What Do You Know About Multiple Sclerosis?

Multiple Sclerosis is a chronic and often disabling disease that attacks the central nervous system which consists of the brain, spinal cord and optic nerve.  Everything we do whether it is taking a step or even breathing all goes through the central nervous system.  The way our central nervous system functions is through the use of neurons, which are electronically excitable cells that process and transmit information through signals.  The signals that neurons send and receive are essential to the function of the central nervous system and allows the human experience to exist. Normally the path of these nerve signals is protected by the myelin sheath which is essential for the signals to reach their destination. However the pathways of a person with MS, the myelin is eroded and the nerve fibers underneath are damaged which affects the signals.   The reason for the loss of myelin is believed to be caused by the mistake attack by immune cells that protect the body from foreign substances. MS is thought to be triggered in a genetically susceptible individual by a combination of one or more environmental facts which causes something to go wrong with the immune cells and they seek out the myelin and attack.  Unpredictable symptoms such as numbness and tingling or blindness and paralysis are caused by distorted signals from the damaged myelin and these symptoms may be a temporarily or permanently lost.  The progress, severity and specific symptoms of MS are unpredictable and vary from one person to another.

People diagnosed with MS can experience one of four different courses of the disease ranging from mild to moderate to serve. Relapsing-Remitting MS is clearly defined attacks of worsening neurological function.  These attacks are followed by partial or complete recovery periods in which the disease does not progress. Approximately 85% of people are initially diagnosed with this type of MS.  Primary- Progressive MS is characterized by slowly worsening neurological function from the beginning with no distinct relapses or remissions.  10% of people are diagnoses with Primary-Progressive MS and the progression rate may vary with occasional minor improvements.  Secondary-Progressive MS is developed from relapsing-remitting MS and the disease worsens more steadily, with or without occasional flare-ups, minor recoveries or plateaus. Approximately 50% of Relapsing-Remitting MS patients developed this form of the disease within 10 years; however, disease-modifying medications have seemed to delay the transition.  The final form of MS is Progressive-Relapsing MS which is relatively rare and people experience steadily worsening  neurological function with clear attacks.  They may or may not experience some recovery following the relapses, but the disease continues to progress without remissions.

In order for a physician to diagnosis a person with MS they must prove specific evidence that fit the criteria for the diagnosis.  They must find evidence of damage in at two separate areas of the central nervous system.  They must find evidence that the damage occurred at least one month apart and rule out all other possible diagnoses. The criteria to diagnose MS includes specific guidelines for using MRI, VEP and cerebrospinal fluid analysis to speed up to diagnostic process.  A MRI is the best imaging technology for detecting the presences of MS plaques or scarring in different parts of the central nervous system.  It can also differentiate old lesions from those that are new or active.  Visual Evoked Potential (VEP) tests are recordings of the nervous system’s electrical response to the stimulation of specific sensory pathways.  With damaged myelin, the response time becomes slower providing evidence of scarring along the nerve pathway.  Cerebrospinal Fluid Analysis is sampled by a spinal tap, detecting the levels of certain immune system proteins and the presence of oligoclonal bands which indicate an immune response within the central nervous system.  However, because these bands are present in other diseases they cannot be relied on as positive proof of MS.  Blood tests are also used to rule out other possible diseases.

There is no cure for MS; however, there are treatment plans in place to modify the disease course, treat attacks, manage symptoms, improve function and safety and provide emotional support.  The use of different medications can reduce the activity of the disease and its progression.  Adherence to one’s treatment plan is essential to the modification the disease.  Treating the attacks caused by the inflamed central nervous system with a high dose corticosteroids can reduce the inflammation and lessen the amount of attacks.  Promoting function through rehabilitation is designed to help improve or maintain one’s ability to perform effectively and safely at home and at work.  Rehab focuses on overall fitness and energy management while addressing problems with accessibility, mobility, speech, swallowing, memory and other cognitive functions.  Patients can also use complementary and alternative medicine, such as yoga or herbal healing, with conventional treatment or instead of the treatments.



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