Multiple Sclerosis

Multiple sclerosis (MS) is a common, sometimes disabling neurologic disorder of young adults, affecting at least 300,000 Americans. The average age of diagnosis is 30, but it typically starts anywhere between the ages of 15 and 50. Occasionally, the disease begins in children or in older adults. Women are affected at least twice as often as men. Although all races may develop MS, it is more common in persons of northern European heritage or ancestry. Interestingly, people with MS seem to be distributed in a remarkable geographic pattern: the highest density occurs in those living furthest from the equator (that is, in temperate zones), suggesting that temperature and other environmental factors may play an important role in causation.

There are several forms of MS. Most people with MS begin with relapsing and remitting symptoms - that is, they experience an abrupt onset of neurological problems (like numbness or tingling, weakness, or unsteady gait) that either improve spontaneously or with treatment - only to come back again (or "relapse") in another way or time. Until recently, when the first truly effective treatments have become available, most people with relapsing MS eventually developed a secondary or chronic progressive form of the disease, which can often then lead to major disability.

In general, MS is not life threatening. The life expectancy of those with MS is only slightly less than that of the general population, and when premature death does occur, it usually is the result of complications such as pneumonia or other infections.

MS involves inflammation within the central nervous system (which includes the brain and spinal cord), followed by demyelination, which is the loss of the protective myelin sheaths which surround nerve fibers. Myelin is like the insulation surrounding and protecting electrical wires. When the myelin is damaged, nerve impulses are not quickly and efficiently transmitted. As a result of the inflammatory process, lesions (called MS "plaques") develop in the brain and spinal cord causing a variety of neurologic symptoms, such as a loss of sight or color vision, numbness or tingling, weakness, unsteady gait, double vision, neuralgic pains, fatigue, heat intolerance, partial or complete paralysis and electric shock sensations when bending the neck. These symptoms may go away or may remain after an attack of MS. They may get progressively worse over time. For individuals with progressive forms of the disease, these symptoms may gradually worsen over time without rapid or abrupt changes, not infrequently leading to disability.

Symptoms associated with relapses or attacks usually develop over a period of hours to days, persist for a matter of days or weeks, and then partially or completely disappear with or without treatment. New attacks may occur at irregular intervals which are usually not predictable.

The definitive cause of MS is unknown. It is known, however, that MS is not contagious and that a combination of inherited and/or environmental factors may contribute to the development of the disease. MS is slightly more likely when there is a close relative with the disease, implying a genetic predisposition. Exposure to a triggering agent, perhaps an unknown virus or toxin, may start the cascade of events that lead to this disease. There is strong evidence that MS is immune-related -- that is, the person's own immune system becomes abnormally stimulated to attack the myelin in the central nervous system.

There is no specific blood or other test that exactly pinpoints MS. The diagnosis of MS is based on a detailed clinical history and examination, showing evidence of multiple neurologic lesions over time, and the lack of an alternative diagnosis. Most often, the neurologist will order one or more complementary diagnostic tests which will help confirm the clinical impression. These tests might include a magnetic resonance imaging (MRI) scan, a lumbar puncture (LP, or spinal tap) to analyze the spinal fluid for changes characteristic of demyelination, or computer-assisted electrodiagnostic tests called evoked potential responses, which can also aid in the determination. The key is early and accurate diagnosis, which is best performed by a specialist like a neurologist.

While there is no prevention or complete cure for MS, the good news is that this is a promising time for patients with this disease. Modern neurological science now offers several new medications that have been shown to improve both symptoms and the underlying disease process itself. Current treatments fall into three main categories:

(1) Symptomatic treatments include medications to decrease muscle stiffness, improve fatigue, control bowel and bladder symptoms, pain, sexual dysfunction, etc.

(2) Acute therapies treat the individual MS attacks (exacerbations) when they occur. These are typically ACTH (an adrenal hormone) and corticosteroids (synthesized adrenal hormones) which are used to shorten or lessen the severity of an attack.

(3) Disease activity modifiers are the newest medications available. These are called modifiers because they can effectively alter the underlying pathological processes that are associated with MS. The first of these is interferon beta 1b (Betaseron®), and subsequently, interferon beta 1a (Avonex® or Rebif®) and glutiramer acetate (Copaxone®). In addition, a number of other agents normally used to treat certain cancers may also be administered in special circumstances, such as mitoxantrone (Novantrone®), azathiaprine (Imuran®), cyclophosphamide (Cytoxan®), and methotrexate.

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