What is Multiple Sclerosis?

Overview

Diagnosing MS involves many tests and loads of discussions with many kinds of health care professionals. You can expect a whole physical examination, a discussion of your anamnesis and a review of your past and/or current symptoms.

You should pay attention to any symptom suggestive of MS. Early identification of MS is very important as a result of a replacement generation of treatments introduced within the Nineties will cut back the frequency and severity of MS attacks. In fact, research has prompted health care professionals to change the diagnostic criteria to treat more cases of MS as early as possible.

At now, there are not any symptoms, physical findings or tests that alone can definitively show that a person has MS. Instead, physicians use many ways, as well as a anamnesis, neurologic exam, tests such as visual evoked potentials (VEPs) and spinal taps and imaging tests such as magnetic resonance imaging (MRI), to make a diagnosis.

For a diagnosis of MS, a health care professional must:

• Discover evidence of damage in at least two separate areas of the central nervous system (CNS), including the brain, spinal cord and optic nerves AND
• Find evidence that the damages occurred at least one month apart AND
• Be able to rule out all other possible diagnoses

In 2001, an international panel of experts convened to update the diagnostic criteria to include guidelines for using MRI, VEP and cerebrospinal fluid analysis to confirm an MS diagnosis faster. Health care professionals can use these tests to look for a second area of damage in a person who has experienced only one MS-like attack. These criteria were further revised in 2005 and again in 2010, termed the Revised McDonald Criteria, to speed up the diagnostic process even more.

The specific tests that help make an MS diagnosis include the following:

• MRI: Health care professionals may use MRI to scan the brain for lesions indicating early evidence of damage, in addition to other tests. An MRI is painless and noninvasive. If you need one, a health care professional will have you lie on your back on a table. The table will be pushed into a tube-like structure and detailed pictures of your brain and, sometimes, spinal cord, will be taken. These pictures area unit able to show scarred areas of the brain.Bear in mind that a standard imaging doesn’t make sure that an individual doesn’t have MS. About five p.c of MS patients have traditional MRIs, consistent with the National degenerative disorder Society. However, it is important to note that the longer a person has a normal MRI, the more important it becomes to look for a diagnosis other than MS.
• Visual evoked potential tests (VEPs): VEPs live however quickly a personality’s systema nervosum responds to sure stimulation. These tests supply proof of medicine scarring on nerve pathways which will not show up throughout medicine exams. Evoked potential tests are painless and noninvasive. A health care professional or technician will place small electrodes on your head to monitor your brain waves and your response to auditory, visual and/or sensory stimuli. The time it takes for your brain to receive and interpret messages is a clue to your condition.
• Spinal tap: A lumbar puncture tests humor (fluid close the brain and spinal cord) for substances that indicate sturdy immune activity within the central systema nervosum and helps rule out infective agent infections and different conditions which will cause medicine symptoms just like those of MS. If you have this test, you will likely be given an injection of local anesthesia. Some people experience a transient headache and nausea after the test.
• Blood tests: These may help rule out other potential causes of symptoms, such as Lyme disease, lupus and AIDS.

If you are diagnosed with MS, it will almost certainly be one of four patterns:

• Relapsing-remitting MS: This is often the foremost common pattern of the malady at the time of identification, poignant eighty five p.c of patients at this stage. People with this pattern of MS expertise clearly outlined exacerbations or relapses, followed by partial or complete remissions (or recovery periods) where the disease stops progressing.
• Secondary progressive MS: consistent with the National degenerative disorder Society, before the introduction of disease-modifying medicine, concerning half people with relapsing-remitting MS full-fledged a gradual worsening of symptoms with or without occasional flare-ups, minor remissions or plateaus within 10 years of initial diagnosis. This form of MS is named secondary progressive MS. At now, the semipermanent information aren’t accessible to work out whether or not or not the transformation in identification from relapsing-remitting to secondary progressive MS is delayed by treatment.
• Primary progressive MS: This pattern of MS is characterized from the onset by a nearly continuous worsening of the disease, with no distinct relapses or remissions. There may be temporary plateaus with minor relief from symptoms but no long-lasting relief. About 10 percent of people with MS have primary progressive MS.
• Progressive-relapsing MS: This manner of the malady is comparatively rare and takes a progressive course from the onset however is also characterised by obvious acute attacks, with or without recovery. In distinction to relapsing-remitting MS, the periods between relapses are characterized by continuing disease progression. About five p.c of individuals with MS have progressive-relapsing MS.

