General Info
What is MS?
Multiple Sclerosis also known as MS is a chronic disease that attacks the central nervous system, i.e. the brain, spinal cord and optic nerves. In severe cases the patient becomes paralyzed and/or blind, while in milder cases there may be numbness in the limbs.
Multiple Sclerosis (MS) is a chronic, nonfatal disease that causes the deterioration of the protective covering of the nerve cells (myelin sheath/white matter) in the brain and spinal cord. This results in the hardening of various parts of the nervous system and the development of scars or the lesions on the disturbed nerves.
The sheath of myelin around the nerve fibres enables messages to be passed fr om the central nervous system to other parts of the body. MS is one of the most common neurological disorders among young adults (between the ages of 20 and 40)
What is wrong when you have MS?
In the white matter of people with MS there are two processes going on that normally do not happen.
1. tiny patches of inflammation occur in the myelin.
2. the myelin starts to break up (“demyelination”) shown in Figure
How MS progresses
The progress the disease takes depending on how severe the inflammation is or how quickly the myelin breaks down is known as “relapse”. The moment inflammation dies down the symptoms of MS gets less; this is known as “remission”.
The different stages in MS are:
Relapsing remitting MS: This type shows relapses and remissions.
Secondary progressive MS: This type starts off with relapses and remissions but a more gradual loss of bodily functions starts to take over.
Primary progressive MS: this type shows no relapses, but there is a gradual loss of bodily functions over time.
Benign MS: This type starts off as relapsing remitting MS but after many years there are scarcely any bodily handicaps.
The white matter and Demyelination
The image shows 4 bright spots where MS has damaged myelin in the brain. MS causes gradual destruction of myelin and transection of neuron axons in patches throughout the brain and spinal cord and refers to the multiple scars on the myelin sheaths.
The scarring causes symptoms.
The white matter contains blood vessels that supply the nervous system with oxygen and food. Inflammation in MS often occurs around the blood vessels. The inflammation of the white matter causes inflammatory cells and fluid to come out of the blood and cause swelling, and the myelin can start to break down.
When this happens the transmission of information is made more difficult in the places that inflammation has occurred
WHEN DOES DEMYELINATION OCCUR?
Demyelination occurs when the white matter/myelin sheath starts to break up involving the number of places where inflammation occurs and the severity of the inflammation.
The myelin coating around the nerve fibres gradually disappears because the layer of myelin is – as it were – eaten away by special inflammation cells. The myelin layer gradually becomes thinner and thinner. This makes it more difficult for the nerve fibres to transmit information
What you need
to know
Causes
Despite a great deal of research, it is still not known what causes MS. Here are some ideas about factors that could be involved in the causes:
Environmental factor
MS seems to be more common in people who live farther from the equator. Another theory proposes that Decreased sunlight exposure and Vitamin D production may help cause MS
Genetic
MS is not considered a hereditary disease however increasing scientific evidence suggests that genetics may play a role in determining a person’s susceptibility to MS.
Virus
Perhaps some sort of childhood illness can link to MS, but there is no reliable proof of any specific virus responsible for MS
Auto-immune disease
Symptoms
Optic neuritis – inflammation of the optic nerve, which controls they eyes. This causes blurred vision.
Loss of muscle strength in arms or legs- The loss can vary from reduced dexterity to actual paralysis, you may need to use stick, crutches or even a wheelchair.
Symptoms affecting the sense of touch – a numb feeling or burning, tingling or prickly feeling.
Pain – due to difficulty walking because of MS, nerves of the face can become painful due to the sense of touch.
The muscles controlling bladder and bowels – People with MS have trouble urinating or completely emptying the bladder.
Sexual problems – MS can have a severe affect on both men and women
Balance/coordination – difficulty grasping objects accompanied by a trembling of the hand.
Tiredness
Difficulties thinking – problems with short-term memory.
