Multiple Sclerosis Symptoms

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About Multiple Sclerosis

Multiple Sclerosis is a chronic disease that affects the brain and spinal cord. multiple sclerosis can cause a variety of symptoms, including changes in sensation, visual problems, weakness, depression, and difficulties with coordination and speech. Although many patients lead full and rewarding lives, multiple sclerosis can cause impaired mobility and disability in the more severe cases.

Multiple Sclerosis attacks the brain and spinal cord, which contain nerves that carry information and allow the brain to control the body. Surrounding and protecting these nerves is a layer of fat, called myelin, which helps nerves carry electrical signals. Multiple Sclerosis causes gradual destruction of myelin (demyelination) in patches throughout the brain and/or spinal cord, causing different symptoms depending upon which signals are interrupted.

Multiple Sclerosis results from attacks by an individual's immune system on his or her own nervous system, and it is therefore categorized as an autoimmune disease. The name multiple sclerosis refers to the multiple scars (or scleroses) on the myelin sheaths.

Signs and Symptoms

Individuals with multiple sclerosis may experience a wide variety of symptoms. The initial attacks are often transient, mild (or asymptomatic), and self-limited. They often do not prompt a health care visit and sometimes are only identified in retrospect once the diagnosis has been made based on further attacks.

The most common initial symptoms reported are: changes in sensation in the arms, legs or face (33%), complete or partial vision loss (optic neuritis) (16%), weakness (13%), double vision (7%), unsteadiness when walking (5%), and balance problems (3%).

Clinical Entities

Three clinical entities warrant further discussion because affected individuals are often eventually diagnosed with multiple sclerosis. (However, multiple sclerosis is only one of several potential causes for these entities.)

Optic Neuritis

Individuals typically experience rapid onset of pain in one eye, followed by blurry vision in part or all of the visual field of that eye. This is a result of involvement of the optic nerve by multiple sclerosis.

At least 15% and as many as 75% of individuals who have an episode of optic neuritis go on to develop multiple sclerosis. The blurred vision usually resolves within six months, but individuals are often left with less vivid color vision (especially red) in the affected eye.

Internuclear Ophthalmoplegia

Individuals usually notice double vision (diplopia), especially when looking to one side. This is the result of failure of the lateral rectus muscle to contract appropriately, so that the eyes do not move equally (called disconjugate gaze). Internuclear ophthalmoplegia occurs when multiple sclerosis affects a part of the brain stem called the medial longitudinal fasciculus, which is responsible for communication between the two eyes.

Transverse Myelitis

Individuals typically develop rapid onset of numbness, weakness, bowel or bladder dysfunction, and/or loss of muscle function, typically in the lower half of the body. This is the result of multiple sclerosis attacking the spinal cord. As many as 80% of individuals with transverse myelitis are left with lasting disabilities, even though there is usually some improvement during the first two years.

Diagnosis

Multiple Sclerosis is difficult to diagnose in its early stages. In fact, definite diagnosis of multiple sclerosis cannot be made until there is evidence of at least two anatomically separate demyelinating events occurring at least thirty days apart. The McDonald criteria represent international efforts to standardize the diagnosis of ms using clinical data, laboratory data, and radiologic data.

Clinical data alone may be sufficient for a diagnosis of multiple sclerosis. If an individual has suffered two separate episodes of neurologic symptoms characteristic of multiple sclerosis, and the individual also has consistent abnormalities on physical examination, a diagnosis of multiple sclerosis can be made with no further testing. Since some people with multiple sclerosis seek medical attention after only one attack, other testing may hasten the diagnosis and allow earlier initiation of therapy.

Course

The course of multiple sclerosis is difficult to predict, and the disease may at times either lie dormant or progress steadily. Several subtypes, or patterns of progression, have been described. Subtypes use the past course of the disease in an attempt to predict the future course. A person diagnosed with a particular subtype may, for unclear reasons, switch from one subtype to another over time.

Factors triggering a relapse

Multiple Sclerosis relapses are often unpredictable and can occur without warning with no obvious inciting factors.

Some attacks, however, are preceded by common triggers. In general, relapses occur more frequently during spring and summer than during autumn and winter. Infections, such as the common cold, influenza, and gastroenteritis, increase the risk for a relapse. Emotional and physical stress may also trigger an attack, as can severe illness of any kind.

Pathophysiology

Although much is known about how multiple sclerosis causes damage, the reasons why multiple sclerosis occurs are not known.

Complications

Multiple Sclerosis is a disease in which the body's immune system attacks the myelin surrounding nerve cells. Myelin is a fatty substance which covers the axons of nerve cells and is important for proper nerve conduction.

A special subset of white blood cells, called T cells, plays a key role in the development of multiple sclerosis. Under normal circumstances, these lymphocytes can distinguish between self and non-self. However, in a person with multiple sclerosis, these cells recognize healthy parts of the central nervous system as foreign and attack them as if they were an invading virus.

Why Multiple Sclerosis Occurs

Although many risk factors for multiple sclerosis have been identified, no definitive cause has been found. Multiple sclerosis likely occurs as a result of some combination of both environmental and genetic factors. Various theories try to combine the known data into plausible explanations. Although most accept an autoimmune explanation, several theories suggest that multiple sclerosis is an appropriate immune response to an underlying condition.

Treatment

There is no known definitive cure for multiple sclerosis. However, several types of therapy have proven to be helpful. 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 multiple sclerosis attacks. Treatment is aimed at returning function after an attack, preventing new attacks, and preventing disability.

