Multiple Sclerosis

Risk Factors A risk factor is something that increases your chance of getting a disease or condition.Risk factors for MS include: Sex: female Age: 15 to 50 years old Exposure to certain viruses Family members who have MS Northern European descent Growing up in a colder climate, as opposed to a tropical climate Symptoms Symptoms may range from mild to severe and may include: Numbness or tingling in the face or limbs Impaired vision in one or both eyes, including: Blurred vision Double vision Loss of vision Eye pain Fatigue Dizziness Muscle stiffness Muscle spasms Muscle weakness Incoordination or falling Trouble walking or maintaining balance Weakness in one or more limbs Bladder problems including : Urgency Hesitancy Incomplete emptying Incontinence Bowel problems, including constipation Sexual dysfunction Slurred speech Difficulty swallowing Forgetfulness, memory loss, and confusion Difficulty concentrating or solving problems Depression Factors that may trigger or worsen symptoms include:

Heat including: Hot weather Hot baths or showers Fever Overexertion Infection Diagnosis The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include: MRI scan a type of machine that uses a magnetic field, radio waves, and a computer to check for damage to the myelin sheath of the nerves in the brain and spinal cord Evoked potentialsa test that records the electrical responses evoked after a sensory stimulus Lumbar puncture (spinal tap)removal of a small amount of fluid from around the spinal cord to check for white blood cells, antibodies, and proteins Treatment The goals of MS treatment are to relieve symptoms, prevent relapses, delay disability, and slow disease progression. Treatments include: Medications Medications may include: Corticosteroidsto reduce nerve tissue inflammation and shorten MS flare-ups Interferon beta (a protein that naturally occurs in the body)used to suppress the immune system Glatiramer acetate to help prevent MS relapses by modifying the function of the immune system Other immunosuppressive drugs such as: Mitoxantrone Azathioprine (off-label treatment option) Methotrexate (off-label treatment option) Intravenous immunoglobulin Natalizumab for relapsing MS (This medication is under a mandatory registration program.) Muscle relaxantsto treat muscle spasms or stiffness Other drugs to treat: Fatigue Depression Pain Bladder or bowel problems Physical Therapies and Lifestyle Changes Therapies and changes may include:

Regular moderate exercise with your doctor's permission (swimming is especially beneficial.) Physical therapy to help maintain muscle strength and tone, dexterity, and walking ability Massage High fiber diet to prevent constipation Stress reduction techniques Psychological Therapies Individual or group therapy will help you learn coping strategies for physical symptoms and emotional stress. Prevention There are no guidelines for preventing MS, because the cause is unknown. To prevent flare-ups or worsening symptoms if you have MS: Take medications as prescribed. Avoid hot weather. Stay in air-conditioned places during periods of hot weather. Get adequate rest. Get regular, moderate exercise with your doctor's permission. Avoid hot showers or baths. Make sure to get enough fiber in your diet. To aid in stress reduction, consider getting regular massages. RESOURCES: Multiple Sclerosis Association of America http://www.msaa.com National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/ National Multiple Sclerosis Society http://www.nationalmssociety.org CANADIAN RESOURCES:

MS Program http://www.msprogram.ca/Default.aspx Multiple Sclerosis Society of Canada http://www.mssociety.ca/en/default.htm References: Bradley WG, Daroff RB, Fenichel G and Jankovic J. Neurology in Clinical Practice e-dition. 4th ed. Butterworth Heinemann; 2003. Available at: http://www.nicp.com/content/default.cfm . Accessed October 25, 2007. Harrisons Principles of Internal Medicine . 16th ed. The McGraw-Hill Companies; 2006. Mayo Clinic and Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . The Merck Manual of Medical Information . Simon and Schuster, Inc; 2000. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm . Accessed October 25, 2007. Rose JW, Carlson NG. Pathogenesis of multiple sclerosis. Continuum Lifelong Learning Neurol. 2007;13:35-62. Last reviewed November 2007 by J. L. Chang, MD, FAASM Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.