Multiple Sclerosis
By Dr. Susanne Birnstiel
The symptoms of MS differ greatly since they depend on the function of the affected neural system. Frequently the first noticed symptoms concern the eyes. These may range from blurred vision to red-green confusion to blindness. Other common symptoms include:
∙ numbness
∙ tingling
∙ muscle pains
∙ weakness in hands and feet
∙ problems with…
balance
sexualilty
bladder and bowels
∙ fatigue
∙ depression
The underlying cause of MS is not
known and likely consists of a combination of the following factors:
1) autoimmune processes, in which the body –for unknown reasons- attacks one of its own substances (similar to rheumathoid arthritis)
2) environmental factors: one theory is a long-forgotten trauma or a common virus, like the mononucleosis virus, could cause damage that now triggers the white blood cells to attack myelin
3) genetic vulnerability: while the risk in the normal population is 1 in every 750 people, the risk for the child of an MS patient is somewhat higher at 1:40; also, MS occurs most frequently in people of northern European heritage
4) gender: women develop MS two to three times as often as men.
Since the symptoms are unspecific,
self-diagnosis of MS is impossible. To properly diagnosis MS, a doctor has to
check neurological symptoms on two exacerbations that last at least 24 hours,
with at least one month between the exacerbations. These two exacerbations have
to concern two different areas of the brain, and other possible explanations
for the symptoms must have been excluded. The clinical diagnosis may be aided
by tests such as:
1) an MRI, showing the lack of myelin in at least two different areas of the brain
2) examination of spinal fluid
3) the “evoked potentials test” should show slower-than-normal responses to visual, auditory or sensory stimuli.
The course of MS varies as widely
as the symptoms; the severity of symptoms, frequency of exacerbations, and
degree of disability are impossible to predict. In general, the following
clinical profiles are observed:
1) in the first 10-15 years, exacerbations of MS symptoms are usually followed by periods in which the symptoms diminish or entirely disappear; this can last for months or even years (relapsing-remitting MS)
2) about half the patients with relapsing-remitting MS develop secondary progressive MS, meaning that after the initial period, the symptoms start to get steadily worse
3) about 15% of patients experience steady worsening of symptoms with only minor periods of remission right from the start of the disease (primary-progressive MS).
The guidelines for the treatment
of MS are currently under revision since the FDA, in November 2004, issued
approval of natalizumab (Tysabri®). Natalizumab restrains the migration of the
damaging white blood cells from the blood (where they should be) into the brain
(where they should not be) and therefore keeps the white blood cells from
causing damage. So far, recommendations have been
1) disease-modifying drugs (interferons and glatiramer acetate) for relapsing-remitting MS; these drugs decrease the frequency and severity of exacerbations and slow down the accumulation of neurological damage
2) immunosuppressive chemotherapy with mitoxantrone for the progressive forms of MS
3) treatment with corticosteroids to counter the inflammation in acute exacerbations.
1) Life with MS can be pretty normal; however, since the disease is unpredictable, it may be prudent to nudge plans, such as those concerning career and housing into a direction that allows for some disability
2) discuss options for a healthy diet and physical exercise with your doctor; you will generally feel better, and a trained muscle is more likely to cope with an MS exacerbation than an untrained one.
3) There are numerous societies and organizations worldwide that offer information, advice and support for MS patients and their families.
