, it is necessary to adopt a positive attitude to cope with the ups and downs and numerous changes of the disease as it progresses. The caregivers of a person with multiple sclerosis must realize the patient is still the same person as before the diagnosis.

Just as people dealing with the disease may face feelings of sadness and depression, so may the caregivers. Feelings of depression should be addressed by a doctor or counselor, and medication may be needed. Learning how to manage stress and maintaining a healthy lifestyle with a balanced diet and exercise can greatly aid in keeping a brighter outlook.

Patients and caregivers alike may also greatly benefit from support groups. Sometimes hearing other people’s stories who are experiencing the same challenges and emotions can be the biggest lift and support people need.

Non-Prescription Therapies for People with Multiple Sclerosis

While medication is almost always recommended for patients living with multiple sclerosis, or MS, patients may also wish to consider additional alternative therapies. Patients should always consult their doctors before beginning a new routine such as an exercise program or a new form of therapy like acupuncture. It is also important to share information about the disease with anyone from whom patients will be receiving treatment, like a massage therapist, for example.

The Basics

Alternative therapies are not scientifically documented as effective treatment for a certain disorder as traditional methods like medication are. However, this does not mean these therapies do not hold benefits for patients with multiple sclerosis. First, however, it is important to start with the basics. Patients living with a progressive disease like multiple sclerosis should practice a healthy routine of a well balanced diet and exercise. While this is important for anyone, it is necessary for patients living with multiple sclerosis to live as healthfully as they can and to try to maintain a healthy weight. Also, maintaining a positive outlook can do wonders for patients living with the disease.

Patients will benefit from a good solid exercise routine but not from a routine which results in pain or muscle stiffness, as they will already be suffering from such because of the disease. Instead, exercises like yoga, swimming, and other gentle routines are the best types of exercise for multiple sclerosis patients. These can help build balance and suppleness in patients with multiple sclerosis. Therapeutic horseback riding can also be extremely beneficial. It is important to build such an exercise routine under the guidance of a physician.

Other Therapies

Patients with multiple sclerosis may also benefit from therapies like acupuncture and massage. Acupuncture must be done with a new needle each time since it does break the skin. The therapy may relieve muscle spasms, pain, and bladder control symptoms. Massage can also aid in relieving muscle tension and depression.

Certain oral supplements like linoleic acid, which is found in sunflower seeds and safflower oil, can relieve some of the symptoms multiple sclerosis patients experience. It is important for people with multiple sclerosis to avoid any therapies with big promotions, claims, and “secret formulas,” because these are neither healthy nor beneficial forms of therapy and may even be types of scams. Stick to therapies performed by certified acupuncturists and massage therapists or ask your doctor for more advice before beginning another form of therapy.

What is the Patient Outlook for People with Multiple Sclerosis?

The outlook for people living with multiple sclerosis, or MS, varies from person to person. While some people may experience repeated periods of relapse and remission, other people may endure the steadily worsening symptoms of the disease. The overall outlook depends on which forms of treatment the patient takes and the lifestyle of the patient.

A Varying Disease

Multiple sclerosis really varies from person to person in terms of the progression and severity of symptoms. Depending on the progress of demyelination in the body, the person may experience debilitating symptoms early on, or may retain most of his functions for the rest of his life. Eventually, approximately 25 percent of patients diagnosed with MS will need the assistance of a wheelchair or some other form of assistance such as a cane. However, being diagnosed with MS does not have to be a death sentence. It is important for patients to pursue the safest but most aggressive form of treatment appropriate to their symptoms in order to delay the progression of the disease as much as possible.

There are treatments available with certain fewer side effects than other drugs, but these treatments may carry their own unique effects, as with the COX-2 drugs and heart problems. However, these treatments may be the key in slowing the progression of MS and relieving many of the symptoms that patients experience. Other treatments are reserved for patients with more severe symptoms, such as chemotherapy-type drugs and treatments involving the eradication and renewal of the patient’s immune system. These treatments are especially for patients who have reached a bleaker point in their outlook, and they may have positive results for these patients.

The patient outlook, while depending largely on the individual’s experience with MS, also depends on the patient’s attitude. One recurrent theme in the treatments and therapies for MS is keeping a positive attitude. Doing so will make dealing with the symptoms of this chronic disease a more manageable experience. Seeking counseling when a brighter outlook eludes you is one of the best things a patient with MS can do. As medical technologies continue to improve, the outlook for patients with MS will become ever brighter, but the basics of a can-do attitude will carry patients a long way.