What is Multiple Sclerosis?
1. What is multiple sclerosis?
MS is a disease of the central nervous system,· which has two major parts, the brain and the spinal cord. Surrounding and protecting the nerve fibers of the central nervous system is a fatty tissue called myelin, which helps nerve fibers conduct electrical impulses. In MS, myelin is lost in multiple areas, leaving scars called sclerosis. These damaged areas are also known as plaques or lesions.
Myelin not only protects nerve fibers, it also makes their job possible. When myelin is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, and this produces the various symptoms of MS. MS is not contagious. No one in your family will catch it from you.
2. What causes this disease?
While the exact cause of MS is unknown, many researchers believe that the damage to myelin results from an abnormal response by the body's immune system. Normally the immune system defends the body against foreign "invaders" such as viruses or bacteria. In autoimmune diseases, the body inadvertently attacks its own tissue. In the case of MS, the substance that is attacked is myelin. Scientists do not yet know what triggers the immune system to attack myelin. Most agree that several factors are involved.
3. What are the symptoms of MS?
Because these depend on which areas of the central nervous system have been attacked, not all people are affected the same way. Symptoms are not only different for different people, but different in the same person from time to time. · They also vary in severity and duration. A person with MS will usually experience more than one symptom, but not all people have all of them. Symptoms include weakness, tingling, numbness or impaired sensation, poor coordination, fatigue, problems with balance, visual disturbances, involuntary rapid eye movement, tremors, spasticity or muscle stiffness, slurred speech, bowel or bladder problems, unstable walking, ( problems with sexual function, sensitivity to heat, and problems with short-term memory, judgment, or reasoning (Cognitive problems). In extreme cases, MS can cause partial or complete paralysis. Remember; the majority of people with MS do not have all these symptoms.
4. How is MS diagnosed?
Because no single test can diagnose MS, several tests and procedures are needed. They are likely to include:
5. Are second opinions-to confirm diagnosis-a good idea?
If you've seen only one doctor it's certainly reasonable to get a second opinion. Your original doctor should not be insulted or hurt because you want to confirm your diagnosis. You might ask your family doctor or call the National MS Society; for a referral to a specialist in your area.
6. What will happen next?
MS is unpredictable and varies widely The disease can go through periods of exacerbation (in which new symptoms appear or existing symptoms become more severe) (in which symptoms decrease or lev& off).
Usually, though, MS follows one of these four patterns:
7. Is MS inherited?
MS is not dfrectly inherited, although studies do reveal familiar predisposition. This means that siblings or other close relatives are somewhat more likely to develop the disease. However 80 percent of people with MS do not have a close relative with MS.
8. Who gets MS?
Women develop MS at a rate almost double that of men. Diagnosis is usually made sometime between ages 20 and 40. It's estimated that in the United States some 350,000 people are living with MS. Some complicated cases of MS are difficult to diagnose, and because it isn't contagious, reporting of cases is not required. So the actual number of people with MS can only be estimated. Worldwide, MS occurs more frequently in temperate than tropical climates, and is more common among Caucasians, especially those of northern European ancestry. African Americans, Hispanic Americans, Asian Americans, and Native Americans all get MS, but at lower rates than people of European ancestry.
9. Are there any therapies that will stop or cure MS?
There is no known cure. But there are treatments that lessen the frequency or severity of attacks. Because treatment for MS is changing so rapidly, it's a good idea to be in contact with your doctor for up-to-date advice. The National MS Society is also a source of information on new developments. Call 1-800-LEARN-MS or your local chapter.
