Understanding Multiple Sclerosis
Understanding Multiple Sclerosis
January 24, 2009
By Julie Stachowiak, Ph.D.

Multiple sclerosis is a chronic disease of the central nervous system. It is probably an autoimmune disease. What does this mean?

* Chronic disease: MS is not curable. However, there are treatments that are showing great promise for slowing down the progression of the disease.
* Disease of the central nervous system: The central nervous system is comprised of your brain and spinal cord.
* Autoimmune disease: This means that your body’s own immune system is attacking itself- in this case, targeting cells in your brain and spinal cord.

Note: Stay up-to-date on multiple sclerosis with my weekly MS newsletter.
What are the Symptoms of MS?

There are over 50 symptoms linked with MS, all which can vary in severity, duration and associated disability. The most common symptoms of MS are:

* Fatigue
* Depression
* Bladder dysfunction
* Numbness and/or tingling
* Sexual dysfunction
* Bowel dysfunction
* Pain
* Dizziness and vertigo
* Spasticity
* Vision problems
* Cognitive impairment

However, all of these symptoms are also common to many other diseases and disorders.
I Think I Have MS. What Should I Do?

If you are experiencing one or more of the symptoms listed and suspect that you have MS, you should see a neurologist. You can either find a neurologist yourself, or get a referral from your primary care physician. Although this is a difficult and scary time, try not to panic and continue to take care of yourself, including getting adequate sleep and rest. While some of the MS symptoms are dramatic, MS itself is not an acute disease – there is very little that is an emergency. It is important that you see a specialist (even if it takes some time to get the appointment) and go through the tests required in a logical manner.
How is MS Diagnosed?

MS is very difficult to diagnose on the basis of symptoms alone, because:

* There is such a large number of symptoms
* Symptoms may appear alone or in combination
* Symptoms can vary in severity
* Symptoms can disappear suddenly
* Symptoms are all common to other diseases

However, there is also no blood test to diagnose MS. Instead, neurologists rely on a combination of the following:

* MRI scans
* Medical history
* Neurologic exam
* Evoked potential testing
* Lumbar puncture
* Blood tests (used to rule out other things)

What Types of MS Are There?

* Relapsing-Remitting MS: The majority (about 85 percent) of people with MS receive an initial diagnosis of relapsing-remitting MS. This type of MS is characterized by definite periods of relapses, then a remitting of symptoms, where the person recovers either entirely or almost entirely.
* Secondary-Progressive MS: Within 10 years of an MS diagnosis, 50 percent of people diagnosed with relapsing-remitting MS will develop secondary-progressive MS, where the symptoms steadily worsen. However, this was the case before the disease-modifying therapies and we don’t yet know the impact of these medications on progression to secondary-progressive MS, but there are indications that the percent of people (who are taking disease-modifying therapy) who progress to this type might be much lower.
* Primary-Progressive MS: 15 percent of people are initially diagnosed with primary-progressive MS, a form of the disease in which there are no relapses or remissions, rather a steady course of progression.
* Progressive-Relapsing MS: Only six to ten percent of people receive this diagnosis. As with primary-progressive MS, the disease follows a steady course of progression, but the patient also experiences relapses of acute symptoms.

Can MS be Treated?

* MS treatment: MS cannot be cured. However, there are medications, called disease-modifying drugs, that work to slow down the damage and symptoms caused by MS by preventing relapses.
* Symptom management: There are excellent medications to address most symptoms. In addition, your doctor may prescribe behavioral or dietary modifications, physical therapy or psychosocial therapy.
* Relapse treatment: High-dose corticosteroids, usually taken intravenously, are used to reduce inflammation in the central nervous system, which can shorten the duration and severity of relapses.

What Causes MS?

No one knows what causes multiple sclerosis (MS), only that it is probably an autoimmune disease. Four main theories have emerged to attempt to explain MS. Each of these theories can explain a piece of the MS puzzle, but none explain everything. It is likely that the cause of MS is a complicated interaction of these four factors: the immune system, the environment, infectious diseases and genetics.
What is a Relapse?

A relapse is either a worsening of symptoms that you already have, or the appearance of new symptoms. Relapses are also referred to as “exacerbations,” “flares” or “attacks.”
What is my Prognosis?

This is difficult to predict, because everyone’s disease course and symptoms are different. Also, the introduction of the disease-modifying therapies seems to be greatly improving the statistics over time, but they are still so new that the long-term benefits are just starting to be seen.

However, the prognosis is the best for people with the following characteristics:

* Women
* Diagnosed before age 35
* Have long intervals between relapses and complete recovery from relapses
* Have relapses with sensory symptoms (such as numbness and tingling), rather than symptoms such as tremor or spasticity

MS usually has very little effect on life span, except in very severe cases.
Is There Anything I Should Avoid?

* Infection: Infections may cause relapses. Avoid getting sick by practicing good hand-washing and get a flu shot if your doctor recommends it.
* Overheating: Heat causes symptoms to get worse temporarily, so do your best to stay cool.
* Stress and Fatigue: There can be an increase in relapses during or right after periods of extreme stress. Fatigue makes all symptoms of MS more difficult to deal with.
* Stimulating Your Immune System: Several herbs have been shown to stimulate immune function, such as echinacea, Asian ginseng and licorice. These should be avoided – look for them in teas and “natural” cold remedies.

Hill, B A. Multiple Sclerosis Q & A: Reassuring Answers to Frequently Asked Questions. New York: Avery. 2003.

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