Multiple Sclerosis Treatment, Causes, Types, Symptoms, Diagnosis And Prevention

Multiple Sclerosis Treatment, Causes, Types, Symptoms, Diagnosis And Prevention


Information on Multiple Sclerosis


Although multiple sclerosis was first diagnosed in 1849, the earliest known description of a person with possible multiple sclerosis dates from fourteenth century Holland. An unpredictable disease of the central nervous system, multiple sclerosis can range from relatively benign to somewhat disabling to devastating as communication between the brain and other parts of the body is disrupted.

The vast majority of patients are mildly affected, but in the worst cases multiple sclerosis can render a person unable to write, speak, or walk. A physician can diagnose multiple sclerosis in some patients soon after the onset of the illness. In others, however, physicians may not be able to readily identify the cause of the symptoms, leading to years of uncertainty and multiple diagnoses punctuated by baffling symptoms that mysteriously wax and wane.

Multiple Sclerosis Treatment, Causes, Types, Symptoms, Diagnosis And Prevention
Multiple Sclerosis


Once a diagnosis of Multiple Sclerosis is made with confidence, patients must consider a profusion of information-and misinformation-associated with this complex disease. This brochure is designed to convey the latest information on the diagnosis, course, and possible Multiple Sclerosis treatment, as well as highlights of current research. Although a pamphlet cannot substitute for the advice and expertise of a physician, it can provide patients and their families with information to understand multiple sclerosis better so that they can actively participate in their care and treatment.

What is Multiple Sclerosis?


During an multiple sclerosis attack, inflammation occurs in areas of the white matter of the central nervous system in random patches called plaques. This process is followed by destruction of myelin, the fatty covering that insulates nerve cell fibers in the brain and spinal cord. Myelin facilitates the smooth, high-speed transmission of electrochemical messages between the brain, the spinal cord, and the rest of the body; when it is damaged, neurological transmission of messages may be slowed or blocked completely, leading to diminished or lost function. The name "multiple sclerosis" signifies both the number (multiple) and condition (sclerosis, from the Greek term for scarring or hardening) of the demyelinated areas in the central nervous system.

How Many People Have Multiple Sclerosis?


No one knows exactly how many people have Multiple Sclerosis. It is believed that, currently, there are approximately 250,000 to 350,000 people in the United States with multiple sclerosis diagnosed by a physician. This estimate suggests that approximately 200 new cases are diagnosed each week.

Suspected Causes of Multiple Sclerosis


Scientists have learned a great deal about multiple sclerosis in recent years; still, its cause remains elusive. Many investigators believe multiple sclerosis to be an autoimmune disease-one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of multiple sclerosis, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus.


The Immune System


To understand what is happening when a person has multiple sclerosis, it is first necessary to know a little about how the healthy immune system works. The immune system - a complex network of specialized cells and organs - defends the body against attacks by "foreign" invaders such as bacteria, viruses, fungi, and parasites. It does this by seeking out and destroying the interlopers as they enter the body. Substances capable of triggering an immune response are called antigens.

The immune system displays both enormous diversity and extraordinary specificity. It can recognize millions of distinctive foreign molecules and produce its own molecules and cells to match up with and counteract each of them. In order to have room for enough cells to match the millions of possible foreign invaders, the immune system stores just a few cells for each specific antigen. When an antigen appears, those few specifically matched cells are stimulated to multiply into a full-scale army. Later, to prevent this army from overexpanding, powerful mechanisms to suppress the immune response come into play.

T cells, so named because they are processed in the thymus, appear to play a particularly important role in multiple sclerosis. They travel widely and continuously throughout the body patrolling for foreign invaders. In order to recognize and respond to each specific antigen, each T cell's surface carries special receptor molecules for particular antigens.

T cells contribute to the body's defenses in two major ways. Regulatory T cells help orchestrate the elaborate immune system. For instance, they assist other cells to make antibodies, proteins programmed to match one specific antigen much as a key matches a lock. Antibodies typically interact with circulating antigens, such as bacteria, but are unable to penetrate living cells. Chief among the regulatory T cells are those known as helper (or inducer) cells. Helper T cells are essential for activating the body's defenses against foreign substances. Yet another subset of regulatory T cells acts to turn off, or suppress, various immune system cells when their job is done.

