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Description

Multiple Sclerosis (MS) is a debilitating disease, which affects the central nervous system. The nerve fibres, which make up our central nervous system and transmit messages from our brain, throughout our body, are wrapped in a fatty sheath, made of a substance known as Myelin. In MS, the Myelin sheath is attacked causing inflammation or damage. Areas of scarring (Sclerosis) result and these scars can disrupt or even block signals within the brain and spinal cord. These scars may cause loss of nerve fibres as well as their ensheathing myelin.

The disruption or blocking of nerve signals within the central nervous system causes a variety of symptoms, depending on which areas of the brain and spinal cord are affected. Symptoms may include:

Loss of coordination/clumsiness
Speech difficulties
Hand shaking/tremor
Loss of bladder/bowel control
Extreme fatigue
Sight impairments
Memory lapses
Vertigo
Weakness
Impaired sensation


Early symptoms are usually mild. MS is a progressive disease and as time goes on, symptoms may become more severe.

The effect of MS varies greatly from patient to patient. The MS Society of Australia identifies the different courses MS could take:

Relapse-Remitting MS  - unpredictable relapses where symptoms worsen or new symptoms appear, followed by partial or total remission, which may last for months or years. Affects approximately 40% of patients.
Secondary Progressive MS ? patient originally has relapse-remitting MS, which develops into progressive disability, often with superimposed relapses. Affects approximately 40% of patients.
Primary Progressive MS ? a lack of distinct attacks, a slow onset and steady worsening of symptoms. Deficits and disability accumulate and may level off at some point, or continue over months and years. Affects approximately 15% of patients.
Relapsing Progressive MS ? a gradual progression of disability from the onset of the disease, accompanied by one or more relapses. Affects approximately 5% of patients.
Benign MS ? after one or two attacks with complete recovery (initial symptoms tend to be less severe) there is no worsening or permanent disability after 15 years. Affects approximately 5% of patients.


MS typically strikes young adults, with symptoms beginning between the ages of 20 and 50. MS is the most common cause of chronic neurological impairment in young people and affects more than 1 million adults worldwide. MS is not hereditary but having a first degree relative with MS does increase a person's risk.

MS strikes 50% more women than men, and is five times more common in temperate climates than in the tropics. The cause of MS is still unknown, however many believe that MS is an autoimmune disease, where the patient's immune system defensive cells mistakenly attack the myelin sheaths. Some believe the cause to be viral; others believe it to be physical or emotional stress. It has yet to be proven that any one virus triggers MS.

Diagnosing MS can be difficult as patients exhibit similar warning signs to other diseases of the central nervous system. Doctors faced with a sudden appearance of symptoms (like those listed above), signalling central nervous system damage, may suspect MS. There is no single test to diagnose MS. If your doctor suspects MS they will order a MRI (magnetic resonance imaging) scan of your brain and/or spinal cord to check for areas of scarring and inflammation in the myelin sheath. This will be done in conjunction with a clinical exam to review coordination, motor skills, vision, balance, sensory, language and emotional function. Other tests your doctor may order can include an eye examination by an ophthalmologist and a lumbar puncture (spinal tap) and electrophysiological tests to assess the passage of nerve impulses through the central nervous system.

MS will only be diagnosed when:

There have been two attacks, at least one month apart, which last a minimum of 24 hours.
There is more than one area of damage in the central nervous system. The areas of damage may be evident on clinical testing or shown by MRI scanning or electrophysiological testing.


Treatment

There is no cure for MS. There are two types of treatments that may be used: treatment to modify the immune system and suppress the disease; and treatment to improve the symptoms.


Drug treatments targeting the immune system may include:

Immunotherapy ? drugs are taken by injection under the skin or into the muscle. The medication slows the frequency and severity of the attacks by about 30%, resulting in less damage to the myelin sheaths.  
Methotrexate ? this drug is traditionally used to treat rheumatoid arthritis and was reported to have a modest effect on some aspects of progressive MS. It is not commonly used.
Mitoxantrone ? a drug used in oncology has been reported to have modest benefits in patients With rapidly progressive MS with frequent attacks. Because of its potential harmful side effects its use is limited to patients who show progressive disability, despite the use of the safer drugs such as beta interferons or Copaxone.
Methylprednisolone ? this is a steroid given by injection to patients who have suffered an attack to shorten the duration of disability. It has no benefit when given continuously A similar drug ? Prednisone, may be given orally.


Patients may experience drug treatment side effects such as drowsiness, fluid retention, flu symptoms etc.

Treatments can target specific symptoms, for instance:

Muscle problems ? drugs and/or physical therapy can ease stiffness and tremors and improve strength.
Fatigue ? some studies have found that drugs used to treat narcolepsy can be helpful in controlling fatigue.
Neurological symptoms ? such as visual disturbances, can be helped with drugs.
Continence ? special exercises, aids and dietary changes can improve continence problems.
Neuropsychological problems ? depression may be treated with counselling or medication. Other cognitive difficulties such as memory loss can be better managed with help from a neuropsychologist.



Prognosis

While there is no cure for MS, most people with MS live near-normal life spans. One in three patients experience a mild form of MS with few serious symptoms for many years after the onset. Three out of four people are still active and can take care of their own daily needs many years after a firm diagnosis of MS. Medical research continues into the cause, treatments and possible cure to MS.

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