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Multiple Sclerosis
Definition: Multiple sclerosis is a common demyelinating neurologic disorder of young adults effecting the central nervous system (brain and spinal cord). There is inflammation followed by demyelination (loss of the myelin insulation surrounding nerve fibers). As a result plaques (areas of demyelination) develop in the central nervous system causing various neurologic symptoms.
Causes: The exact causes of multiple sclerosis are unknown and factors that determine the course are unknown. There are factors thought to make a patient more susceptible to the disease. These include geographic distribution, environmental factors, genetic factors and immune mechanisms (among others). Exposures to a trigger, such as a virus may initiate a disease or an attack.
Signs and Symptoms: Symptoms develop as a result of where the plaques are. Therefore the symptoms vary widely such as vision loss, double vision, numbness or tingling, weakness, tiredness and bowel and bladder problems. Symptoms develop over hours to days and persist for days or weeks. The symptoms may completely or partially disappear or have no improvement.
Clinical Findings: Physical examination findings vary widely and may include sensory loss, muscle weakness, decreased vision, double vision and gait difficulties.
Diagnostic Testing: The diagnosis of multiple sclerosis is based on history and neurologic examination. Tests performed may include an MRI of the brain and spinal cord, laboratory studies (blood work), lumbar puncture for evaluation of the cerebral spinal fluid, and evoked potentials.
Disease Course and Prognosis: Multiple sclerosis effects women at least two times more than men. It typically begins between the ages of 15 and 50. The average age of diagnosis is 30. Occasionally it can begin in children or older adults.
There are two main types of multiple sclerosis. Most often patient’s have relapsing/remitting disease. This is where the disease starts with a sudden onset of symptoms and with or without treatment improve or completely resolve. They then have recurrent episodes or relapses. The other main type of multiple sclerosis is chronic/progressive where symptoms slowly begin and continue to worsen and progress. Over half of patients with multiple sclerosis will develop a progressive course. Multiple sclerosis effects all individuals differently and its course is very unpredictable. The disease does not significantly change life expectancy. Multiple sclerosis is not a life threatening disease.
Treatment: The aim of treatment is to shorten exacerbations and if possible relieve neurologic symptoms. Medications can be used for fatigue, spasticity and components of tremors among other symptomatology. Treatment for acute exacerbations of multiple sclerosis include intravenous steroids. It is believed that these treatments can help shorten an acute attack. Long term steroid use is not effective or indicated. There is no preventative therapy nor therapy that stops the disease progression. For the relapsing/remitting type of multiple sclerosis disease modifying agents are available and these include interferon beta –1b (Betaseron), interferon beta – 1A (Avonex) and glatiramer acetate (Copaxone).
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