Killer T cells, on the other hand, directly attack diseased or damaged body cells by binding to them and bombarding them with lethal chemicals called cytokines. Since T cells can attack cells directly, they must be able to discriminate between "self" cells (those of the body) and "nonself" cells (foreign invaders). To enable the immune system to distinguish the self, each body cell carries identifying molecules on its surface. T cells likely to react against the self are usually eliminated before leaving the thymus; the remaining T cells recognize the molecular markers and coexist peaceably with body tissues in a state of self-tolerance.

In autoimmune diseases such as multiple sclerosis, the detente between the immune system and the body is disrupted when the immune system seems to wrongly identify self as nonself and declares war on the part of the body (myelin) it no longer recognizes. Through intensive research efforts, scientists are unraveling the complex secrets of the malfunctioning immune system of patients with multiple sclerosis.

Components of myelin such as myelin basic protein have been the focus of much research because, when injected into laboratory animals, they can precipitate experimental allergic encephalomyelitis (EAE), a chronic relapsing brain and spinal cord disease that resembles multiple sclerosis. The injected myelin probably stimulates the immune system to produce anti-myelin T cells that attack the animal's own myelin.

Investigators are also looking for abnormalities or malfunctions in the blood/brain barrier, a protective membrane that controls the passage of substances from the blood into the central nervous system. It is possible that, in multiple sclerosis, components of the immune system get through the barrier and cause nervous system damage.

Scientists have studied a number of infectious agents (such as viruses) that have been suspected of causing multiple sclerosis, but have been unable to implicate any one particular agent. Viral infections are usually accompanied by inflammation and the production of gamma interferon, a naturally occurring body chemical that has been shown to worsen the clinical course of multiple sclerosis. It is possible that the immune response to viral infections may themselves precipitate an multiple sclerosis attack. There seems to be little doubt that something in the environment is involved in triggering multiple sclerosis.

Genetics


In addition, increasing scientific evidence suggests that genetics may play a role in determining a person's susceptibility to multiple sclerosis. Some populations, such as Gypsies, Eskimos, and Bantus, never get multiple sclerosis. Native Indians of North and South America, the Japanese, and other Asian peoples have very low incidence rates. It is unclear whether this is due mostly to genetic or environmental factors.

In the population at large, the chance of developing multiple sclerosis is less than a tenth of one percent. However, if one person in a family has multiple sclerosis, that person's first-degree relatives-parents, children, and siblings-have a one to three percent chance of getting the disease.

For identical twins, the likelihood that the second twin may develop multiple sclerosis if the first twin does is about 30 percent; for fraternal twins (who do not inherit identical gene pools), the likelihood is closer to that for non-twin siblings, or about 4 percent. The fact that the rate for identical twins both developing multiple sclerosis is significantly less than 100 percent suggests that the disease is not entirely genetically controlled. Some (but definitely not all) of this effect may be due to shared exposure to something in the environment, or to the fact that some people with multiple sclerosis lesions remain essentially asymptomatic throughout their lives.

Further indications that more than one gene is involved in multiple sclerosis susceptibility comes from studies of families in which more than one member has multiple sclerosis. Several research teams found that people with multiple sclerosis inherit certain regions on individual genes more frequently than people without multiple sclerosis. Of particular interest is the human leukocyte antigen (HLA) or major histocompatibility complex region on chromosome 6. HLAs are genetically determined proteins that influence the immune system.

The HLA patterns of multiple sclerosis patients tend to be different from those of people without the disease. Investigations in northern Europe and America have detected three HLAs that are more prevalent in people with multiple sclerosis than in the general population. Studies of American multiple sclerosis patients have shown that people with multiple sclerosis also tend to exhibit these HLAs in combination-that is, they have more than one of the three HLAs-more frequently than the rest of the population. Furthermore, there is evidence that different combinations of the HLAs may correspond to variations in disease severity and progression.

Studies of families with multiple cases of multiple sclerosis and research comparing genetic regions of humans to those of mice with EAE suggest that another area related to multiple sclerosis susceptibility may be located on chromosome 5. Other regions on chromosomes 2, 3, 7, 11, 17, 19, and X have also been identified as possibly containing genes involved in the development of multiple sclerosis.

These studies strengthen the theory that multiple sclerosis is the result of a number of factors rather than a single gene or other agent. Development of multiple sclerosis is likely to be influenced by the interactions of a number of genes, each of which (individually) has only a modest effect. Additional studies are needed to specifically pinpoint which genes are involved, determine their function, and learn how each gene's interactions with other genes and with the environment make an individual susceptible to multiple sclerosis. In addition to leading to better ways to diagnose multiple sclerosis, such studies should yield clues to the underlying causes of multiple sclerosis and, eventually, to better treatments or a way to prevent the disease.