10. Are there any therapies to relieve symptoms?
Yes. Talk to your doctor about youl problems. For example, stiffness in the muscles may be reduced by prescription drugs such as baclofen (Lioresal ), dantrolene, (Dantrium ), or diazepam (Valium ). Fatigue may be managed with amantadine or pemoline (Cylert ). Spasticity and fatigue may also be treated with physical and occupational therapies. Bladder problems sometimes with oxybutynin (Ditropan ) or propantheline (Pro-Banthin&). Techniques such as self- catheterization can be easily learned. Prompt treatment of urinary tract infections and adequate intake of fluids may help prevent other bladder complications. Bowel problems may be managed with diet to increase bulk, suppositories, or medications. Pain in MS is treated according to the cause. Burning, painful, or unusual sensations may be managed with medications such as carbamazepine (Tegretol ) or (Elavili).
11 . What can rehabilitation offer?
Physical therapy (PT) can help strengthen weakened or uncoordinated muscles. PT might include range-of-motion exercises, stretching, training in walking and best ways to use canes, walkers, or other assistive devices, transfer training (which means learning how to move from wheelchairs to cars, (for example), and strengthening exercises to increase overall, function and stamina. Occupational Therapy (OT) is geared to improving independence in daily living. OT teaches techniques for dressing, grooming, eating, and driving, and may also provide exercises for coordination and strength. An occupational therapist can recommend equipment and ways to adapt the home or workplace for safety and independence. Speech therapy improves communication skills for those who may have difficulty speaking or swallowing due to weakness or poor coordination of the muscles. Techniques used by speech therapists (also called speech pathologists) might include exercise, voice training, or the use of special devices.
12. Does exercise help?
Exercise alone cannot alter MS, but it can improve overall health and it may prevent complications from disuse inactivity. Because exercise helps to regulate appetite and sleep patterns, and contributes to feelings of well being, there are psychological as well as physicaladvantages to be gained from a regular exercise program. The doctor or therapist can work out a combination of activities that will benefit the most.
13. Is depression common for someone with MS?
It's common to feel fear, confusion, loss of control, and grief at a diagnosis or worsening of MS. At one time or another; 30 to 40 percent of people with MS experience what doctors define as mild or moderate depression. Depression can also be a direct result of the damage this disease causes. Depression is treatable, with medications and with counseling.
14.Does smoking or drinking affect MS?
There's no evidence that smoking makes MS worse. But smoking can cause shortness of breath, susceptibility to lung infections, and heartbeat irregularities - symptoms that could add to disability. And because of weakness and incoordination, a smoker with these symptoms may be a fire waiting to happen! Drinking causes incoordination, poor balance, and slurred speech. It also impairs judgment and alters behavior. All this adds to existing neurological symptoms, although, again, there's no evidence that alcohol makes MS worse.
15. How does heat affect MS?
Heat doesn't make MS worse permanently. But many though not all, people with MS find that hot and humid weather a hot bath or shower or a fever temporarily makes their symptoms worse. It's a good idea to avoid the heat of day and to bathe in warm rather than hot water. Many people with MS find that cooling, with ice packs, iced drinks, and cool baths, helps to reduce symptoms. An air conditioner may be an essential piece of equipment and may even be tax deductible if your doctor recommends it.
16. Is dental or surgical dangerous?
The risks of general anesthesia for a person with MS are about the same as for everyone else, with one exception: those who have severe, advanced MS may have respiratory problems that require caution. There is no reason to avoid such common local anesthetics as novocaine unless you know you're allergic to them. Spinal anesthetics, such as the epidural anesthetic used during childbirth, are more problematic. Although most people with MS tolerate epidural anesthesia well, some neurologists feel that there are potential complications in the method and don't recommend it.
17. What about vaccination against the flu?
Flu vaccination is controversial. Flu shots may cause an increase in MS symptoms for some people. However there is currently no evidence to support the idea that flu shots cause an increased number of exacerbations. On the other hand, there is good evidence of a relationship between viral infections such as flu and exacerbations. People who are frail or who have had an exacerbation that followed a case of the flu may want to consider flu shots. As a rule, people on immune-suppressing medications should avoid any vaccinations. You should discuss the individual pros and cons with your doctor.
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