MS varies thus greatly in every person that it’s onerous to predict the course the malady would possibly take. However, some studies show that folks UN agency have few attacks within the 1st 5 years following a positive identification of MS, long intervals between attacks, complete recoveries and attacks that area unit sensory solely in nature typically have a less enervating type of the malady.

On the opposite hand, people who have early symptoms that include tremors, lack of coordination or frequent attacks with incomplete recoveries generally have a more progressive form of MS. These early symptoms indicate that a lot of medulla (the fatty insulation close nerve cells within the brain and spinal cord) has been broken.

Since MS typically strikes a girl throughout childbearing years, many women with the disease wonder if they should have a baby. Studies show that MS has no adverse effects on the course of pregnancy, labor or delivery; in fact, symptoms often stabilize during pregnancy. Although MS poses no important risks to a craniate, physical limitations of the mother may make caring for a child more difficult. Also, ladies with MS UN agency area unit considering having a baby ought to ask their health care professionals that medicine to avoid throughout physiological state and whereas breastfeeding. The disease-modifying drugs are not recommended during breastfeeding because it isn’t known if they are excreted in breast milk.

Treatment

There is no cure for MS, but some agents can modify the course of the disease, manage symptoms and treat exacerbations. These drugs include the following:

• Fingolimod (Gilenya): Gilenya was FDA-approved in 2010 to help reduce frequency of attacks and to delay physical disability in people with relapsing forms of MS. It is a replacement category of medication referred to as a sphingosine 1-phosphate receptor modulator, which is thought to reduce damage to nerve cells by trapping certain white blood cells within the lymph nodes, preventing them from entering the brain and spinal cord. Gilenya is given by mouth once a day. Gilenya is not recommended for people with preexisting heart conditions.
• Teriflunomide (Aubagio): Aubagio became the second oral disease-modifying treatment for MS when it was FDA-approved in 2012. The once-a-day pill is also prescribed to treat adults with reversion sorts of MS. Aubagio inhibits the operate of immune cells which will contribute to MS. It will inhibit a key protein needed by white blood cells (lymphocytes), reducing the proliferation of T and B immune cells active in MS and may additionally inhibit production of immune messenger chemicals by T cells. Common facet effects embody diarrhoea, abnormal liver tests, nausea and hair loss. It is not recommended for pregnant women or people with liver problems.
• Interferon beta-1b (Betaseron, Extavia): Interferon beta-1b, which was introduced in the 1990s, is prescribed to reduce the frequency of exacerbations of relapsing forms of MS, including secondary-progressive MS patients who continue to experience acute attacks or relapses. Betaseron associate degreed Extavia also are approved for patients UN agency have intimate with a primary episode and UN agency have an MRI result in keeping with MS. Betaseron and Extavia ar injected each different day underneath the skin. Common facet effects embody flu-like symptoms (which reduce over time) and reactions at the injection web site. Rare side effects include elevated liver enzymes and depression.
• Interferon beta-1a (Avonex, Rebif): Both Avonex and Rebif are approved by the U.S. Food and Drug Administration (FDA) for individuals with reversion sorts of MS to decrease the frequency of exacerbations and slow progression of incapacity. Avonex is injected once every week, typically within the massive muscles of the thigh, higher arm or hip. Rebif is injected three times a week. The proof trial, that compared Avonex and Rebif, found that patients treated with Rebif were more likely to be relapse-free at 24 and 48 weeks than those treated with Avonex. Side effects of each medication embody flu-like symptoms when injection, which lessen over time, and rarely, seizures, depression, mild anemia or liver problems.
• Glatiramer acetate (Copaxone): Copaxone is FDA-approved to reduce the number of relapses in people with relapsing-remitting MS and for those who have experienced a first clinical episode and have MRI results that point to MS. While interferon beta-1a and interferon beta-1b work by dampening the immune system, glatiramer acetate works differently to influence the immune system and its cells. Copaxone is injected daily. Common facet effects embody injection web site reactions, runny nose, tremor, unusual tiredness and weight gain. Rarer facet effects embody anxiety, chest tightness, shortness of breath and flushing.
• Mitoxantrone (Novantrone): An antineoplastic drug that’s a part of a gaggle of medicines referred to as antineoplastics, Novantrone helps in the treatment of MS by suppressing the activity of B cells, T cells and macrophages that are thought to attack the myelin sheath. Based on the results of a series of European studies done on Novantrone over 10 years, the FDA approved the drug for reducing neurologic disability and/or the frequency of relapses in people with secondary progressive MS, progressive-relapsing MS and worsening relapsing-remitting MS. Novantrone is taken by injection once each 3 months. Common facet effects, which may go away as your body adjusts to the medication, include nausea, hair loss and menstrual irregularities. Rarer and doubtless a lot of serious facet effects embody fever or chills, lower back or side pain, stomach pain and heart problems (therefore, patients should be screened for heart disease before they start taking Novantrone).
• Natalizumab (Tysabri): Tysabri was FDA approved in 2006 to help reduce the frequency of attacks in people with relapsing forms of MS. It should be used alone, not in combination with any other medications. The drug works by blocking potentially damaging immune cells from crossing into the brain and spinal cord. Tysabri is given intravenously once every four weeks. It is usually reserved for patients who have not responded well to other MS medications. Common side effects include headache, pain in your arms or legs, tiredness, joint pain, depression, diarrhea and pain in the stomach area. More serious side effects include increased risk of infection and increased risk of progressive multifocal leukoencephalopathy (PML), a viral infection of the brain that usually leads to death or severe disability.

