Alternate Names: MS

Causes and Risks:

Multiple sclerosis involves repeated episodes of inflammation of nervous tissue in any area of the central nervous system (brain and spinal cord). The location of the inflammation varies from person to person and from episode to episode. The inflammation destroys the covering of the nerve cells in that area (myelin sheath), leaving multiple areas of scar tissue (sclerosis) along the covering of the nerve cells.This results in slowing or blocking the transmission of nerve impulses in that area, leading to the symptoms of MS.

Symptoms vary because the location and extent of each attack varies. There is usually a stepwise progression of the disorder, with episodes that last days, weeks, or months alternating with times of reduced or no symptoms (remission). Recurrence (relapse) is common.

The exact cause of the inflammation associated with MS is unknown. Geographic studies indicate there may be an environmental factor involved with MS. It has a higher incidence in northern Europe, northern United States, southern Australia, and New Zealand than in other areas of the world.In some cases there maybe a familial tendency toward the disorder, with higher incidence in certain family groups than in the general population. An increase in the number of immune cells in the body of a person with MS indicates that there may be a type of immune response that triggers the disorder. The most frequent theories about the cause of multiple sclerosis include a virus-type organism, an abnormality of the genes responsible for control of the immune system, or a combination of both factors.

Multiple sclerosis (MS) affects approximately 1 out of 1,000 people. Women are affected more commonly than men. The disorder most commonly begins between 20 to 40 years old but can happen at any age. Risks include a family history of MS and living in a geographical area with a higher incidence rate for MS.

Prevention: There is no known prevention.

Symptoms:

• weakness of one or more extremities
• paralysis of one or more extremities
• tremor of one or more extremities
• muscle spasticity (uncontrollable spasm of muscle groups)
• muscle atrophy
• movement, dysfunctional
  • slowly progressive
  • beginning in the legs
• numbness, decreased or abnormal sensation in any area
• tingling
• facial pain
• pain in an extremity
• may start suddenly
• loss of vision -- usually affects one eye at a time
• double vision
• eye discomfort
• rapid eye movements, uncontrollable
• eye symptoms worsen on movement of the eyes
• decreased coordination
• loss of balance
• decreased ability to control small or intricate movements
• walking/gait abnormalities
• muscle spasms (especially in the legs)
• dizziness
• vertigo
• urinary hesitancy, difficult to begin urinating
• strong urge to urinate (urinary urgency)
• frequent need to urinate
• incontinence (leakage of urine, loss of control over urination)
• decreased memory
• decreased spontaneity
• decreased judgment
• loss of ability to think abstractly
• loss of ability to generalize
• depression
• decreased attention span
• slurred speech
• difficulty speaking or understanding speech
• fatigue, tired easily

• constipation
• hearing loss
• positive Babinski’s reflex

Signs and Tests:

Symptoms of MS may mimic many other neurologic disorders. A history of at least two attacks separated by a period of reduced or no symptoms may indicate the pattern of attack/remission seen in MS. If there are observable decreases in any functions of the central nervous system (such as abnormal reflexes), the diagnosis of MS may be suspected.

Examination by the health care provider may show focal neurologic deficits (localized decreases in function). This may include decreased or abnormal sensation, decreased ability to move a part of the body, speech or vision changes, or other loss of neurologic functions. The type of neurologic deficit may indicate, to some extent, the location of the damage to the nerves.

Eye examination may show abnormal pupil responses, changes in the visual fields or eye movements, nystagmus (rapid eye movements) triggered by movement of the eye, decreased visual acuity, or abnormal findings on a fundoscopy (an examination of the internal structures of the eye).

Tests that indicate or confirm multiple sclerosis include:

• head MRI scan that shows scarring or a lesion
• spine MRI scan that shows scarring or a lesion
• lumbar puncture (spinal tap)
• CSF oligoclonal banding
• CSF IgG index

Treatment:

There is no known cure for multiple sclerosis at this time. However, there are promising new therapies that may decrease exacerbations and delay progression of the disease. Treatment is aimed at controlling symptoms and maintaining function to give the maximum quality of life.

Patients with a relapsing-remitting course are now placed on immune modulating therapy that requires injection under the skin or in the muscle once or several times a week. This may be in the form of interferon (such as Avonex or Betaseron) or another medicine called glatiramer acetate (Copaxone). They are all similar in their effectiveness and the decision on which to use depends on side-effect profile.

Other than protective therapies, steroids aregiven to decrease the severity of an attack if it occurs. Other medicines include Baclofen, Tizanidine orDiazepammay be used to reduce muscle spasticity. Cholinergic medications may be helpful to reduce urinary problems. Antidepressant medications may be helpful for mood or behavior symptoms. Amantadine may be given for fatigue.

Physical therapy, speech therapy, occupational therapy, or similar forms of therapy may be helpful. This may improve the person’s outlook, reduce depression, maximize function, and improve coping skills. A planned exercise program early in the course of the disorder helps to maintain muscle tone.

Social work, counseling, and support groups may aid in coping. For this condition, see multiple sclerosis - support group. A healthy lifestyle is encouraged, including good general nutrition. Adequate rest and relaxation help to maintain energy levels. Attempts should be made to avoid fatigue, stress, physical deterioration, temperature extremes, and illness to reduce factors that may trigger an MS attack.

Prognosis:

The expected outcome is variable and unpredictable. Although the disorder is chronic and incurable, life expectancy can be normal or nearly so, with a life span of 35 or more years after diagnosis occurring commonly. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.

The amount of disability and discomfort varies with the severity and frequency of attacks and the part of the central nervous system affected by each attack. Commonly, there is initially a return to normal or near-normal function between attacks. As the disorder progresses, there is progressive loss of function with less improvement between attacks.

There is a rare, acute type of MS that can cause death within weeks to a few years. There is also a benign form of MS that develops relatively few symptoms for many years.

Complications:

• progressive disability
• urinary tract infections
• side effects of medications used to treat the disorder

Call your health care provider if symptoms indicate that multiple sclerosis may be present. This is a chronic condition, but symptoms may mimic or mask (disguise) symptoms of acute, serious conditions such as stroke.

Call your health care provider if symptoms progressively worsen despite treatment.

Call your health care provider if the condition deteriorates to the point where home care is no longer possible.