Mood changes
Dizziness
Prognosis
MS can also be described as an auto immune disease meaning the people with MS produce inflammatory reactions against their own nerve tissue
Subtype of the disease:
Individuals with progressive subtypes of MS have a more rapid decline in function, and supportive equipment such as a wheelchair is often needed after six to seven years
Individual’s gender:
Those diagnosed before age 35 have the best prognosis and females generally have a better prognosis than males
Race:
Black individuals tend to develop MS less frequently
Age:
The earlier in life MS occurs, the slower disability progresses. Individuals who are older than fifty when diagnosed are more likely to experience a chronic progressive course with more rapid disability.
Initial symptoms:
Such as numbness or tingling are markers for a relatively good prognoses, whereas difficulty walking and weakness are markers for a relatively poor prognosis
The degree of disability the person experience varies among individuals with MS. Generally 1 of 3 individuals will still be able to work after 15-20 years.
The life expectancy of people with MS is now nearly the same as the of unaffected people, this is due to improved methods of limiting disability such as physical, occupational and speech therapy along with treatment.
Nevertheless half of the deaths in people with MS are directly related to the consequences of the disease, while 15% more are due to suicide.
Diagnosis
Multiple Sclerosis is difficult to diagnose in its early stages. In fact, definite diagnosis of MS cannot be made until there is evidence of at least two anatomically separate demyelinating events occurring at least thirty days apart.
Clinical data:
Is sufficient if an individual has suffered two separate episodes of neurological symptoms characteristic off MS and the individual also has consistent abnormalities on physical examination.
MRI of the brain and spine:
MRI of the Brain and spine is often used to evaluate individuals with suspected MS. MRI shows areas of demyelination as bright lesion on T2 weighted images.
Lumbar puncture:
A long hollow needle is used to take a sample of the fluid surrounding the brain and spinal cord and can provide evidence of chronic inflammation of the central nervous system
Evoked potentials:
Checking of certain nerve fibres with wires stuck to the back of the head measuring the speed the nerves transmits messages while the person being examined is looking at a pattern on a TV screen. The more demyalination, the slower the transmission of impulses
measured.
FACTORS TRIGGERING A RELAPSE
Multiple Sclerosis relapses are often unpredictable and can occur without warning with no obvious inciting factors. Some of the factors triggering a relapse are:
Seasons
Relapses occur more frequently during spring and summer than in autumn and winter
Infections
Such as cold, influenza increase the risk for a relapse
Emotional and physical stress
Severe illness of any kind
Heat
Pregnancy
Pregnancy can directly affect the susceptibility for relapse. The last three months of pregnancy offer a natural protection against relapses; however during the first few months after deliver, the risk for a relapse is increased to 20-40%. But it does not influence long term disability. Children born to mothers with MS are not at increased risk.
Treatment
Corticosteroids – Usually an infusion or drip is used by means of a substance related to the hormones
Interferon – beta interferon (two kinds: 1a and 1b) which are licensed in SA thus far Beta interferon reduce the frequency of attacks in relapsing remitting MS by about 30 per cent Clinical trials have also shown some benefit to people with secondary progressive MS but only where relapses are the cause of increasing disability. There are currently no evidence showing benefits of these drugs for people with primary progressive MS although research continues.
Alternative treatments are also used like Acupuncture, yoga, meditation, aromatherapy, herbal preparations; homeopathy and osteopathy are just some of the treatments that are widely available.
Interferon’s are derived from human cytokines which help regulate the immune system.
Avonex is used once a week, intra-muscular
Rebif is used 3 times a week, subcutaneous
Inteferon 1 b
Betaferon is used every other day, subcutaneous
Glatiramer Acetate
Trade name is Copaxone is used every day, subcutaneous
Mitoxantrone (Trade name Novantrone)
Is effective but limited by cardiac toxicity and is used for secondary progressive, progressive-relapsing and worsening relapsing –remitting MS
Natalizumab (Trade name Tysabri)
With Relapsing-remitting attacks Patients are typically given high doses of intravenous corticosteroids to end the attack sooner and leave fewer lasting deficits.
Currently there are no approved treatments for primary progressive ms though several medications are being studied
