Donald Aulds, M.D.
Multiple Sclerosis (MS) is an autoimmune disease affecting the brain and spinal cord. It affects women more than men and usually starts between the ages of 20 and 40. Present studies have indicated that it is a disease in which antibodies built in the body attack the myelin sheath of the nerves (the protective covering of the nerve). When this occurs, nerve conduction is either slowed or stopped. MS is a disease that progresses with time and the degree of progression varies in individuals. The antibodies against the nerve tissue cause inflammation that can occur in any area of the spinal cord and brain. It has been noted that the disease is geographic with more cases being diagnosed in northern Europe, southern Australia, New Zealand and northern US. Also, there appears to be a familial trend so people with a family history may be at higher risk.
What are the symptoms of MS?
Symptoms will vary from one person to another depending on the location involved and the severity of the inflammation. The pattern of symptoms may last from days to months and flare up or have remissions. A few things have been shown to trigger recurrence of symptoms including stress, fever, hot baths, and sun exposure. The symptoms vary and include:
- Muscular symptoms – loss of balance, numbness or unusual sensations, muscle spasms, difficulty with movement including walking, difficulty with coordination, weakness and tremors
- Eye symptoms – pain in the eyes, rapid eye movements, double vision, and vision loss
- Bowel and bladder symptoms – difficulty initiating urination, constipation, frequency of urination, urgency and urine incontinence
- Numbness, tingling or pain – muscle spasms, facial pain, crawling or burning sensation in arms and legs
- Speech and swallowing – trouble chewing and swallowing, and slurred speech that may be difficult to understand
- Brain symptoms – poor judgment, poor attention span, memory loss, poor problem solving, dizziness, hearing loss, and feelings of sadness
- Sexual symptoms – vaginal dryness in the female and erectile dysfunction in the male
- Fatigue – most common symptom that seems to worsen as the disease progress and seems to be worse in the afternoon and evening
What are the complications of MS?
The complications of MS vary depending on the severity of the disease but may include depression due to the lack of being able to adjust and work with the disease, difficulty with routine due to the difficulty with thinking and poor attention span, need for indwelling catheter if the bladder is severely affected leading to greater risk of urinary tract infections, and side affects to the medications that may be needed.
How is MS diagnosed?
Because the symptoms of MS are not specific and may mimic other diseases, MS is usually diagnosed once other conditions have been ruled out. The neurological exam may show reduced nerve function leading to abnormal reflexes, decreased sensation, and difficulty with movement. The eye exam can reveal abnormal pupil responses, changes in vision, rapid movement of the eye and changes in the retina. Tests include lumbar puncture or spinal tap to test the cerebrospinal fluid, MRI of the brain and/or spine, and nerve conduction studies.
What are the treatments available for MS?
At this time there are no known cures for MS, but therapies are available to try to reduce the severity and relapses of the disease. The goal of therapy is to attempt to maintain as normal a quality of life as possible. Medications that are currently available include:
- Interferons – Avonex, Betaseron and Rebif are some of the most commonly used medications for MS. Other interferons may include glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri).
- Immune drugs – methotrexate, azathioprine (Imuran), and immunoglobulins
- Steroids – usually decrease severity of attacks
- Muscle-spasm medications
- Antifatigue medications – Amantadine
- Medications to decrease urinary symptoms
Physical therapy, occupational therapy, and speech therapy may be helpful depending on the severity of the disease. Exercise programs, rest, relaxation techniques, good nutrition, and avoiding stress have been helpful for many people.
The prognosis for the disease varies from person to person and cannot be predicted. Life expectancy is usually normal but depends on the severity of the MS. Most people can function normally for at least 20 years or more. The degree of disability and discomfort depends on the frequency and severity of the attacks and the affected area of the brain and spinal cord.
If you feel you have symptoms suggesting MS, contact your physician and discuss your concerns.