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Types of Multiple Sclerosis


Relapsing remitting multiple sclerosis: multiple sclerosis symptoms appear, known as an attack or relapse, then disappear completely or partially. This is the most common type of multiple sclerosis and affects around 85% of people diagnosed with multiple sclerosis.

Multiple Sclerosis Treatment, Causes, Types, Symptoms, Diagnosis And Prevention


Secondary progressive multiple sclerosis: This can be a stage of multiple sclerosis after relapsing remitting, in which the amount of disability builds-up, irrespective of relapses.

Primary progressive multiple sclerosis: multiple sclerosis symptoms worsen over time, rather as separate relapses.

Benign multiple sclerosis: A person who has a small number of attacks but then recovered completely may have benign multiple sclerosis.

Multiple sclerosis in children: multiple sclerosis rarely affects children under 16.

Who Gets Multiple Sclerosis?


Most people experience their first multiple sclerosis symptoms between the ages of 20 and 40, but a diagnosis is often delayed. This is due to both the transitory nature of the disease and the lack of a specific diagnostic test-specific symptoms and changes in the brain must develop before the diagnosis is confirmed.

Although scientists have documented cases of multiple sclerosis in young children and elderly adults, symptoms rarely begin before age 15 or after age 60. Whites are more than twice as likely as other races to develop multiple sclerosis. In general, women are affected at almost twice the rate of men; however, among patients who develop the multiple sclerosis symptoms at a later age, the gender ratio is more balanced.

Multiple sclerosis is five times more prevalent in temperate climates-such as those found in the northern United States, Canada, and Europe-than in tropical regions. Furthermore, the age of 15 seems to be significant in terms of risk for developing the disease: some studies indicate that a person moving from a high-risk (temperate) to a low-risk (tropical) area before the age of 15 tends to adopt the risk (in this case, low) of the new area and vice versa. Other studies suggest that people moving after age 15 maintain the risk of the area where they grew up.

These findings indicate a strong role for an environmental factor in the cause of multiple sclerosis. It is possible that, at the time of or immediately following puberty, patients acquire an infection with a long latency period. Or, conversely, people in some areas may come in contact with an unknown protective agent during the time before puberty. Other studies suggest that the unknown geographic or climatic element may actually be simply a matter of genetic predilection and reflect racial and ethnic susceptibility factors.

Periodically, scientists receive reports of multiple sclerosis "clusters." The most famous of these multiple sclerosis "epidemics" took place in the Faeroe Islands north of Scotland in the years following the arrival of British troops during World War II. Despite intense study of this and other clusters, no direct environmental factor has been identified. Nor has any definitive evidence been found to link daily stress to multiple sclerosis attacks, although there is evidence that the risk of worsening is greater after acute viral illnesses.

Multiple Sclerosis Symptoms


Multiple Sclerosis symptoms may be mild or severe, of long duration or short, and may appear in various combinations, depending on the area of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70 percent of multiple sclerosis patients.

Multiple Sclerosis Treatment, Causes, Types, Symptoms, Diagnosis And Prevention
Multiple Sclerosis Symptoms


The initial symptom of multiple sclerosis is often blurred or double vision, red-green color distortion, or even blindness in one eye. Inexplicably, visual problems tend to clear up in the later stages of multiple sclerosis. Inflammatory problems of the optic nerve may be diagnosed as retrobulbaror optic neuritis. Fifty-five percent of multiple sclerosis patients will have an attack of optic neuritis at some time or other and it will be the first symptom of multiple sclerosis in approximately 15 percent. This has led to general recognition of optic neuritis as an early sign of multiple sclerosis, especially if tests also reveal abnormalities in the patient's spinal fluid.

Most multiple sclerosis patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, multiple sclerosis can produce partial or complete paralysis. Spasticity-the involuntary increased tone of muscles leading to stiffness and spasms-is common, as is fatigue. Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness.

Most people with multiple sclerosis also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations; uncommonly, some may also experience pain. Loss of sensation sometimes occurs. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with multiple sclerosis have hearing loss.

Approximately half of all people with multiple sclerosis experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it is often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared.

Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. Scientists do not yet know whether altered cognition in multiple sclerosis reflects problems with information acquisition, retrieval, or a combination of both. Types of memory problems may differ depending on the individual's disease course (relapsing-remitting, primary-progressive, etc.), but there does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction. .

Depression, which is unrelated to cognitive problems, is another common feature of multiple sclerosis. In addition, about 10 percent of patients suffer from more severe psychotic disorders such as manic-depression and paranoia. Five percent may experience episodes of inappropriate euphoria and despair-unrelated to the patient's actual emotional state-known as "laughing/weeping syndrome." This syndrome is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and emotions, and is usually seen only in severe cases.

As the disease progresses, sexual dysfunction may become a problem. Bowel and bladder control may also be lost.

In about 60 percent of multiple sclerosis patients, heat-whether generated by temperatures outside the body or by exercise-may cause temporary worsening of many multiple sclerosis symptoms. In these cases, eradicating the heat eliminates the problem. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For the same reason, swimming is often a good exercise choice for people with multiple sclerosis.

The erratic symptoms of multiple sclerosis can affect the entire family as patients may become unable to work at the same time they are facing high medical bills and additional expenses for housekeeping assistance and modifications to homes and vehicles. The emotional drain on both patient and family is immeasurable. Support groups (listed on a card in the pocket at the back of this pamphlet) and counseling may help multiple sclerosis patients, their families, and friends find ways to cope with the many problems the disease can cause.


Possible Symptoms of Multiple Sclerosis

  • Muscle weakness
  • Spasticity
  • Impairment of pain, temperature, touch senses
  • Pain (moderate to severe)
  • Ataxia
  • Tremor
  • Speech disturbances
  • Vertigo
  • Bladder dysfunction
  • Bowel dysfunction
  • Sexual dysfunction
  • Euphoria
  • Cognitive abnormalities
  • Multiple Sclerosis Index


Multiple Sclerosis Diagnosis


When faced with a patient whose symptoms, neurological examination, and medical history suggest multiple sclerosis, physicians use a variety of tools to rule out other possible disorders and perform a series of laboratory tests which, if positive, confirm the diagnosis.

Imaging technologies such as MRI-often used in conjunction with the contrast agent gadolinium, which helps distinguish new plaques from old on MRI -can help locate central nervous system lesions resulting from myelin loss. However, since these lesions can also occur in several other neurological disorders, they are not absolute evidence of multiple sclerosis. Magnetic resonance spectroscopy (MRS) is a new tool being used to investigate multiple sclerosis. Unlike MRI, which provides an anatomical picture of lesions, MRS yields information about the biochemistry of the brain in multiple sclerosis.

Evoked potential tests, which measure the speed of the brain's response to visual, auditory, and sensory stimuli, can sometimes detect lesions the scanners miss. Like imaging technologies, evoked potentials are helpful but not conclusive because they cannot identify the cause of lesions.

The physician may also study the patient's cerebrospinal fluid (the colorless liquid that circulates through the brain and spinal cord) for cellular and chemical abnormalities often associated with multiple sclerosis. These abnormalities include increased numbers of white blood cells and higher-than-average amounts of protein, especially myelin basic protein and an antibody called immunoglobulin G. Physicians can use several different laboratory techniques to separate and graph the various proteins in multiple sclerosis patients' cerebrospinal fluid. This process often identifies the presence of a characteristic pattern called oligoclonal bands.

Because there is no single test that unequivocally detects multiple sclerosis, it is often difficult for the physician to differentiate between an multiple sclerosis attack and symptoms that can follow a viral infection or even an immunization. Many doctors will tell their patients they have "possible multiple sclerosis." If, as time goes by, the patient's symptoms show the characteristic relapsing-remitting pattern, or continue in a chronic and progressive fashion, and if laboratory tests rule out other likely causes, or specific tests become positive, the diagnosis may eventually be changed to "probable multiple sclerosis."

A number of other diseases may produce symptoms similar to those seen in multiple sclerosis. Other conditions with an intermittent course and multiple sclerosis-like lesions of the brain's white matter include polyarteritis, lupus erythematosus, syringomyelia, tropical spastic paraparesis, some cancers, and certain tumors that compress the brainstem or spinal cord. Progressive multifocal leukoencephalopathy can mimic the acute stage of an multiple sclerosis attack. The physician will also need to rule out stroke, neurosyphilis, spinocerebellar ataxias, pernicious anemia, diabetes, Sjogren's disease, and vitamin B12 deficiency. Acute transverse myelitis may signal the first attack of multiple sclerosis, or it may indicate other problems such as infection with the Epstein-Barr or herpes simplex B viruses. Recent reports suggest that the neurological problems associated with Lyme disease may present a clinical picture much like multiple sclerosis.

