Multiple Sclerosis
What is MS
- Autoimmune disease affecting the brain, spinal cord and optic nerves.(the central nervous system (CNS).
- causes inflammation that damages the fatty substance that surrounds and insulates the nerve fibers (myelin), the nerve fibers themselves, and the specialized cells that make myelin.
- The effect is that messages within the CNS are damaged or stopped completely.
- This can produce symptoms in any part of the body
- The damaged areas develop scar tissue which gives the disease its name – multiple areas of scarring or multiple sclerosis.
- MS can have variable symptoms and they tend to flare up periodically
What causes MS
The exact cause of MS is not known.
- Genetic Factors
- MS is not an inherited disease but there is genetic risk that may be inherited.
- The risk of developing MS is higher if one of your first degree relatives (parents, siblings and children) has MS, but is lower than the rates seen in identical twins.
In identical twins, if one twin has MS the risk that the other twin will develop MS is about 1 in 4. - In the general population, the risk of developing MS is about 1 in 750 – 1000. In identical twins, About 200 genes have been discovered that each contribute a small amount to the overall risk of developing MS.
- Research is ongoing.
- Environmental Factors
- Geographic area and Vitamin D.
- MS is known to occur more frequently in areas that are farther from the equator.
- People born in an area with a high risk of MS who then move to an area with a lower risk before the age of 15 assume the risk of their new area.
- This suggest that exposure to some environmental agent before puberty may predispose a person to develop MS later on.
- Low vitamin D levels in the blood have been identified as a risk factor for the development of MS.
- People who live closer to the equator are exposed to greater amounts of sunlight year-round. As a result, they tend to have higher levels of naturally-produced vitamin D, which is thought to support immune function and may help protect against immune-mediated diseases like MS.
- Smoking
- Cigarette smoking seems to plays an important role in MS.
- Studies have shown that smoking increases a person’s risk of developing MS.
- Smoking is associated also with more severe disease and more rapid disease progression. Fortunately, stopping smoking is associated with a slower progression of disability.
- Body size
- The role of body size in MS is being studied.
- Several studies have shown that obesity in childhood and adolescence, particularly in girls, increased the risk of later developing MS.
- Other studies have shown that obesity in early adulthood may also contribute to an increased risk of developing MS.
- Also, obesity may contribute to inflammation and more MS activity in those already diagnosed with MS.
- Infectious Factors
- There are many studies about viruses and bacteria — including measles, canine distemper, human herpes virus-6, Epstein-Barr virus (EBV), and Chlamydia that may contribute to causing MS.
- Previous infection with EBV (Epstein-Barr virus), the virus that causes mononucleosis contributes to the risk of developing MS.
- However just being infected with Epstein Barr virus is not enough by itself to cause MS.
Types of MS
Four basic MS disease courses (also called types or phenotypes) have been defined
- Clinically Isolated Syndrome
- First episode of neurologic symptoms caused by inflammation and demyelination in the central nervous system.
- The episode, which by definition must last for at least 24 hours.
- Not all of these people go on to develop MS.
- If CIS is accompanied by lesions on a brain MRI (magnetic resonance imaging) that are similar to those seen in MS, the person has a high likelihood of a second episode of neurologic symptoms and diagnosis of relapsing-remitting MS.
- When CIS is not accompanied by MS-like lesions on a brain MRI, the person has a much lower likelihood of developing MS.
- Relapsing Remitting
- The most common disease course is characterized by clearly defined attacks of new or increasing neurologic symptoms.
- Relapses or exacerbations are followed by periods of partial or complete recovery (remissions) where all symptoms may disappear.
- There is no apparent progression of the disease during the periods of remission.
- Approximately 85 percent of people with MS are initially diagnosed with RRMS.
- Secondary Progressive
- SPMS follows an initial relapsing-remitting course.
- Will eventually transition to a secondary progressive course in which there is a progressive worsening of neurologic function (accumulation of disability) over time.
- Primary Progressive
- PPMS is characterized by worsening neurologic function (accumulation of disability) from the onset of symptoms
- Without early relapses or remissions.
- Approximately 15 percent of people with MS are diagnosed with PPMS.
Symptoms
- MS symptoms are variable and unpredictable.
- No two people have exactly the same symptoms
- Dizziness/vertigo
- Fatigue
- Bladder problems
- Gait problems
- Involuntary muscle spasm
- Each person’s symptoms can change or fluctuate over time.
- Always get evaluated for symptoms that are new and persistent (lasting more 7-10 days).
Treating MS
Treatments Can:
- Help modify or slow the disease course
- Treat relapses (also called attacks or exacerbations)
- Manage symptoms
- Improve function and safety
- Address emotional health
- Treating MS usually involves a neurologist and multiple doctors and other professionals in several specialties
- More than a dozen disease-modifying medications have been approved by the U.S. Food and Drug Administration (FDA) to treat MS.
- Reduce the frequency and severity of relapses (also called attacks or exacerbations)
- Reduce the accumulation of lesions in the brain and spinal cord as seen on MRI and may slow the accumulation of disability for many people with MS.
- Rehabilitation programs focus on function—to improve or maintain your ability to perform effectively and safely at home and at work.
