What is Multiple Sclerosis?
Multiple Sclerosis (MS) is a chronic autoimmune disorder that attacks the central nervous system. It causes deterioration of the myelin, which is an insulating sheath surrounding the neurons or nerve cells of the body. This process is known as demyelination. When myelin is destroyed, normal nerve function is disrupted. Symptoms of MS vary depending on the affected nerves, but typically impact the motor and sensory functions of the body.
Autoimmune diseases such as MS are the result of the body’s immune system turning on itself, and mistakenly attacking healthy tissue. For as of yet unknown reasons, the body of people with MS sends white blood cells and antibodies to attack the myelin. Some researchers believe the immune system is confused by certain proteins in the myelin and targets them as invaders to be destroyed. Myelin can be compared to the insulation found on electrical wiring. It is manufactured within the brain by specialized cells called glia. Its function is to aid in the smooth transmission of electrical impulses through the nerves to the rest of the body. It also keeps these impulses from cross circuiting and abnormally affecting other cells. When demyelination occurs, the myelin becomes inflamed and swollen. Eventually it becomes detached and is destroyed. The areas where the myelin is stripped become scarred areas of exposed grey neuron material referred to as plaques. The word sclerosis literally means “scarring.” These plaques cause an interruption of normal electrical activity and cause the nerves to malfunction. As progression of MS continues, the nerves themselves become damaged. As far as researchers can tell, there is no rhyme or reason to where new plaques will appear. Therefore, it is difficult to predict how MS will progress.
MS affects over one million people worldwide. Approximately 250,000 of those cases are here in the United States. Certain people are more likely to get MS than others. It affects twice many women as men, and is most commonly found in folks between the ages of twenty and forty. Initial symptoms rarely strike those under 15 years of age or over 60. Race is a factor as well. Most cases are found in peoples of Northern European descent. The U.S., Canada, and Northern Europe have more MS patients than other parts of the world.
What Causes Multiple Sclerosis?
The exact cause for the immune system dysfunction that causes MS is not known, despite extensive research. But there are some theories that are helping to put the puzzle together. The main ones focus on genes, environmental factors and viruses. Statistics tell us that risk is increased for MS if you have a close relative with the disorder. We also know that certain races, mainly Northern Europeans, have a greater incidence of MS than other races. At the same time, MS is very rarely found in other races such as Asians, Eskimos, and Indians of North and South America. These facts point to a genetic connection, but the details are not known.
Environment is suspected to be a factor as well. One very interesting study showed that younger people in low-risk groups who moved into areas with a high incidence of MS were likely to take on the risks of their new environment. With older folks under the same circumstances, the results were the opposite—they maintained their low-risk status despite their new surroundings. This causes speculation that perhaps environmental factors—either predisposing individuals or protecting them from MS—are acquired early in life and not dependent on geographical location later in life. So, it appears that race and environment may work together to play a role in risk for MS. Other ideas about the role of environment are being batted around as well. Some think electrical injuries, chemical exposure, or trauma might also make some folks more susceptible to MS.
Viral causes are suspected for MS, partly because they have been implicated in other autoimmune diseases. How this might work in MS is not understood at this point, but there are a couple of leading theories. One school thinks the immune system may be actually attacking a legitimate virus that has yet to be identified, and that myelin is just an innocent bystander that is a casualty of this conflict. Others believe that the immune system mistakenly believes myelin to be a viral protein it has seen before in other infections.
What Are the Symptoms of Multiple Sclerosis?
MS generally progresses in three or four well-established patterns:
- The most common is called the relapsing-remitting pattern. This is characterized by typical symptomatic attacks that may last several weeks or months, followed by complete or almost complete remission. The attacks return periodically, usually quite far apart (up to a year) in the early stages of MS, and progressively closer together (several months) in the latter stages. This is most common in younger folks with MS.
- Primary progressive is a pattern whereby the symptoms worsen steadily with little or no remission. There may be occasional periods of slight improvement. This is most common in patients who experience their first symptoms after the age of 40.
- Secondary progressive patients start with cycles of increased and decreased symptoms, and eventually progress into a more steady decline. Over 50% of initial relapsing-remitting cases eventually fall under this category of MS.
- A small percentage of folks with MS have benign MS. Their symptoms are generally minor, and they do not progress much throughout their lifetime.
