Making Head Way with Multiple Sclerosis

Category: Multiple Sclerosis Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD

Carolyn awoke one day with blurred obstructed vision along with numbness in her legs and dizziness.  A trip to her doctor's office triggered an order of blood tests, an MRI, and a referral to an ophthalmologist and a neurologist.  Carolyn was diagnosed with multiple sclerosis, a disease of the central nervous system (CNS).

Our brain and spinal cord, that house the main pathway of our body's nerve signals, offer a layer of insulation, called myelin that surround and protect these nerve cells. Without this protective, tunnel-like sheath, nerve signals could not travel a proper path, which could lead to faulty connections between neighboring nerve fibers.  Like a plastic cover that surrounds the many wires of an electric cable, myelin covers nerve fibers to ensure that the nerve signals have safe uninterrupted passage, like electricity traveling through its cable without short-circuiting.

With MS, myelin sheaths break down (demyelination) due to inflammation caused by the autoimmune process.  Eventually, areas of demyelination turn into scar tissue (sclerosis), thus the term "multiple sclerosis".  This scar tissue, also known as plaque, appears as tiny patches on an MRI and disrupts the normal communication pathway that nerve signals travel to and from other parts of the body.

Typically, MS emerges between the age of fifteen and fifty, either suddenly or gradually, and in more women than men. In the United States, whites, especially those of Scandinavian decent, are more likely to develop MS than people of color, which is thought to be linked to an interaction between certain genetic aspects and viral infection.

Characteristic symptoms of multiple sclerosis are numbness, visual disturbance, abnormal gait, imbalance, muscle weakness or spasm, urinary incontinence, vertigo, slurred speech or even pain.

There are several forms of MS.  Relapsing-remitting MS (RRMS) occurs about 25% of the time and is characterized by intermittent relapses to include worsening of existing symptoms or the development of new symptoms.  Over the course of 10-15 years, about 50 % RRMS will evolve into progressive MS, known for more frequent relapses, incomplete remission bouts, and general overall deterioration.  The primary progressive MS (PPMS) occurs about 12% of the time and is the worse form of MS due to the fact that disability steadily increases from the moment of diagnosis.  On the other hand, benign MS (BMS) does not worsen with time and where there is no permanent disability.

Today, early diagnosis with the help of the MRI and spinal tap, physicians can start aggressive treatment such as biologic agents like beta interferon and a monoclonal antibodies called TYSABRI (natalizumab).

Thanks to this development, people like Carolyn have good reason to be optimistic and can expect improved symptoms, reduced frequency of relapse, and even slowed progression.

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