About MS
Multiple Sclerosis (MS)
Multiple Sclerosis (MS) is an auto-immune disease of the central nervous system (CNS). In Multiple Sclerosis, inflammation of nervous tissue causes the loss of myelin, a fatty material which acts as a sort of protective insulation for the nerve fibers in the brain and spinal cord. This demyelination leaves multiple areas of hard scarred tissue (plaques) along the covering of the nerve cells. Another feature of MS is the destruction of axons, which are the long filaments that carry electric impulses away from a nerve cell. The demyelination and axon destruction disrupts the ability of the nerves to conduct electrical impulses to and from the brain, and produces the various symptoms of MS.
About 2 million people worldwide have Multiple Sclerosis, and the incidence appears to be increasing. Onset of symptoms typically occurs between the ages of 15 and 40 years, with a peak incidence in people in their 20s and 30s. Women are affected twice as often as men. Multiple Sclerosis occurs worldwide but is most common in Caucasian people of northern European origin. It is extremely rare among Asians and Africans.
Recent studies suggest that the MS disease process starts long before symptoms begin, and by the time symptoms appear, there are already signs of brain and spinal cord atrophy. The cause of MS is unknown, though some research indicates a genetic contribution to MS susceptibility, and research is also being conducted on the possibility that certain infectious pathogens may be involved in the onset of MS. The course of MS is unpredictable and each individual will experience a variety of symptoms. Some of the more common symptoms include: fatigue, heat sensitivity, pain, spasticity (muscle cramps and spasms), cognitive problems, depression, balance, and coordination problems and bowel & bladder symptoms. Symptoms will vary depending on the course of the illness, and according to the type of MS the individual has. There are five basic types of Multiple Sclerosis.
Benign MS
Approximately 10-15% of those with MS have the benign form. This form of MS has rare, very mild attacks separated by long periods with no symptoms, does not worsen with time, and produces no permanent disability. As the defining characteristic of benign MS is the long term absence of symptoms, it can only be diagnosed after ten or more years. The phrase “benign MS” is sometimes used inaccurately to describe a period of mild symptoms following diagnosis and subsequent disease activity may show that this period of no symptoms was instead a time of remission, and that the person actually has relapsing/remitting MS. Benign MS tends to be associated with less severe symptoms at onset.
Relapsing-Remitting MS (RRMS)
The majority of people with MS are first diagnosed with the relapsing-remitting form (RRMS). In RRMS there are unpredictable relapses (exacerbations, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months), and then there is a partial or total remission (recovery). In RRMS, the disease may be inactive for months or years. On average, people with relapsing-remitting MS have one or two attacks a year.
Secondary Progressive MS (SPMS)
After 10 years, about half of the individuals who are initially diagnosed with Relapsing-Remitting MS find that the frequency of relapses decreases but disability increases. This is known as Secondary Progressive MS (SPMS). As with RRMS, Secondary Progressive MS can vary widely. For some patient’s, the increase or progression of disability is very gradual, and for others it can occur more quickly. In general however, recovery from attacks become less and less complete, and symptoms tend to increase and disability grows. Clinical attacks become less pronounced and remissions tend to disappear, but more CNS tissue has now been destroyed and the cumulative damage is more apparent on MRI’s.
Primary Progressive MS (PPMS)
About 10% of people with MS are diagnosed with a form in which disability increases from the outset. This is known as Primary Progressive MS (PPMS). This form of MS is characterized by a slow steady onset, usually beginning with walking difficulties, steadily worsening motor dysfunctions and increased disability, but typically with a lack of distinct inflammatory attacks.
Progressive Relapsing MS (PRMS)
Progressive Relapsing MS (PRMS) is progressive from the start with acute symptom flare-ups, but may have some relapses with continued deterioration between them. It occurs in less than 5% of patients.
There are two basic strategies for treating Multiple Sclerosis. One approach attempts to reduce the underlying inflammation and the presumed impaired immune attack against the nervous system. The other strategy emphasizes treatments to relieve Multiple Sclerosis symptoms. Since the introduction of the interferon medications – Avonex (Interferon beta-1a), Betaseron etc. (Interferon beta-1b) and Rebif (Interferon beta-1a), along with Copaxone (Glatiramer acetate), RRMS is now considered a treatable disease. These so-called “CRAB” therapies for MS are the only clinically proven treatments for affecting the underlying course of Multiple Sclerosis, and for decreasing overall exacerbation rate. For individuals with the progressive forms of MS, immunosuppressant drugs like Novantrone (Mitoxantrone) may also be helpful.
A test called the Expanded Disability Status Scale (EDSS) is used to rate the severity of MS symptoms. It is also used after a diagnosis to gauge the status of the disease, and score the effectiveness of treatments. The scale ranges from zero to ten with higher scores indicating more severe symptoms. Unfortunately, there is no single test that can accurately diagnose MS and for this reason several laboratory procedures are necessary before a diagnosis can be made. These procedures usually include: an Analysis of Cerebrospinal Fluid (CFS); an Evoked Potential (EP) Test; and Magnetic Resonance Imaging (MRI).
