What is Multiple Sclerosis?
Multiple Sclerosis is a progressive degenerative disease of the central nervous system with recurrent episodes of neurologic
dysfunction disconnected in time and space and associated with evidence of demyelination of the central nervous system.
It affects the patient in different areas of the nervous system at various points in time.
What causes Multiple Sclerosis?
The cause is unknown but believed to be related to an auto immune disease resulting from a viral infection.
Multiple sclerosis results in destruction of the myelin surrounding the nerves of the CNS. The destruction is thought to be
caused by the body’s immune system attacking the myelin sheath disrupting the transmission of information in the CNS and
lead to the symptoms seen in multiple sclerosis.
1.In Multiple Sclerosis, there is multiple scattered greying well defined lesions from few small mm size to few cm in size
present in the white matter and extending to the grey matter of the brain.
2.The lesions vary from partial to complete destruction of the myelin sheath with relative sparing of the axon , glia and
Who is at risk of Multiple Sclerosis?
Multiple Sclerosis occurs between 20 to 50 years old.
It is more common in Northern Europeans.
Women are affected 2 times more than men.
Triggers that can cause the onset of MS are:
What are the symptoms of Multiple Sclerosis?
The typical symptoms of Multiple Sclerosis are multiple and variable which explains its name.
There may be mild cases which may not need treatment or severe cases which need confinement to wheelchairs.
There is a typical course of exacerbations and remissions over a peroid of years and increased residual neurological deficit
1.impairment of vision is usually an early sign of MS
2.diplopia can occur with optic neuritis
3.unsteady gait due to the effect of the disease on the cerebellum which control balance and co-ordination
4.paresthesia or tingling sensation in the fingers and toes
5.weakness of the muscles leading to hemiplegia
6.facial paresis, vertigo and hearing loss
7.seizures when foci in the brain are over stimulated
8.Constipation and urinary incontinence may also occur as a result of the weakened muscles
9.one peculiar trait is that higher temperatures aggravate the symptoms in MS patients. Nerve conduction at higher
temperature such as a hot shower cause the slowing in the transmission of messages in nerves that have already lost myelin.
How is the diagnosis of Multiple Sclerosis made?
The diagnosis of Multiple Sclerosis is difficult and involve
1.History of a multiple symptoms involving the nervous system
2.physical and neurological examinations for peripheral neurological deficit.
3.blood count and chemistry, urine analysis are all routine laboratory tests used to rule out other diagnoses
4.Cerebral spinal fluid evaluation may show mild mononuclear pleocytosis (less than 40 cells per cubic meter, protein normal
or increased and high gamma globulin IgG.
5.MRI can search for changes within the brain or spinal cord that are particular to multiple sclerosis.
What are the complications for Multiple Sclerosis ?
1.Weakness of the muscles leading to hemiplegia
2.spasticity of the muscles with rigidity and cramps
3.Poor co-ordination and imbalance
4.urinary and bladder problems
5.visual loss and pain suggesting optic neuritis , an inflammation of the eyeball
What is the treatment for Multiple Sclerosis?
Multiple Sclerosis cannot be cured but can be suppressed:
2.Proper diet and nutrition to strengthen the muscles of the body
3.physiotherapy to strengthen muscles
4.occupational therapy to help stimulate the mind
5.Speech therapy for speech and awallowing
1.Glatiramer acetate is able to reduce the relapse rates of multiple sclerosis by about one-third and appears to reduce the
overall progression of multiple sclerosis
2.Natalizumab is a monoclonal antibody that binds to white blood cells which are thought to play a role in causing the
nervous system damage in multiple sclerosis. It also reduces the rates of relapses of MS by two thirds.
3.Fingolimod is a daily oral medication to treat MS by reducing the number of lymphocytes which is believe to cause
inflammation in MS.
4.Interferon which are anti-viral agents has found to reduce relapses of MS by one third.
What is the prognosis of Multiple Sclerosis?
5.Previous treatment used to be ACTH injections and corticosteroids. These are are seldom used.
What is the prognosis of Multiple Sclerosis?
MS is unfortunately still not curable at this time.
Most patients about 65 % with the relapsing and remitting form may improve to a stage where relapses are very much reduced.
Unfortunately they continue to have more disabling symptoms or secondary progressive multiple sclerosis.
15% become worse with progressive relapses.
10% has primary progressive MS with no remissions in between.
Death usually results from pneumonia and heart trouble.