Investigators are continuing their search for a definitive test for multiple sclerosis. Until one is developed, however, evidence of both multiple attacks and central nervous system lesions must be found-a process that can take months or even years-before a physician can make a definitive diagnosis of multiple sclerosis.

Definite multiple sclerosis Consistent course (relapsing-remitting course with at least 2 bouts separated by at least 1 month, or slow or stepwise progressive course for at least 6 months) Documented neurologic signs of lesions in more than one site of brain or spinal cord white matter Onset of symptoms between 10 and 50 years of age Absence of other more likely neurologic explanation Probable Multiple Sclerosis History of relapsing-remitting symptoms. Signs not documented and only one current sign commonly associated with multiple sclerosis. Documented single bout of symptoms with signs of more than one white matter lesion; good recovery, then variable symptoms and signs Absence of other more likely neurologic explanation Possible Multiple Sclerosis History of relapsing-remitting symptoms No documentation of signs establishing more than one white matter lesion Absence of other more likely neurologic explanation.

Multiple Sclerosis Treatment


There is as yet no cure for multiple sclerosis. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. Naturally occurring or spontaneous remissions make it difficult to determine therapeutic effects of experimental treatments; however, the emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new therapies.

Until recently, the principal medications physicians used for multiple sclerosis treatment were steroids possessing anti-inflammatory properties; these include adrenocorticotropic hormone (better known as ACTH), prednisone, prednisolone, methylprednisolone, betamethasone, and dexamethasone. Studies suggest that intravenous methylprednisolone may be superior to the more traditional intravenous ACTH for patients experiencing acute relapses; no strong evidence exists to support the use of these drugs to treat progressive forms of multiple sclerosis. Also, there is some indication that steroids may be more appropriate for people with movement, rather than sensory, symptoms.

Multiple Sclerosis Treatment, Causes, Types, Symptoms, Diagnosis And Prevention

While steroids do not affect the course of multiple sclerosis over time, they can reduce the duration and severity of attacks in some patients. The mechanism behind this effect is not known; one study suggests the medications work by restoring the effectiveness of the blood/brain barrier. Because steroids can produce numerous adverse side effects (acne, weight gain, seizures, psychosis), they are not recommended for long-term use.

One of the most promising multiple sclerosis research areas involves naturally occurring antiviral proteins known as interferons. Two forms of beta interferon (Avonex and Betaseron) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting multiple sclerosis. A third form (Rebif) is marketed in Europe. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. In addition, MRI scans suggest that beta interferon can decrease myelin destruction.

Investigators speculate that the effects of beta interferon may be due to the drug's ability to correct an multiple sclerosis-related deficiency of certain white blood cells that suppress the immune system and/or its ability to inhibit gamma interferon, a substance believed to be involved in multiple sclerosis attacks. Alpha interferon is also being studied as a possible treatment for multiple sclerosis. Common side effects of interferons include fever, chills, sweating, muscle aches, fatigue, depression, and injection site reactions.

Scientists continue their extensive efforts to create new and better therapies for multiple sclerosis. Goals of therapy are threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease progression. Some therapies currently under investigation are discussed below.

Immunotherapy


As evidence of immune system involvement in the development of multiple sclerosis has grown, trials of various new treatments to alter or suppress immune response are being conducted. These therapies are, at this time, still considered experimental.

Results of recent clinical trials have shown that immunosuppressive agents and techniques can positively (if temporarily) affect the course of multiple sclerosis; however, toxic side effects often preclude their widespread use. In addition, generalized immunosuppression leaves the patient open to a variety of viral, bacterial, and fungal infections.

Over the years, multiple sclerosis investigators have studied a number of immunosuppressant treatments. Among the therapies being studied are cyclosporine (Sandimmune), cyclophosphamide (Cytoxan), methotrexate, azathioprine (Imuran), and total lymphoid irradiation (a process whereby the multiple sclerosis patient's lymph nodes are irradiated with x-rays in small doses over a few weeks to destroy lymphoid tissue, which is actively involved in tissue destruction in autoimmune diseases). Inconclusive and/or contradictory results of these trials, combined with the therapies' potentially dangerous side effects, dictate that further research is necessary to determine what, if any, role they should play in the management of multiple sclerosis. Studies are also being conducted with the immune system modulating drugs linomide (Roquinimex), cladribine (Leustatin), and mitoxantrone.

