Multiple sclerosis

There are many diseases that can affect the brain and central nervous system. Multiple sclerosis or MS falls into the category of central nervous system diseases. Roughly 350,000 to 500,000 people have multiple sclerosis in the United States.

Definition & Facts

Multiple sclerosis is a chronic and progressive disease in which the myelin sheath of the nerve cells in the brain and spinal cord are involved. It can affect the optic nerves in the eyes, cause problems with balance and coordination, difficulty with muscle control, speech impairment, extreme fatigue, and depression. While MS is progressive, it is not considered to be a deadly disease.

It affects women more than men, and appears to be more frequent in white women than other ethnic groups. The age range for diagnosis is between 20 and 50; however, younger people can also develop MS.

Symptoms & Complaints

• Difficulty with vision.
• Loss of coordination.
• Loss of balance.
• Weakness of the limbs.
• Difficulty concentrating

As the disease progresses, problems with processing information and problems with heat sensitivity may become issues for those battling MS.

Causes

Multiple sclerosis is an autoimmune disease. When the autoimmune system is functioning normally, it will only attack harmful bacteria and viruses to protect from illnesses. When the autoimmune system malfunctions, it attacks the body’s own tissues. In the case of multiple sclerosis, the immune system attacks the brain and spinal cord.

Ongoing studies are being performed to see what triggers the immune system to attack the central nervous system and how to stop or slow down that process. People who are vitamin D deficient may be at greater risk for developing MS. Studies have suggested that people who live in regions where sunlight is more abundant are less likely to develop multiple sclerosis perhaps due to the link between sunlight and vitamin D production.

Multiple sclerosis is not contagious though genetics may play a role. If a family member has multiple sclerosis, or another type of autoimmune disease, the likelihood that other family members may have it is increased. There is a school of thought that some individuals are born with a trigger in their genes that makes them more likely to respond to environmental factors that cause multiple sclerosis. While other studies have been done to determine other factors that may cause MS, there is not enough substantive data to support other causes.

Diagnosis & Tests

Diagnosing multiple sclerosis can be difficult because symptoms such as neuritis, numbness, tingling, and blurred vision could mimic symptoms of other diseases. If a person suspects that he/she may have multiple sclerosis, it is imperative to start keeping a log of what is happening, writing down symptoms and how long they last.

Once a patient has been referred to a neurologist, the doctor will want to run a battery of tests. Patients will undergo an MRI to look for abnormal areas on the brain and spine. An injection of dye that acts as an MRI contrast agent such as gadolinium is injected and if there are any abnormal areas, these areas will "light up" on the images.

Testing of the cranial nerves gives the neurologist insight into a patient's sensation, coordination, strength, and reflexes. This type is noninvasive and does not hurt. The doctor asks the patient to perform certain tasks (touching the nose, walking on the toes, etc), as well as performing an eye examination.

Another test that may be done is evoked potential testing. This is another noninvasive test in which electrodes are placed onto the scalp and attached to an electroencephalograph (EEG). It records how the brain responds to stimuli. Weakened responses indicate that the sheath of the spine has been affected and MS may be a possibility.

A spinal tap, or lumbar puncture is a procedure in which a needle is placed between the vertebrae to draw out cerebrospinal fluid. The fluid is then analyzed for increased immune activity. A lumbar puncture can be done via a technique called fluoroscopy. A fluoroscope helps the doctor or technician guide the needle. This technique is preferred by many patients as it reduces anxiety about the procedure. Once a patient has received a definitive diagnosis of multiple sclerosis, he or she can then start to receive the types of treatment that is needed.

Treatment & Therapy

Treatment and therapy for multiple sclerosis must be set up so that it addresses a particular patient’s needs. For some, very little treatment may be required, while others, who may be more severely affected by MS, will need extensive care. The goal of treatment and therapy for multiple sclerosis is to help individuals to improve and maintain functionality so that they can go on with their everyday lives.

During rehab, patients are taught how to reduce tiredness and address issues with moving around, driving, and attending social and leisure activities -- all in an effort to lessen the impact of MS and improve quality of life. A person who has been diagnosed with MS may have require physical therapy to help improve balance, strength, walking, and address issues with fatigue.

An occupational therapist would assist those who need help with remaining independent, as well as guiding a patient on the use of devices and equipment that will make being at home and work less challenging. Additionally, an occupational therapist can evaluate and treat problems with thinking and memory.

For many patients with MS, cognition, or the ability to think, concentrate, and remember, is an issue. A neuropsychologist, occupational therapist, or speech language therapist can be of great assistance to those with these types of difficulties. While each of these specialists will use different techniques, the shared goal is to help a patient function at his or her optimal level.

For a lot of people with multiple sclerosis, getting or maintaining adequate employment is a cause for anxiety. A vocational occupational therapist is someone who can help with job preparedness as well as maintaining employment. A person who specializes in vocational occupational therapy is also trained to teach patients with MS which assistive devices will be of value in helping that person to maintain employment as well as devices that will make performing certain job duties easier.

Sometimes a person with MS will develop difficulties with speech. This happens because the central nervous system has been compromised in a way such that the control of the muscles that have to do with speech and swallowing have been reduced. The speech language pathologist helps the patient to develop ways to make communication easier as well as safety with swallowing.

Prevention & Prophylaxis