Because of the nature of MS, it is hard to predict exact symptoms, particularly in the latter stages of the disease. It all depends on where the plaques form, and which nerves are affected. In the early stages, general symptoms include:
- Muscle weakness, typically starting on one side of the body at a time. Sometimes it starts as weakness below the waist on both sides. Muscle weakness is often the first symptom for many people.
- Loss of coordination
- Loss of balance
- Difficulty walking
- Numbness in the extremities
- Pain or “pins and needles” in the numb areas
- Visual difficulties, including double vision or blurring
Later stages may include:
- Muscle spasticity and stiffness
- Loss of bladder and bowel control
- Difficulty swallowing
- Slurred Speech
- Blind spots and inability to see colors properly
- Cognitive changes such as memory lapses, difficulty concentrating, depression, and personality changes.
- A minority of patients may experience what is called “disease-related euphoria.” This is an abnormally elevated mood that may appear after years of active MS.
- Sexual dysfunction
Some of these symptoms, especially the cognitive ones, may be partly a physiological result of MS, and partly a reaction to the symptoms. Depression is a big problem for many MS patients. Unfortunately, suicide is a significant cause of death for many MS patients, especially younger ones. Considering the list of symptoms and the progressive, degenerative nature of the illness, it is no wonder that sufferers struggle with depression. Many patients and loved ones find that a support group is helpful.
How is Multiple Sclerosis Diagnosed?
Patterns of symptoms are often the first clue in diagnosis of MS. If MS is suspected, there are tests that can help decipher if MS is likely:
- Health care providers usually start with a general neurological exam. This may cover your sensitivity to pain, vibrations and heat; muscle strength and tone; gait and coordination; reflexes; and cognitive issues such as memory and judgment.
- Magnetic Resonance Imaging Scan (MRI) is often the next step. This image scanning technology uses a magnetic field and radio waves to provide a view of what is happening inside the patient’s body. Often plaques, if present, will be visible that indicate a loss of myelin and point towards MS.
- Evoked Potential Tests measure the speed of electrical reactions in the nerves and compare them to the norms. A slower than average speed is an indicator of possible MS. These are done using small electrical charges on the skin (somatosensory evoked potential), light patterns flashed in the eyes (visual evoked potential), and sounds aimed at the ears (auditory evoked potential).
- A Lumbar Puncture (LP), or more commonly called a “spinal tap,” is a test that involves drawing cerebrospinal fluid (CSF) from the spinal chord. The CSF is then analyzed for certain substances associated with MS, such as elevated white blood cells or abnormal levels of immune proteins. This test can be very dangerous, and I would recommend that you only submit to it only if it is absolutely necessary. The skill and experience of the technician is the most important safety factor. Complications, while rare, can be severe, including coma and sudden death.
- After testing is completed, patients are usually classified in one of three diagnoses, depending on the results: Definite MS, Probable MS, or Possible MS.
What Treatments Are Available for MS?
There are a slew of pharmaceutical drugs that are used to treat MS and relieve the symptoms. I am not going to go into them all. However, I would like to discuss one of the more common drugs: beta interferon. This is a genetically engineered copy of a protein that naturally occurs in the body. This protein is known to act as an antiviral, and helps to regulate the immune system. Beta interferon is very widely prescribed, especially for relapse-remitting patients (the most common type of MS). The reason I mention this drug, is that there is a more natural alternative to beta interferon. It is called alpha interferon, and is naturally derived from white blood cells. Alpha interferon is a relatively new option, but preliminary studies show that its effectiveness may be much greater than beta interferon. In addition, it is a much more natural substance to put into your body. If you have MS, or know someone who does, I definitely recommend looking into alpha interferon.
Remedies such as physical therapy can help patients to deal with the muscular problems associated with MS. Stretching and strengthening of the muscles is beneficial to many folks. Swimming is an excellent exercise that is wonderfully helpful and a favorite pastime for many MS patients. It allows for a low-impact workout that utilizes many of the body’s muscles.
A diet low in saturated fats, especially animal fats, and high in essential fatty acids, is thought to be helpful. Essential fatty acids, such as omega-3’s, are very important to MS patients. Studies have shown that myelin cannot form or function properly without these substances. Cold-water fish such as salmon or mackerel are great sources of omega-3 fatty acids.