Multiple sclerosis (MS) is a chronic disease that can affect any part of the central nervous system, and thus can cause a wide variety of symptoms. It can range in severity from relatively benign to somewhat disabling to devastating.
“MS is something that sounds really terrifying to most people, but the developments that have been made in just the past 10 years make it a disease that is very manageable,” said Dr. Elizabeth Minto, assistant professor of neurology at the University of South Alabama College of Medicine and a neurologist with USA Physicians Group. “I try to reassure my patients that while MS is a chronic and progressive disease, it is treatable.”
Though the cause of MS is unknown, the disease results from an autoimmune attack on myelin, an insulating substance around nerve fibers in the brain and spinal cord. This damage, termed demyelination, disrupts the normal communication between the brain and other parts of the body, including the eyes, limbs, and even bowel and bladder.
Dr. Minto says that MS affects each patient differently – depending on the extent and location of demyelinating lesions in the nervous system.
“MS can cause any symptom that you can think of because it can attack anywhere in the brain or spinal cord,” she said. Some symptoms are more common in MS, including vision loss (typically in one eye), double vision, or weakness or numbness on one side of the body.
“The disease has an incredibly broad spectrum of severity,” she added. “It can also cause blindness, wheelchair dependence, the inability to walk, and the inability to control bladder function.” Depression, disabling fatigue, and stress are also very common in patients with MS.
Due to its wide variety of symptoms and lack of a single definitive diagnostic test, the diagnosis of MS can often be a difficult process. According to Dr. Minto, MS is typically diagnosed when a patient's history of neurological symptoms suggests multiple lesions and is confirmed when an MRI shows evidence of demyelinating lesions. “A lot of people fear they have MS because of vague symptoms, like fleeting numbness or tingling” she says. “But, if neurologic examination and MRI are normal, the diagnosis of multiple sclerosis is effectively ruled out.”
According to Dr. Minto, the onset of MS symptoms tends to come on over several days, slowly worsening before starting to get better. This is contrasted with symptoms of a stroke, which tend to be at their worst right from the onset. “Often, patients may have a flare of MS and their symptoms return back to their baseline or close to baseline when the inflammation subsides. They do well until they have another exacerbation, where they may develop new symptoms or have worsening of prior symptoms.”
Dr. Minto says flares of MS, termed exacerbations, are the hallmark of the disease and the cause of progression of disability. While there is no cure for MS, there are several treatments that have been proven to be effective at preventing the number of relapses and the severity of them.
Dr. Minto said the standard treatments for MS are injections, specifically interferon beta and glatiramer acetate. “There wasn’t a treatment other than steroids for exacerbations until the 1990s when it was discovered that interferon beta was effective at reducing the progression of lesions and the development of new symptoms,” she said. Currently, there are four different types of interferons available. They can be dosed daily, weekly, or several times per week. Glatiramer acetate is proven to be as effective as interferon, but works in a different way. It is a daily injection that is thought to mimic myelin, thus interfering with the immune attack on nerve tissue.
More recently, oral medications have been developed and approved by the FDA for treatment of MS. These medications, which are taken daily, work in different ways to alter the body's immune response and reduce the number of MS attacks. “The development of oral medications, as opposed to injections, is exciting for patients since needles can be painful and anxiety producing and can also be associated with injection site reactions, infection, and cosmetically unappealing skin changes,” says Dr. Minto.
For people who have progression of their symptoms or MRI lesions, or whose MS is more severe, a prescription medicine called natalizumab, marketed under the name Tysabri, is available. Tysabri is approved for adult patients with relapsing forms of MS to slow the worsening of disability that is common in patients with MS and decrease the number of flare-ups. This treatment is available at the USA Neuroscience Infusion Center at USA Medical Center. Typically, patients come once a month for treatment, which takes approximately two hours.
Although treatments for MS do not reverse symptoms that are already present, they are proven to reduce the risk of further exacerbations and progression of disability. According to Dr. Minto, treatment options for MS will continue to improve.
“I believe most of us know at least one neighbor, coworker, or friend who has MS that we are not even aware of – because treatments are working,” Dr. Minto said. “Many people with MS work, take care of their families, and make valuable contributions to their community. MS doesn't carry with it the automatic sentence of disability that it did in the past.”
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