Two other experimental multiple sclerosis treatments - one involving the use of monoclonal antibodies and the other involving plasma exchange, or plasmapheresis - may have fewer dangerous side effects. Monoclonal antibodies are identical, laboratory-produced antibodies that are highly specific for a single antigen. They are injected into the patient in the hope that they will alter the patient's immune response. Plasmapheresis is a procedure in which blood is removed from the patient, and the plasma is separated from other blood substances, which may contain antibodies and other immmunologically active products. These other blood substances are discarded and the plasma is then transfused back into the patient. Because their worth as treatments for multiple sclerosis has not yet been proven, these experimental treatments remain at the stage of clinical testing.

Bone marrow transplantation (a procedure in which bone marrow from a healthy donor is infused into patients who have undergone drug or radiation therapy to suppress their immune system so they will not reject the donated marrow) and injections of venom from honey bees are also being studied. Each of these therapies carries the risk of potentially severe side effects.

Therapy to Improve Nerve Impulse Conduction


Because the transmission of electrochemical messages between the brain and body is disrupted in multiple sclerosis, medications to improve the conduction of nerve impulses are being investigated. Since demyelinated nerves show abnormalities of potassium activity, scientists are studying drugs that block the channels through which potassium moves, thereby restoring conduction of the nerve impulse. In several small experimental trials, derivatives of a drug called aminopyridine temporarily improved vision, coordination, and strength when given to multiple sclerosis patients who suffered from both visual symptoms and heightened sensitivity to temperature. Possible side effects of these therapies include paresthesias (tingling sensations), dizziness, and seizures.


Therapies Targeting an Antigen


Trials of a synthetic form of myelin basic protein, called copolymer I (Copaxone), have shown promise in treating people in the early stages of relapsing-remitting multiple sclerosis. Copolymer I, unlike so many drugs tested for the treatment of multiple sclerosis, seems to have few side effects. Recent trial data indicate that copolymer I can reduce the relapse rate by almost one third. In addition, patients given copolymer I were more likely to show neurologic improvement than those given a placebo. The Food and Drug Administration has made the drug available to people with early relapsing-remitting multiple sclerosis through its "Treatment IND" program and is currently reviewing data from a large-scale study to determine whether or not to approve the drug for marketing.

Investigators are also looking at the possibility of developing a multiple sclerosis vaccine. Myelin-attacking T cells were removed, inactivated, and injected back into animals with experimental allergic encephalomyelitis (EAE). This procedure results in destruction of the immune system cells that were attacking myelin basic protein. In a couple of small trials scientists have tested a similar vaccine in humans. The product was well-tolerated and had no side effects, but the studies were too small to establish efficacy. Patients with progressive forms of multiple sclerosis did not appear to benefit, although relapsing-remitting patients showed some neurologic improvement and had fewer relapses and reduced numbers of lesions in one study. Unfortunately, the benefits did not last beyond two years.

A similar approach, known as peptide therapy, is based on evidence that the body can mount an immune response against the T cells that destroy myelin, but this response is not strong enough to overcome the disease. To induce this response, the investigator scans the myelin-attacking T cells for the myelin-recognizing receptors on the cells' surface. A fragment, or peptide, of those receptors is then injected into the body. The immune system "sees" the injected peptide as a foreign invader and launches an attack on any myelin-destroying T cells that carry the peptide. The injection of portions of T cell receptors may heighten the immune system reaction against the errant T cells much the same way a booster shot heightens immunity to tetanus. Or, peptide therapy may jam the errant cells' receptors, preventing the cells from attacking myelin.

Despite these promising early results, there are some major obstacles to developing vaccine and peptide therapies. Individual patients' T cells vary so much that it may not be possible to develop a standard vaccine or peptide therapy beneficial to all, or even most, multiple sclerosis patients. At this time, each treatment involves extracting cells from each individual patient, purifying the cells, and then growing them in culture before inactivating and chemically altering them. This makes the production of quantities sufficient for therapy extremely time consuming, labor intensive, and expensive. Further studies are necessary to determine whether universal inoculations can be developed to induce suppression of multiple sclerosis patients' overactive immune systems.