Note: Talk to your health care provider if you experience side effects from one of the above-mentioned drugs. There may be strategies you can use to minimize the side effects; they may abate in a few months or you may be able to switch to one of the other drugs and avoid the side effects. If you stop taking the drug, it may seem like there are no consequences, but MS damage can occur steadily and silently for long periods before the next attack.

Steroids like methylprednisolone typically ar prescribed to treat acute attacks of MS, whether the person is taking a disease-altering drug or not. These medication speed the recovery from the acute attack however don’t stop sickness progression. Long-term use of steroids additionally has several facet effects, together with ulcers, weight gain, acne, cataracts, pathology and polygenic disorder.

Chemotherapies that suppress the immune system broadly and were originally designed to treat certain cancers are sometimes used for progressive MS. In addition to Novantrone, cyclophosphamide (Cytoxan) and azathioprine (Imuran) are used similarly but do not have approval from the FDA for treatment of MS.

A process in which the antibodies are filtered from a person’s blood called plasmapheresis may be successful, particularly when used in combination with immunosuppressants for short-term treatment of some progressive patients. However, its use is controversial.

For symptom management, health care professionals have an arsenal of medications. For example, baclofen (Lioresal) and tizanidine (Zanaflex) are antispasticity medications often prescribed to relieve muscle spasms, cramping and tightness of muscles in MS patients. Each has varying side effects in varying degrees. Your health care professional should be able to find one that provides comfort and relief for almost any symptom you have.

Although currently unapproved by the FDA for MS treatment, a growing number of health care providers now consider use of the botulinum toxin (Botox) as an effective short-term treatment option for certain types of MS-related problems, such as muscle stiffness and urinary problems, when first-line treatment is ineffective.

Nonmedical strategies for coping with MS

An MS diagnosing does not got to stop your life, however you may got to learn—and practice—strategies for managing fatigue and addressing alternative temporary or semipermanent disabilities. Physical and activity therapists will assist you develop methods and choose helpful devices to navigate the work and residential surroundings.

