Multiple sclerosis (patient information)

For the WikiDoc page for this topic, click here


 * Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. ; Assistant Editor(s)-in-Chief: Ethan Leeman

Overview
Multiple sclerosis, often abbreviated MS, is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS. Multiple sclerosis refers to the scars (sclerosis - or legions) of white matter of the brain of the spinal cord. No one knows what causes MS. It may be an autoimmune disease, which happens when your body attacks itself. Multiple sclerosis affects women more than men. It often begins between the ages of 20 and 40. Some people lose the ability to write, speak or walk. New symptoms can either come in discrete attacks or accumulate slowly over time. There is no cure for MS, but medicines may slow it down and help control symptoms. Physical and occupational therapy may also help.

What are the symptoms of Multiple sclerosis?
Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions).

Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.

It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.

Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body.

Muscle symptoms:


 * Loss of balance
 * Muscle spasms
 * Numbness or abnormal sensation in any area
 * Problems moving arms or legs
 * Problems walking
 * Problems with coordination and making small movements
 * Tremor in one or more arms or legs
 * Weakness in one or more arms or legs

Bowel and bladder symptoms:


 * Constipation and stool leakage
 * Difficulty beginning to urinate
 * Frequent need to urinate
 * Strong urge to urinate
 * Urine leakage (incontinence)

Eye symptoms:


 * Double vision
 * Eye discomfort
 * Uncontrollable rapid eye movements
 * Vision loss (usually affects one eye at a time)

Numbness, tingling, or pain


 * Facial pain
 * Painful muscle spasms
 * Tingling, crawling, or burning feeling in the arms and legs

Other brain and nerve symptoms:


 * Decreased attention span, poor judgment, and memory loss
 * Difficulty reasoning and solving problems
 * Depression or feelings of sadness
 * Dizziness and balance problems
 * Hearing loss

Sexual symptoms:


 * Problems with erections
 * Problems with vaginal lubrication

Speech and swallowing symptoms:


 * Slurred or difficult-to-understand speech
 * Trouble chewing and swallowing

Fatigue is a common and bothersome symptoms as MS progresses. It is often worse in the late afternoon.

What causes Multiple sclerosis?
MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve impulses are slowed down or stopped.

The nerve damage is caused by inflammation. Inflammation occurs when the body's own immune cells attack the nervous system. Repeated episodes of inflammation can occur along any area of the brain, optic nerve, and spinal cord.

Most likely MS occurs as a result of some combination of genetic, environmental and infectious factors. Epidemiological studies of MS have provided hints on possible causes for the disease. Theories try to combine the known data into plausible explanations, but none has proved definitive.

MS is not a hereditary disease, but some genetic variations can increase the risk of developing MS. Specifically differences in the human leukocyte antigen system, a group of genes on chromosome 6, are linked to MS. MS is more common in some ethnic groups than in others.

Who is at highest risk?
Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.

Environmental factors, such as smoking and decreased light exposure have been shown to increase the risk of MS, while other factors, such as diet and hormone intake, have had inconclusive results.

Lastly, many different microbes have been proposed as potential triggers of MS, but none have been substantiated.

When to seek urgent medical care?
Call your health care provider if:


 * You develop any symptoms of MS
 * Symptoms get worse, even with treatment
 * The condition deteriorates to the point where home care is no longer possible

Diagnosis
MS can be difficult to diagnose since the symptoms are very similar to other medical problems. Clinical data alone may be sufficient for a diagnosis of MS if an individual has suffered separate episodes of neurologic symptoms characteristic of MS. Since some people seek medical attention after only one attack, other testing may hasten and ease the diagnosis. The most commonly used diagnostic tools are:
 * Neuroimaging,
 * Cerebrospinal fluid analysis
 * Evoked potential tests
 * MRI of the brain and spine shows areas of demyelination (lesions or plaques).

Treatment options
Although there is no known cure for multiple sclerosis (MS), several therapies for multiple sclerosis have proven helpful. Multiple sclerosis is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS).

The most common initial course of the disease is the relapsing-remitting subtype, which is characterized by unpredictable attacks (relapses) followed by periods of relative remission with no new signs of disease activity. After some years, many of the people who have this subtype begin to experience neurologic decline without acute relapses as the secondary progressive subtype. Other, less common, courses of the disease are the primary progressive (decline from the beginning without attacks) and the progressive-relapsing (steady neurologic decline and superimposed attacks). Different therapies are used for patients experiencing acute attacks, for patients who have the relapsing-remitting subtype, for patients who have the progressive subtypes, for patients without a diagnosis of MS who have a demyelinating event, and for managing the various consequences of MS.

The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects, and many possible therapies are still under investigation. At the same time different alternative treatments are pursued by many patients, despite the paucity of supporting, comparable, replicated scientific study.

Where to find medical care for Multiple sclerosis?
Directions to Hospitals Treating Multiple sclerosis

What to expect (Outlook/Prognosis)?
The outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.

The following typically have the best outlook:


 * Females
 * People who were young (less than 30 years) when the disease started
 * People with infrequent attacks
 * People with a relapsing-remitting pattern
 * People who have limited disease on imaging studies

The amount of disability and discomfort depends on:


 * How often you have attacks
 * How severe they are
 * The part of the central nervous system that is affected by each attack

Most people return to normal or near-normal function between attacks. Slowly, there is greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair.

Those with a support system are often able to remain in their home.

Possible complications

 * Depression
 * Difficulty swallowing
 * Difficulty thinking
 * Less and less ability to care for self
 * Need for indwelling catheter
 * Osteoporosis or thinning of the bones
 * Pressure sores
 * Side effects of medications used to treat the disorder
 * Urinary tract infections