What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a chronic disease of the central nervous system (brain and spinal cord). It is an unpredictable condition that can be relatively benign, disabling, or devastating. Some individuals with MS may be mildly affected while others may lose their ability to write, speak, or walk - when communication between the brain and other parts of the body becomes disrupted.

What causes multiple sclerosis?

The exact cause of MS is not known. It is likely to result from interactions between genetic factors and environmental influences.

• Genetic Factors-
  No single gene has been identified to date as a cause of MS. Based on a number of observations, MS is believed to be a "polygenic" disease, meaning that a number of genes predispose a person to developing MS in the appropriate setting.
  
  

• Environmental Factors-
  Although a number of infectious and toxic factors have been proposed as a cause of MS, none have been proven to do so definitely. The most studied contenders are infectious agents such as bacteria and viruses.
  
  

What are the symptoms of MS?

The symptoms of MS are numerous. They may be mild or severe, of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. The following are the most common symptoms of MS. However, each individual may experience symptoms differently. Symptoms may include:

• initial symptoms of MS:
  The following are often initial symptoms of MS:
  
  
  • blurred or double vision
    
    
  • red color distortion
    
    
  • pain and loss of vision due to optic neuritis, an inflammation of the optic nerve
    
    
  • difficulty walking
    
    
  • paresthesia - abnormal sensation, or pain, such as numbness, prickling, or "pins and needles."
    
    
  • muscle weakness in the extremities (partial or complete paralysis is possible)
    
    
• other symptoms of multiple sclerosis:
  Throughout the course of the illness, an individual may experience any/all of the following symptoms, to a varying degree:
  
  
  • difficulty with coordination (impaired walking or standing may result)
    
    
  • spasticity - the involuntary increased tone of muscles leading to stiffness and spasms.
    
    
  • fatigue (this may be triggered by physical activity, may subside with rest; constant, persistent fatigue is possible)
    
    
  • loss of sensation
    
    
  • speech impediments
    
    
  • tremor
    
    
  • dizziness
    
    
  • hearing loss
  
  
  
  • bladder or bowel problems
  
  
  
  • psychological problems (Depression, Anxiety, Mood Swings)

  Approximately 50 percent of all people with MS experience cognitive impairments related to their disease. The effects of these impairments may be mild, often detectable only after comprehensive testing, and may include difficulty with any/all of the following:
  
  

  • concentration
  • attention
  • memory
  • poor judgment

Symptom categories of MS:

primary symptoms - a direct result of demyelination, the destruction of myelin (the fatty sheath that surrounds and insulates nerve fibers in the central nervous system) may result in the following: weakness numbness tremor loss of vision pain paralysis loss of balance bladder and bowel dysfunction

secondary symptoms - complications that arise as a result of the primary symptoms, for example: paralysis can lead to bedsores bladder dysfunction may cause repeated urinary tract infections inactivity can result in weakness, poor postural alignment and trunk control, muscle imbalances, decreased bone density, and/or shallow, inefficient breathing

tertiary symptoms - the social, vocational, and psychological complications of the primary and secondary symptoms, for example: a person who becomes unable to walk or drive may lose his/her livelihood strain of dealing with a chronic neurological illness may disrupt personal relationships depression is often seen among people with MS

The symptoms of MS may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is multiple sclerosis diagnosed?

With today's medicine, there is no definitive test available to diagnose multiple sclerosis. However, a probable diagnosis can be made by following a careful process which demonstrates findings that are consistent with MS, that also rule out other causes and diseases.

What are the two criteria used when diagnosing MS?

1. There must have been two attacks at least one month apart. An attack is a sudden appearance of or worsening of any MS symptom or symptoms that lasts at least 24 hours.
   
   
2. There must be more than one area of damage to the central nervous system myelin, the sheath that surrounds and protects nerve fibers, which must have occurred at more than one point in time and was not caused by any other disease.
   
   
3. A gradually progressive worsening of gait for more than a year.

What does an evaluation for MS cover?

Evaluation for MS often covers an extensive review of the following:

• mental (cognitive) functions
• emotional functions
• language functions
• movement and coordination
• vision
• balance
• functions of the five senses
• sesory functions

Evaluation procedures for MS:

The following may be used when evaluating for multiple sclerosis:

• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; to detect the presence of plaques or scarring caused by MS.

• evoked potentials - procedures that record the brain's electrical response to visual, auditory, and sensory stimuli; to show if there is a slowing of messages in the various parts of the brain.

• cerebral spinal fluid analysis (Also called spinal tap or lumbar puncture.) - a procedure used to make an evaluation or diagnosis by examining the fluid withdrawn from the spinal column; to check for cellular and chemical abnormalities associated with MS.

• blood tests (to rule out other causes for various neurological symptoms)

Treatment for MS:

With advances in medicine, several drugs are now available to help patients with multiple sclerosis. Specific treatment for MS will be determined by your physician based on:

• the type of MS
• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatments for the conditions associated with MS may include the following:

• medication
• clinical trials
• assistive technology
• rehabilitation activities

Rehabilitation for people with MS:

Rehabilitation varies depending upon the range, expression, severity, and progression of symptoms. MS rehabilitation may help to accomplish the following:

• restore functions that are essential to the activities of daily living (ADLs)

• help the patient to reach maximum independence

• promote family involvement

• empower the patient to make the appropriate decisions relating to his/her care

• educate the patient regarding the use of assistive devices (i.e., canes, braces, walkers, wheelchairs)

• establish an appropriate exercise program that promotes muscle strength, endurance, and control

• reestablish motor skills

• improve communication skills for patients who have difficulty speaking because of weakness or incoordination of face and tongue muscles

• manage bowel or bladder incontinence

• provide cognitive retraining

• adapt the home environment to emphasize function, safety, accessibility, and mobility