Multiple sclerosis, sometimes called just MS, is a disabling neurological illness that affects the brain and spinal cord. The disease is usually progressive, meaning it continues to get worse over time.

Nerve cells normally are surrounded by an insulating sheath made of a fatty substance called myelin that helps to transmit nerve impulses. In MS, this myelin sheath is inflamed or damaged, which disrupts or slows nerve impulses and leaves areas of scarring called sclerosis. These areas of myelin damage and scarring are called MS plaques. In addition, recent evidence suggests that multiple sclerosis also damages nerve cells, not just their myelin lining.

The disruption of nerve signals causes a variety of symptoms that can affect vision, sensation and body movements. These symptoms usually come and go through a series of episodes when symptoms suddenly get worse (called relapses) alternating with periods of recovery when symptoms improve (called remissions). Many people have a long history of MS attacks over several decades. In these cases, the disease may worsen in "steps," when the attacks occur. For others, the disease worsens steadily. In a minority of patients, MS causes relatively few problems.

Although the exact cause of MS has been debated for decades, scientists now believe it is an autoimmune disease, which means the immune system mistakenly attacks its own body, in this case the myelin sheaths of the nerves. In some cases, the trigger for an MS attack seems to be a viral infection, but at other times, other physical or emotional stress is blamed. As a rule, the timing, duration and damage of MS attacks is unpredictable.

MS is the most common neurological disease in young people, and it affects more than 1 million young adults worldwide. It is 5 times more common in temperate climates than in the tropics and affects women twice as often as men. Close relatives of a person with MS are up to 7 times more likely than the average person to develop the disease themselves, and children of a person with MS have about 20 times the average risk. However, even though genetic (inherited) factors seem to play a large role in the development of this disease, no single MS gene has been identified. Recent evidence suggests, however, that certain variations in the interleukin 7 receptor gene may be importatnt as they are highly correlated with the risk of developing MS. This gene is involved in the development and upkeep of immune cells.

Although the symptoms of MS usually begin in someone who is younger than 40, people between ages 40 and 60 sometimes are affected.

Symptoms of MS vary depending on which areas of the brain and spinal cord are affected.

MS can cause the following problems:

• Sudden loss of vision; blurred or double vision
• Slurred speech
• Clumsiness, especially on one side
• Unsteady gait
• Loss of coordination
• Trembling of a hand
• A feeling of extreme tiredness
• Facial symptoms including numbness, weakness or pain
• Loss of bladder control (incontinence)
• Inability to empty the bladder
• Tingling, numbness or a feeling of constriction (constriction) in the arms, legs or elsewhere
• Weakness or a heavy feeling in the arms or legs

Your doctor will look for signs of neurological problems, including vision changes, difficulty in walking or in coordinating body movements, muscle weakness, trembling hands or loss of sensation.

To confirm the diagnosis of MS, your doctor probably will order a magnetic resonance imaging (MRI) scan of your brain and/or spinal cord to check for areas of inflammation and myelin sheath destruction. Other possible diagnostic tests include a detailed eye examination by an ophthalmologist (a physician who specializes in eye problems), special tests called evoked potentials to record electrical activity in the brain and a lumbar puncture (spinal tap) to obtain spinal fluid for analysis. Spinal fluid may show abnormal types of proteins called immunoglobulins, a characteristic finding in MS.

MS is a lifelong illness that can follow one of several different patterns. The three most common patterns are:

• Relapsing remitting MS � In this form of MS, there are relapses (episodes when symptoms suddenly get worse), followed by remissions (periods of recovery). Between relapses, the patient's condition usually is stable, without deterioration. While this type accounts for up to 90% of cases at disease onset, many people with relapsing remitting MS enter a secondary progressive phase (described below) over time.



• Primary progressive MS � In this form, symptoms worsen gradually and continuously. There are no episodes of relapses and remissions. This type accounts for about 10% of cases.



• Secondary progressive MS � In this form, someone who originally had relapsing remitting MS begins to have gradual deterioration in nerve function, with or without relapses. Secondary progressive MS ultimately affects 50% of people with relapsing remitting MS.

There is no way to prevent MS.

There is no cure for MS. There are two types of treatments: those that modify the immune system to suppress the disease, and those that improve the symptoms of MS.

The following treatments improve some of these symptoms of MS:

• Fatigue � Feelings of overwhelming exhaustion are common in people with MS, and can be improved with a variety of medications including pemoline (Cylert), amantadine (Symmetrel), methylphenidate (Ritalin) and certain antidepressants.



• Spasticity � Muscle tightness and spasms can be disabling for MS patients with spinal cord damage. These symptoms can be improved with medications such as baclofen (Lioresal), diazepam (Valium) and dantrolene (Dantrium).



• Bladder dysfunction � Bladder dysfunction is common in patients with spinal cord damage from MS, but symptoms can be improved with a variety of medications such as oxybutynin (Ditropan) or imipramine (Tofranil).



• Depression � This is a common problem for patients with MS, but this potentially disabling symptom can be improved with a variety of antidepressant medications.



• Neurological symptoms � Anti-seizure medications decrease the risk of repeat seizures, and these medications may reduce some of the uncomfortable neurological symptoms that commonly occur during MS attacks.

Treatments that suppress the disease include:

• Corticosteroid drugs � These are the primary treatment for MS relapses, and are often given intravenously (directly into a vein). Corticosteroids appear to shorten the length of MS relapses and may accelerate recovery in an attack, but their long-term effect on the course of the illness is not known.



• Interferon beta � This is used primarily to treat relapsing remitting MS, and it comes in three different injectable forms: interferon beta-1a (Avonex and Rebif), and interferon beta-1b (Betaseron). Studies have shown that these medications may lower the rate of MS relapses by as much as 30%. They may also reduce the risk of the disease getting worse and of disability, though not all studies have confirmed this.



• Glatiramer acetate (Copaxone) � This drug is an alternative treatment for relapsing remitting MS. Some physicians recommend this drug when interferon beta therapy cannot be used, has been used but is no longer effective, or is not tolerated well. Other experts prescribe it as initial therapy. It may be used in other patterns of MS but its overall effectiveness for them is less clear.



• Natalizumab (Tysabri) � This treatment is often prescribed when interferon and glatiramer treatment fail or are not tolerated in the treatment of active, relapsing remitting MS. This antibody inhibits the movement of immune cells into tissues of the nervous system, an effect that may prevent damage. Rare reports of progressive multifocal leukoencephalopathy (PML), a degenerative and potentially fatal brain disease, limit the use of natalizumab in MS.



• Other immune-modifying medications � Other medications that can be used to suppress the disease include azathioprine (Imuran), methotrexate (Folex, Methotrexate LPF, Rheumatrex), cyclophosphamide (Cytoxan, Neosar), mitoxantrone (Novantrone), daclizumab, cyclosporine (Gengraf; Neoral; Sandimmune) and cladribine (Leustatin).

Call your doctor immediately if you have symptoms of MS.

A minority of those with MS have a relatively harmless form of the illness, but the majority of patients suffer from some type of neurological disability over time. In general, MS is a progressive illness that can last 30 to 40 years, but the degree of progression and eventual disability varies from patient to patient. There is great hope that newer forms of treatment will have significant long-term effects in improving the lives of MS patients.

National Multiple Sclerosis Society
Toll-Free: 1-800-344-4867
http://www.nmss.org/

Multiple Sclerosis Foundation
6350 North Andrews Ave.
Fort Lauderdale, FL 33309-2130
Phone: 954-776-6805
Toll-Free: 1-800-225-6495
Fax: 954-938-8708
Email: support@msfocus.org
http://www.msfacts.org/