Multiple Sclerosis

What is Multiple Sclerosis and what causes it?

As explained by the National MS society, multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. It is considered to be an autoimmune disorder as the body’s own defence system attacks myelin, the fatty substance that surrounds and protects the nerve fibres in the central nervous system. The nerve fibres themselves can also be damaged. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fibre is damaged or destroyed, nerve impulses travelling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur.

Treatments

There is currently no known cure for MS, but there are a variety of treatments available for both the treatment of relapses (points during the disease in which a particular symptom lasts for over 24 hours) and the management of MS. All treatments have possible side effects (see common side effects)

Possible treatments of relapses (or exacerbations) include:

• Steroids (most common): The most common treatment regimen is a 3-5 day course of intravenous Solu-Medrol (methylprednisolone). High-dose oral Deltasone (prednisone) may also be used. Corticosteroids are not believed to have any long-term benefit on the disease.
• Intravenous immunoglobulin (IVIG): IVIG is a blood product which contains the pooled polyvalent, IgG (immunoglobulin (antibody) G) extracted from the plasma of over one thousand blood donors. IVIG's effects last between 2 weeks and 3 months. It is common for the use of autoimmune diseases.
• Plasmapheresis (Plasma exchange): Is a process in which blood is withdrawn from the person suffering a severe relapse which cannot be treated with steroids or IVIG. The bloods plasma is withdrawn from the person and replaced and then both the red and white blood cells re-enter the person. The process takes around 3-6 hours.

Treatments of the management of MS typically work to slow down the progression of MS by suppressing the immune system and lowering the attack of cells on the myelin sheath. These treatments can be administered in different frequencies depending on the drug and in a variety of ways including:

• Oral tablets
• Infusions
• Self controlled needles

For a list of the variety of medications on the management of MS see National MS Society

The Diagnosis of Multiple Sclerosis

Diagnosis of MS may be long and difficult due to the fact that each person suffering from MS suffers from individual symptoms, and it is therefore difficult to pin-point a common cause. People who are diagnosed with a clinically isolated syndrome (CIS) have had one episode of neurologic damage that is similar to the damage that occurs in MS, but they have not yet met the criteria for a definite diagnosis of MS. For a definite diagnosis of MS doctors commonly rely on:

• MRI scans that display lesions in the CNS
• At least two 'relapses' defined by CNS system damage that lasted over 24 hours
• A lumbar puncture (or spinal tap)

Facts about Multiple Sclerosis

• 2,500,000 people are estimated to suffer from MS worldwide
• MS effects women twice as much as it does men
• On average, the diagnosis of MS is between 25-40 years of age
• About 85 percent of those who are newly diagnosed have the relapsing-remitting form of MS
• No two people will experience the same symptoms
• MS is not contagious, and there is no known reason for the disease however in countries further from the equator, the incidence of MS increases.

Four different ‘courses’ of Multiple Sclerosis

1. Relapsing Remitting MS: People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks—which are called relapses, flare-ups, or exacerbations —are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.
2. Primary Progressive MS: This disease course is characterized by slowly worsening neurologic function from the beginning—with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.
3. Secondary Progressive MS: Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.
4. Progressive Relapsing MS: In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

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