Multiple Sclerosis

General Illness Information

Medical Term: Multiple Sclerosis

Common Name: None Specified

Description: Chronic, slowly progressive, neurological disease characterized by myelin loss in the brain and spinal cord, causing neurological symptoms. Myelin is the tissue that covers the brain and the spinal cord. It usually begins in young adulthood (ages 20 to 40), is more common in females, and is more prevalent in cooler climates. A third of all affected patients have mild disease, another third have moderate disease, and a final third have severe disease, with rapid progression.

Causes: The underlying cause is unknown.  However, auto-immune, genetic and viral causes are suspected.

The basic pathological defect is patchy degeneration of the white matter (myelin) in the brain and the spinal cord. The result is an inability to conduct impulses.

Prevention: Cannot be prevented at present, but relapses can be shortened by therapy.

Avoid infections, and treat any infection early. Infections may trigger relapses.

Signs & Symptoms

  • Characterized by remissions and exacerbations.
  • Onset is usually insidious
  • Early stages:
  • Vague eye problems, such as intermittent blurred or double vision. (Optic neuritis)
  • Weakness, difficulty with walking or balance.
  • Vague loss of sensation or numbness and tingling, especially in the extremities.
  • Apathy, lack of judgment or inattention.
  • Late stages:
  • Marked weakness and loss of muscle function.
  • Marked sensory loss.
  • Difficulty with speaking. (Scanning speech)
  • Loss of bladder or bowel control.
  • Extreme mood swings.
  • Cranial nerve palsies.

Risk Factors

  • Family history of disease
  • Children and adolescents raised in cool climates. Moving to a warmer climate later does not affect the course or natural history.

Diagnosis & Treatment

  • The diagnosis is indirect, and usually suspected  from clinical and laboratory features. Many other diseases, which are treatable, must be ruled out.
  • If the diagnosis is not clear-cut, CT scans, MRI and cerebrospinal fluid examination may be required.

General Measures:

  • Emotional support, encouragement, and reassurances are necessary to help avoid a hopeless outlook.
  • Try to lead as normal a life as possible, but avoid fatigue.
  • Avoid warm surroundings, even a hot shower. Heat can temporarily worsen symptoms.
  • No specific therapy. Remissions occur spontaneously and make treatment evaluations difficult.
  • Catheterizations for inadequate bladder emptying (indwelling catheter may be necessary in a few patients).
  • Hospitalization or nursing-home care may be necessary, depending on the severity of the disease.

Medications:

  • Cortisone drugs during periods of relapse or when symptoms worsen.
  • Muscle relaxants to control muscle spasms.
  • Betaseron, or Avonex, or Copaxone  may be tried in prevention of relapses.
  • Intravenous immunoglobins are under investigation.
  • Methotrexate may be used to prevent relapses and progression of disease.
  • Newer treatments are being evaluated, and close supervision by a neurologist is necessary.

Activity:

Take regular rest periods. A regular program of physical exercise and mental activity is essential. Obtain physical therapy with mechanical devices (wearing braces, use of a cane or walker) to overcome physical handicaps. Swimming is an ideal form of exercise, because of the buoyant support and coolant effects that it provides.

Diet:

Eat a normal, well-balanced diet.

Possible Complications :

  • Urinary-tract infections.
  • Pressure sores from prolonged bed rest.
  • Constipation caused by inactivity.
  • Depression.

Prognosis

  • Though medications help to allay the severity of relapses, and also to delay relapses, there is still no cure for the disease.
  • The course is highly variable, and unpredictable, and progressively downhill.  At first, months or years may separate episodes, but inevitably the intervals grow shorter, and eventually the patient becomes disabled.
  • The life span in most cases is not markedly affected, and the average illness lasts over 25 years.
  • In a small number of patients, the course is rapidly downhill, and occasionally fatal within one or two years.

Other

Nothing Specified.

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