Protein antigen feeding is similar to peptide therapy, but is a potentially simpler means to the same end. Whenever we eat, the digestive system breaks each food or substance into its primary "non-antigenic" building blocks, thereby averting a potentially harmful immune attack. So, strange as it may seem, antigens that trigger an immune response when they are injected can encourage immune system tolerance when taken orally. Furthermore, this reaction is directed solely at the specific antigen being fed; wholesale immunosuppression, which can leave the body open to a variety of infections, does not occur. Studies have shown that when rodents with EAE are fed myelin protein antigens, they experience fewer relapses. Data from a small, preliminary trial of antigen feeding in humans found limited suggestion of improvement, but the results were not statistically significant. A multi-center trial is being conducted to determine whether protein antigen feeding is effective.

Cytokines


As our growing insight into the workings of the immune system gives us new knowledge about the function of cytokines, the powerful chemicals produced by T cells, the possibility of using them to manipulate the immune system becomes more attractive. Scientists are studying a variety of substances that may block harmful cytokines, such as those involved in inflammation, or that encourage the production of protective cytokines.

A drug that has been tested as a depression treatment, rolipram, has been shown to reduce levels of several destructive cytokines in animal models of multiple sclerosis. Its potential as a therapy for multiple sclerosis is not known at this time, but side effects seem modest. Protein antigen feeding, discussed above, may release transforming growth factor beta (TGF), a protective cytokine that inhibits or regulates the activity of certain immune cells. Preliminary tests indicate that it may reduce the number of immune cells commonly found in multiple sclerosis patients' spinal fluid. Side effects include anemia and altered kidney function.

Interleukin 4 (IL-4) is able to diminish demyelination and improve the clinical course of mice with EAE, apparently by influencing developing T cells to become protective rather than harmful. This also appears to be true of a group of chemicals called retinoids. When fed to rodents with EAE, retinoids increase levels of TGF and IL-4, which encourage protective T cells, while decreasing numbers of harmful T cells. This results in improvement of the animals' clinical symptoms.

Remyelination


Some studies focus on strategies to reverse the damage to myelin and oligodendrocytes (the cells that make and maintain myelin in the central nervous system), both of which are destroyed during multiple sclerosis attacks. Scientists now know that oligodendrocytes may proliferate and form new myelin after an attack. Therefore, there is a great deal of interest in agents that may stimulate this reaction. To learn more about the process, investigators are looking at how drugs used in multiple sclerosis trials affect remyelination. Studies of animal models indicate that monoclonal antibodies and two immunosuppressant drugs, cyclophosphamide and azathioprine, may accelerate remyelination, while steroids may inhibit it. The ability of intravenous immunoglobulin (IVIg) to restore visual acuity and/or muscle strength is also being investigated.

Diet


Over the years, many people have tried to implicate diet as a cause of or treatment for multiple sclerosis. Some physicians have advocated a diet low in saturated fats; others have suggested increasing the patient's intake of linoleic acid, a polyunsaturated fat, via supplements of sunflower seed, safflower, or evening primrose oils. Other proposed dietary "remedies" include megavitamin therapy, including increased intake of vitamins B12 or C; various liquid diets; and sucrose-, tobacco-, or gluten-free diets. To date, clinical studies have not been able to confirm benefits from dietary changes; in the absence of any evidence that diet therapy is effective, patients are best advised to eat a balanced, wholesome diet.

Unproven Therapies


Multiple sclerosis is a disease with a natural tendency to remit spontaneously, and for which there is no universally effective treatment and no known cause. These factors open the door for an array of unsubstantiated claims of cures. At one time or another, many ineffective and even potentially dangerous therapies have been promoted as treatments for multiple sclerosis. A partial list of these "therapies" includes: injections of snake venom, electrical stimulation of the spinal cord's dorsal column, removal of the thymus gland, breathing pressurized (hyperbaric) oxygen in a special chamber, injections of beef heart and hog pancreas extracts, intravenous or oral calcium orotate (calcium EAP), hysterectomy, removal of dental fillings containing silver or mercury amalgams, and surgical implantation of pig brain into the patient's abdomen. None of these treatments is an effective therapy for Multiple Sclerosis or any multiple sclerosis symptoms.

Living with multiple sclerosis


When you get an illness like bronchitis or the flu, you know you'll be feeling better and functioning normally within a week or so. However, with chronic illness such as multiple sclerosis, it is different. It may never go away and can disrupt your life in many ways. But, by keeping a positive attitude, you should be better able to cope with the changes.