Physical therapy sometimes focuses on walking (including exploitation ambulant aids correctly), balance and stability in standing, maintaining range of motion and functional strengthening. Occupational therapy focuses a lot of on ways in which to accomplish specific everyday tasks reception and work, further as managing your energy. Some programs embrace techniques to enhance memory and concentration.

Check your health plan for coverage. Not all cover physical and occupational therapy.

Symptoms that have an effect on your memory and concentration could also be the foremost painful to speak regarding. But acknowledging these symptoms and discussing them with health care professionals and your family are the first steps toward getting them under control. The National disseminated sclerosis Society will direct you toward support teams and publications which will facilitate. Visit its website at www.nationalmssociety.org.

Things you can do at home to manage fatigue or limited mobility include:

• Declutter your living areas.
• Divide household tasks more equitably with family members.
• Simplify tasks like cooking so they are less stressful. For example, cook more frozen vegetables or freeze individual servings of a meal, so you can give yourself time off from meal preparation.
• Make tasks less fatiguing. For example, put a table and chair in the kitchen so you can sit while cutting or stirring.
• Identify and abide by your priorities. If it’s important for you to continue working, take some shortcuts with household tasks, or eliminate some of them.
• Cut back on tiring leisure activities, or make energy-conserving adaptations (such as planting a smaller garden).
• Minimize or combine trips.

At work you may want to try the following:

• Manage your workload to accommodate fatigue. For example, if you feel good in the morning but tire rapidly in the afternoon, do your most demanding work in the morning.
• Ask your employer about flex time.
• Consider multiple short breaks instead of an hour-long lunch. Perhaps a 30-minute lunch and two 15-minute breaks.
• When you’re having trouble concentrating, close your office door or take your work to a quiet area, if possible.

“Journaling” can also be a helpful coping strategy. A written or recorded account will assist you keep track of once symptoms occur, the management tools that job best for specific symptoms, your medication schedule and plenty of alternative issues related to your condition. Recording your thoughts and feelings may also be helpful to you. However, it’s vital to not get frantic and obsess over every very little feeling or sensation.

Exercise can be therapeutic and is at least as important for women with MS as for other women. If you have got MS, the final thing you would like is to develop alternative health problems—such as fleshiness, polygenic disorder or heart condition.

People with MS, however, shouldn’t “go for the burn” throughout exercise as a result of heating will trigger symptoms and worsen fatigue. Some girls with MS relish exercise in an exceedingly cool pool, however others realize that the hassle of driving and dynamical doubly is just too fatiguing. A physiotherapist will assist you style associate degree acceptable exercise program.

Prevention

No matter what quantity you exercise, however healthful your diet is or however well you’re taking care of yourself, there’s no thanks to stop disseminated sclerosis (MS). It affects people randomly. But it also is somewhat manageable. If detected early, medications may slow the progress of the disease and the severity of symptoms.

There is now preliminary evidence suggesting that higher vitamin D levels are associated with a decreased risk of MS. Research printed within the Journal of the yank Medical Association found that among white men and ladies, the risk of multiple sclerosis decreased by 41 percent with every increase of twenty ng/ml higher than twenty four in vitamin D levels. And previous studies, including one done on women who took vitamin D supplements, also show a connection between higher vitamin D levels and lower risk of MS. Other analysis suggests that UV from the sun (vitamin D is synthesized within the body as a results of UV from the sun) might dampen the immune attack, and that people who live closer to the equator—and therefore, get more sun exposure—are less likely to get MS. This growing body of research on the link between vitamin D and risk for MS may help explain this phenomenon. The Food and Nutrition Board at the Institute of Medicine recommends 600 international units (IU) of vitamin D for people ages 1 to 70 and 800 IU for those over 70. Neurologists typically advocate a lot of higher levels, but 4,000 IU is taken into account the higher level intake while not increasing health risks.