Management of Acute Attacks

During symptomatic attacks, patients are often hospitalized. They are typically given high doses of corticosteroids such as methylprednisolone intravenously for several days to increase the chances that the attack will end sooner and leave fewer lasting deficits. There is some support for using oral corticosteroid pills during an attack, but clinical practice varies. However, there is no data to support the continued use of steroids for preventing ms after an initial attack.

Management Of Progressive Multiple Sclerosis

Treatment of progressive multiple sclerosis is more difficult than relapsing-remitting multiple sclerosis, and many patients do not respond to any therapy.

A wide range of medications have been used to try to slow the progression of disease. Many therapies have been shown to have some effect on disease progression and resulting disability, but most therapies have significant side effects which limit their long-term use. Therefore they are often appropriate only for the most rapidly progressive cases.

Management Of Demyelination Without A Diagnosis Of Multiple Sclerosis

Several studies have shown that starting treatment with interferon (Avonex or Rebif) during the initial attack (and prior to the second attack required for a definite diagnosis of multiple sclerosis) can decrease the chance that a patient will develop multiple sclerosis.

A separate medication, intravenous immunoglobulin (IVIG) has also shown promise in reducing progression to multiple sclerosis in this set of patients. Therefore, in certain patients, it is important that therapy be started prior to definite diagnosis.

Management Of The Effects Of Multiple Sclerosis

Because much of the damage caused by multiple sclerosis is irreversible, management of the resulting deficits is very important. As for any patient with neurologic deficits, a multidisciplinary approach is key to limiting and overcoming disability. Physical therapy, occupational therapy, and speech therapy are all important components of a comprehensive approach to maintaining quality of life.

Therapies Under Investigation

A family of cholesterol-lowering drugs, the statins, have shown anti-inflammatory effects in animal models of multiple sclerosis. However, as of 2005 there is not sufficient evidence that statins are beneficial in the treatment of human ms patients with normal cholesterol levels.

A recent study found that women who took vitamin D supplements were 40% less likely to develop multiple sclerosis than women who did not take supplements. However, this study does not provide enough data to conclude that vitamin D has a beneficial influence on ongoing ms. Furthermore, it could not distinguish between a beneficial effect of vitamin D and that of multivitamin supplements including vitamin E and various B vitamins, which may also exert a protective effect.

Side Effects Of Medications For Relapsing-Remitting Multiple Sclerosis

The two most common types of medications used to treat relapsing-remitting multiple sclerosis have significant side effects which warrant further discussion. Both the interferons and glatiramer acetate are available only in injectable forms, and both can cause irritation at the injection site.

Interferons are produced in the body during illnesses such as influenza in order to help fight the infection. They are responsible for the fever, muscle aches, fatigue, and headache common during influenza infections.

Prognosis

The future course of the disease (or prognosis) for people with multiple sclerosis depends on the subtype of the disease, the individual's sex and race, their age, their initial symptoms, and the degree of disability they experience. The life expectancy of people with multiple sclerosis is now nearly the same as that of unaffected people. This is mainly due to improved methods of limiting disability, such as physical therapy and speech therapy, and more successful treatment of common complications of disability,such as pneumonia and urinary tract infections.

Risk Factors

In northern Europe, continental North America, and Australasia, about one of every 1000 citizens suffers from multiple sclerosis, whereas in the Arabian peninsula, Asia, and continental South America, the frequency is much lower. In sub-Saharan Africa, multiple sclerosis is extremely rare.

With important exceptions, there is a North-South gradient in the Northern hemisphere and a South-North gradient in the Southern hemisphere, with multiple sclerosis being much less common in people living near the equator.

Climate, diet, geomagnetism, toxins, sunlight exposure, genetic factors, and infectious diseases have all been discussed as possible reasons for these regional differences. Environmental factors during childhood may play an important role in the development of multiple sclerosis later in life.

This idea is based on several studies of migrants showing that if migration occurs before the age of fifteen, the migrant acquires the new region's susceptibility to ms. If migration takes place after age fifteen, the migrant keeps the susceptibility of his home country. Additionally, smoking has been shown to be an independent risk factor for developing multiple sclerosis.

History

A French neurologist named Jean-Martin Charcot (1825–93) was the first person to recognize multiple sclerosis as a distinct, separate disease in 1868.

Summarizing previous reports and adding his own important clinical and pathological observations, Charcot called the disease sclerose en plaques.

The three signs of multiple sclerosis now known as Charcot's triad are dysarthria (problems with speech), ataxia (problems with coordination), and tremor.

Prior to Charcot, Robert Hooper (1773–1835), a British pathologist and practicing physician, Robert Carswell (1793–1857), a British professor of pathology, and Jean Cruveilhier (1791–1873), a French professor of pathologic anatomy, had described and illustrated many of the disease's clinical details.

Natural Remedies

Although some doctors recommend fish oil capsules for people with multiple sclerosis, few investigations have explored the effects of this supplement.

In one small trial, people with multiple sclerosis were given approximately 20 grams of fish oil in capsules per day. After one to four months, 42% of these people received slight but significant benefits, including reduced urinary incontinence and improved eyesight.

However, a longer double-blind trial involving over 300 people with multiple sclerosis found that half this amount of fish oil given per day did not help.

A preliminary, two-year intervention trial tested the effects of fish oil supplements (5 ml of fish oil per day, providing 400 mg of EPA and 500 mg of DHA) combined with other dietary supplements and dietary changes in people with newly diagnosed, relapsing-remitting multiple sclerosis.

References For Multiple Sclerosis Article

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