Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system). Multiple sclerosis (MS) affects woman more than men. The disorder most commonly begins between ages 20 and 40. MS is manifested by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve impulses are slowed down or stopped. MS is a progressive disease, meaning the nerve damage gets worse over time. The nerve damage is caused by inflammation. How quickly MS gets worse varies from person to person. The disease can also be extremely debilitating.
There are four distinct categories of multiple sclerosis: Primary progressive MS causes steady progression of symptoms with few periods of remission. Relapsing-Remitting MS causes worsening of symptoms (exacerbations) that occur with increasing frequency, along with periods of reduced symptoms (remission). Secondary progressive MS is initially similar to relapsing-remitting MS but eventually follows a progressive course without remissions. Relapsing-Progressive MS causes cumulative damage during exacerbations and remissions.
The cause of the disease is unknown, but there are a number of suspected theories. Considerable studies have focused on the possibility that MS is a disease related to an impairment of the body’s immune system. In autoimmune diseases, the immune system reacts against the patients own body, rather than performing its normal protective role against illness. The clinical observation that MS sometimes occurs in families has served as a basis that there could be a genetic predisposition. Exposure to environmental agents such as bacteria and viruses may be a causative factor. There is also a higher incidence of MS in colder climates.
The most common early symptoms include sensory abnormalities (i.e. tingling, numbness, itching, tightness, burning, shooting pain in the back and limbs), difficulty walking, eye pain and vision loss. Symptoms of the disease vary, depending on where the damage occurs, and range from minor physical annoyances to major disabilities. As the disease progresses, symptoms can include many of the following:
- Balance and equilibrium abnormalities (i.e. dizziness, vertigo, uncoordinated movements and/or tremor)
- Bladder and bowel dysfunction (i.e. urgency, incontinence, nocturia and/or constipation)
- Behavioral changes (i.e. mood swings and/or depression)
- Cognitive dysfunction (i.e. impaired memory, reasoning or concentration)
- Facial numbness
- Motor abnormalities (i.e. muscle weakness, spasticity or spasm)
- Sexual dysfunction (i.e. erectile dysfunction or sexual inactivity)
- Vision abnormalities (i.e. eye pain, vision loss in one eye, double vision (diplopia) and/or involuntary eye movement (nystagmus))
Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks or months. These episodes alternate with periods of reduced or no symptoms. Fever, hot baths, sun exposure and stress can trigger or worsen attacks. Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body. There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of any treatment is to control symptoms and help maintain a normal quality of life.
Physical, speech and occupational therapy along with assistive devices (wheelchairs, bed lifts, walkers, wall bars, shower chairs) and planned exercise programs tend to help greatly. A healthy diet, rest and avoiding fatigue, stress, temperature extremes and illness are important for the MS patient as well. Household changes to ensure safety and ease in moving around the home are often needed. The outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.
There are many treatments that can alter the course for multiple sclerosis. There is a group of medications referred to as, “Immuno-Modulating Agents or “IMA’s” also commonly referred to as the “ABC’s”. These drugs include Avonex®, Betaseron® and Copaxone®. In the event that a patient has not responded or is no longer responding to the IMA’s, other therapies such as IVIG (intravenous immune globulin) or Mitoxantrone may be used alone or in combination with IMA’s. Introduction of these secondary medications is often associated with long periods of clinical remission.
It is important to note that through these combinations, patients have been able to achieve long periods of remission that may last for years. However, when things are not going well, medications may also be needed to relieve muscle spasms, reduce urinary and bowel problems, modify mood or behavior symptoms or reduce fatigue. In addition, steroids are often used to decrease the severity of attacks.
A chronic and unpredictable disease, such as multiple sclerosis, has significant impact not only on the patient but also on loved ones. The patient is not the only one who suffers. Partners and children must also cope with this often debilitating disease and the changes it may bring. If a person has little or no physical disability, the family life may not change at all. But, there may be times when changes need to be made that could include modifying family activities, choosing ones that are less physically demanding and time-consuming. The most important thing to do is to communicate openly about the emotions and issues related to MS. It is especially important for someone to explain to loved ones how MS affects the individual. Some symptoms of MS are not apparent to others, and family members depend on verbalization to let them know when a problem occurs.