Facts to Know

1. Nearly 200 people in the United States are diagnosed with multiple sclerosis (MS) every week. There are 400,000 Americans with MS, according to the Multiple Sclerosis Society.
2. Most people with MS are diagnosed between the ages of 20 and 50.
3. Two to three times as many women as men develop MS.
4. The progress, severity and specific symptoms of MS in any one person cannot be predicted.
5. Symptoms of MS are unpredictable and vary greatly from person to person.
6. MS is not contagious or fatal. While quality of life is often changed for those diagnosed with MS, the disease does not significantly affect length of life.
7. Although there are no drugs to cure MS, treatments are available that can alter the course of the disease. Many symptoms can be treated and managed successfully.
8. Multiple sclerosis is Greek for “many scars” which aptly describes the manner in which the disease manifests itself—as scars or plaques on the brain.
9. Myelin is a substance made of fat and protein that helps speed messages through the central nervous system. Demyelination is the destruction of that substance. When myelin is destroyed, the messages from the brain to the rest of the body are slowed or destroyed. This results in impaired function and the symptoms of MS.
10. Genetics play a role in the development of MS, but the disease is not directly inherited. In other words, you have an increased chance of developing MS if a relative has the disease.

Key Q&A

1. What will happen to me if I am diagnosed with MS?Since this disease affects people so differently, it is impossible to predict. It is important to remember that most people with MS do not end up in a wheelchair, and life expectancy is normal or near normal. About 85 percent of people initially diagnosed with MS have relapsing-remitting MS, characterized by temporary attacks followed by periods of remission. About half those diagnosed with relapsing-remitting MS develop secondary progressive MS, in which there is a worsening of symptoms with or without occasional flare-ups and minor remissions. About 20 percent of those diagnosed will do well with no major treatments, but no one knows who they are up front. That can only be determined after many years of observation.
2. What are the symptoms?MS affects each person differently. Symptoms are a direct result of demyelination—the destruction of myelin, the substance made of fat and protein that helps speed messages through the central nervous system. When myelin is destroyed, the messages from the brain to the rest of the body are either slowed or destroyed. This results in impaired function and symptoms associated with MS, which can include difficulty walking, unusual fatigue, vision loss, strange tactile sensations like numbness or weakness, tremors, a lack of coordination, slurred speech, sudden paralysis and bladder dysfunction.Complications that are a result of the primary symptoms are often called secondary symptoms—urinary tract infections due to bladder dysfunction, for example. Other secondary symptoms include poor postural alignment and trunk control, decreased bone density (increasing risk of fracture) and shallow, inefficient breathing. Paralysis can lead to the secondary symptom of pressure sores. While secondary symptoms can be treated, the goal is to prevent them by treating the primary symptoms.There is a third classification of symptoms—the social and psychological effects. People with MS often become depressed. Psychologists, psychiatrists and social workers can help treat these symptoms.It is important to remember that many MS symptoms can be effectively managed and complications avoided with regular care by a neurologist and other health professionals.
3. Is there any treatment for MS?There is no cure for MS, but there are medications that may reduce disease activity in relapsing MS. These include Avonex, Rebif, Betaseron and Extavia, all of which are injectable. In addition, the drug Copaxone is used for the relapsing-remitting form of MS and for those who have experienced a first clinical episode and have MRI results that point to MS, Tysabri is used for the treatment of relapsing forms of the disease in people who have not responded well to other therapies, and Gilenya is used to reduce frequency of relapses and to delay physical disability in people with relapsing MS. In people with progressive MS, Novantrone can be used to reduce disability and the frequency of relapses in patients with secondary-progressive, progressive-relapsing or worsening relapsing-remitting MS. However, the lifetime dose of Novantrone is limited due to cardiac toxicity.

   Many aspects of MS can be effectively managed. For example, exacerbations can often be treated successfully with steroids. These drugs reduce inflammation at the site of new demyelination, allowing you to return to normal functioning more quickly than if they were not used. However, steroids have not been proven to have any long-term effect on the course of the disease and do have severe side effects. Also, physical and occupational therapy (rehabilitation) may help improve impaired functions. Counseling may have a positive effect on the psychological toll the disease takes on a person and her family.