Definition

Multiple sclerosis (MS) is a chronic, disabling disease of the central nervous system. The disease causes inflammation, destruction, and scarring of the sheath that covers nerve fibers, called myelin, in the brain and spinal cord. As a result, electrical signals from the brain are slowed or blocked from reaching the eyes, muscles, and other parts of the body.

	Nerve Fiber (Neuron)
	© 2008 Nucleus Medical Art, Inc.

There are several types of MS:

• Relapsing-remitting MS—Symptoms suddenly reappear every few years, last for a few weeks or months, then go back into remission. Symptoms sometimes worsen with each occurrence.
• Primary progressive MS—Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
• Secondary progressive MS—After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
• Progressive relapsing MS—Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.

Causes

Malfunction of the body's immune system seems to be the cause of MS, but the exact cause of this malfunction is unknown.

The following conditions may contribute to MS:

• Viral or other infection
• Genetic factors (heredity)
• Environmental factors
• Degeneration of parts of the nervous system

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 potentials—a 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:

• Corticosteroids—to 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 relaxants—to 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.

Harrison’s 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.

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