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Multiple Sclerosis Multiple sclerosis (MS) is a chronic, sometimes disabling, disease of the central nervous system affecting approximately 400,000 people in the United States, according to the National Multiple Sclerosis Society. It affects two to three times as many women as men. MS develops more often in Caucasians than in other races. About 200 new cases of MS are diagnosed in the United States every week. The cause of MS is still unknown, but most researchers think it results from an abnormal response by the body’s immune system. Some researchers believe this abnormal immune response could be caused by a virus, although it is unlikely that there is just one virus responsible for triggering the condition. Researchers do know that MS is not contagious. And while it is not an inherited disease, genetic susceptibility plays a role. There is a higher risk for MS in families where it has already occurred. Other possible causes include environmental triggers such as exposure to toxins and heavy metals, as well as low levels of vitamin D. It is believed that MS is an autoimmune disease. In MS, the immune system—for reasons still not understood—attacks and destroys myelin and the oligodendrocytes(oligo, few; dendro, branches; cytes, cells) that produce it. Though the body usually sends in immune cells to fight off bacteria and viruses, in MS they misguidedly attack the body’s own healthy nervous system, thus the term autoimmune disease.Rheumatoid arthritis and lupus are other types of autoimmune diseases. In multiple sclerosis, these misdirected immune cells (certain types of lymphocytes, T-cells and killer cells) attack and consume myelin, damaging the myelin sheath—the fatty insulation surrounding nerve cells in the brain and spinal cord. Myelin acts like the rubber insulation found in an electric cable and facilitates the smooth transmission of high-speed messages between the brain and the spinal cord and the rest of the body. As areas of myelin are affected, messages are not sent efficiently or they never reach their destination. Eventually, there is a buildup of scar tissue (sclerosis) in multiple places where myelin has been lost; hence the disease’s name: multiple sclerosis. These plaques

or scarred areas, which only are a fraction of an inch in diameter, can interfere with signal transmission. The underlying nerve also may be damaged, further worsening symptoms and reducing the degree of recovery. The disease can manifest itself in many ways. Sometimes the diseased areas cause no apparent symptoms, and sometimes they cause many; this is why the severity of problems varies greatly among people affected with MS. Multiple sclerosis usually strikes in the form of attacks or exacerbations. This is when at least one symptom occurs, or worsens, for more than 24 hours. The symptom(s) can last for days, weeks, months or indefinitely. The most common pattern of multiple sclerosis is relapsing-remitting MS. It is characterized by periods of exacerbation followed by periods of remission. The remissions occur because nervous system cells have ways of partially compensating for their loss of ability. There’s no way to know how long a remission will last after an attack—it could be a month or it could be several years. But disease activity usually continues at a low, often almost indiscernible level, and MS often worsens over time as the signal-transmitting portion of the cells— the axons—are damaged. Most commonly, multiple sclerosis starts with a vague symptom that disappears completely within a few days or weeks. Temporary weakness, tingling or pain in a limb can be a first sign. Ataxia (general physical unsteadiness and problems with coordination), temporary blurring or double vision, memory disturbances and fatigueare also symptoms that can appear suddenly and then vanish for years after the first episode, or in some cases never reappear. The symptoms of MS vary greatly, as does their severity, depending on the areas of the central nervous system that are affected. Most people suffer minor effects. The disease can, however, completely disable a person, preventing him or her from speaking and walking in the most extreme cases. The bodily functions that are commonly affected by MS are:  vision  coordination

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strength sensation speech and swallowing bladder and bowel control sexuality cognitive function (thinking, concentration and short-term memory)

A varying degree of dysfunction may occur within these general areas. For instance, one person may suffer blurred vision while another may suffer double vision. Or one person may suffer from tremors while another will experience clumsiness of a particular limb. Specific symptoms associated with MS can include: fatigue: a debilitating kind of general fatigue that is unpredictable and out of proportion to the activity; fatigue is one of the most common (and one of the most troubling) symptoms of MS. cognitive function: short-term memory problems and difficulty concentrating and thinking, typically not severe enough to seriously interfere with daily functioning, although sometimes it does. Judgment and reasoning may also be affected. visual disturbances: blurring of vision, double vision (diplopia), optic neuritis, involuntary rapid eye movement and (rarely) total loss of sight. balance and coordination problems: loss of balance, tremor, unstable walking (ataxia), dizziness (vertigo), clumsiness of a limb and lack of coordination. weakness: usually in the legs. spasticity: altered muscle tone can produce spasms or muscle stiffness, which can affect mobility and walking. altered sensation: tingling, numbness (paresthesia), a burning feeling in an area of the body or other indefinable sensations. abnormal speech: slowing of speech, slurring of words and changes in rhythm of speech.

difficulty in swallowing (dysphagia). bladder and bowel problems: the need to urinate frequently and/or urgently, incomplete emptying or emptying at inappropriate times, constipation and loss of bowel control. sexuality and intimacy: impotence, diminished arousal and loss of sensation. pain: facial pain and muscle pains. sensitivity to heat: this often causes symptoms to get worse temporarily. Though these are some of the symptoms commonly associated with MS, not all people with MS will experience all of them. Most will experience more than one symptom, however. There is no typical case of MS. Each is unique. Today, life expectancy for those with MS is normal or close to normal. Most people with MS begin experiencing symptoms between the ages of 20 and 50. But initial symptoms may be vague, may come and go with no pattern or may be attributed to other factors or conditions. For instance, a woman who experiences sudden bouts of vertigo once every few months may explain away the symptom by linking it to her menstrual cycle. Or, perhaps, someone who suddenly has a bit of blurry vision may blame too many hours at the office. Diagnosis Diagnosing MS involves several tests and a lot of discussions with several types of health care professionals. You can expect a complete physical examination, a discussion of your medical history and a review of your past and/or current symptoms. You should pay attention to any symptom suggestive of MS. Early diagnosis of MS is important because a new generation of treatments introduced in the 1990s can reduce 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 this point, there are no symptoms, physical findings or tests that alone can definitively show that a person has MS. Instead, physicians use several strategies, including a medical history, 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 MSlike 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 images are able to show scarred areas of the brain.Bear in mind that a normal MRI does not ensure that a person does not have MS. About 5 percent of MS patients have normal MRIs, according to the National Multiple Sclerosis 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 measure how quickly a person’s nervous system responds to certain stimulation. These tests offer evidence of neurological

scarring along nerve pathways that may not show up during neurologic 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 spinal tap tests cerebrospinal fluid (fluid surrounding the brain and spinal cord) for substances that indicate strong immune activity in the central nervous system and helps rule out viral infections and other conditions that can cause neurological symptoms similar to 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 the most common pattern of the disease at the time of diagnosis, affecting 85 percent of patients at this stage. People with this pattern of MS experience clearly defined exacerbations or relapses, followed by partial or complete remissions (or recovery periods) where the disease stops progressing. Secondary progressive MS: According to the National Multiple Sclerosis Society, before the introduction of disease-modifying drugs, about half of individuals with relapsing-remitting MS experienced 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 called secondary progressive MS. At this point, the long-term data are not available to determine whether or not the changeover in diagnosis from relapsing-remitting to secondary progressive MS is delayed by treatment. For more Information visit us our website:

Multiple sclerosis  
Multiple sclerosis  

Multiple sclerosis (MS) is a chronic, sometimes disabling, disease of the central nervous system affecting approximately 400,000 people in t...