Multiple Sclerosis Treatment, Causes, Types, Symptoms, Diagnosis And Prevention
Living with multiple sclerosis

How can I maintain a positive attitude?


Multiple sclerosis should not define who you are. You are the same person you were before you were diagnosed - you just have a heavier load to bear. The best thing you can do is to learn how to make your life better. Here are some tips:

Get help if you need it. The most important step you can take is to seek help as soon as you feel less able to cope. Taking action early will enable you to understand and deal with the many effects of multiple sclerosis. Learning to manage stress will help you maintain a positive physical, emotional and spiritual outlook on life. A mental health care provider can design a treatment plan to meet your specific needs. Strategies can be designed to help you regain a sense of control over your life and improve your quality of life. At times, if depression is present, medication may be prescribed to help lift your mood.

Find a support group. Support groups can be a very useful sharing experience. They provide an environment where you can learn new ways of dealing with your illness. You may want to share approaches you have discovered with others. You will also gain strength in knowing that you are not facing your hardships alone.

Consider counselling. Sometimes people have problems that are better addressed in a one-on-one atmosphere. By participating in individual counselling, you may be able to more effectively express sensitive or private feelings that you have about your illness and its impact on your life and relationships.

Take good care of yourself. Eat healthy, exercise and learn techniques to help you deal with stress better, and get enough rest.

Keep a diary. Write down your experiences, symptoms and feelings. Not only will this be a valuable tool for your doctor, but it will also help you learn to express yourself.

Take control. There is often such a sense of uncertainty with multiple sclerosis that it may help to take control of the things in your life that you can control. You should also consider some of your life-planning issues such as finances, work, adapting your home and other practical issues. Be proactive in your health, educate yourself and ask questions.

Multiple sclerosis: Eating well


Healthy eating is important for everyone, but it is particularly important if you have a chronic illness, such as multiple sclerosis. Good nutrition, especially adequate calories and protein, helps maintain your body's store of protein, provides energy, helps heal wounds and fight infection.

What are some basic nutrition guidelines for people with Multiple Sclerosis?


  • Eat a variety of foods from each food group.
  • Maintain your weight through a proper balance of exercise and food.
  • Choose foods low in saturated fat and cholesterol, unless otherwise directed by your doctor.
  • Try to limit how much sugar you eat.
  • Moderate your use of salt.
  • If you choose to drink alcohol, do not consume more than one or two drinks per day. (Always ask your doctor about alcohol consumption.)
  • Drink eight 6-8 glasses of water per day.
  • Limit caffeine consumption.

Can Life Events Affect the Course of Multiple Sclerosis?


While there is no good evidence that daily stress or trauma affects the course of multiple sclerosis, there is data on the influence of pregnancy. Since multiple sclerosis generally strikes during childbearing years, a common concern among women with the disease is whether or not to have a baby. Studies on the subject have shown that multiple sclerosis has no adverse effects on the course of pregnancy, labor, or delivery; in fact symptoms often stabilize or remit during pregnancy. This temporary improvement is thought to relate to changes in a woman's immune system that allow her body to carry a baby: because every fetus has genetic material from the father as well as the mother, the mother's body should identify the growing fetus as foreign tissue and try to reject it in much the same way the body seeks to reject a transplanted organ. To prevent this from happening, a natural process takes place to suppress the mother's immune system in the uterus during pregnancy.

However, women with multiple sclerosis who are considering pregnancy need to be aware that certain drugs used to treat multiple sclerosis should be avoided during pregnancy and while breast feeding. These drugs can cause birth defects and can be passed to the fetus via blood and to an infant via breast milk. Among them are prednisone, corticotropin, azathioprine, cyclophosphamide, diazepam, phenytoin, carbamazepine, and baclofen.

Unfortunately, between 20 and 40 percent of women with multiple sclerosis do have a relapse in the three months following delivery. However, there is no evidence that pregnancy and childbirth affect the overall course of the disease one way or the other. Also, while multiple sclerosis is not in itself a reason to avoid pregnancy and poses no significant risks to the fetus, physical limitations can make child care more difficult. It is therefore important that multiple sclerosis patients planning families discuss these issues with both their partner and physician.

Multiple Sclerosis Life Expectancy


Multiple sclerosis is a chronic autoimmune disease where the body's immune system itself, attacks a part of the body, suspecting the part as a 'foreign body'. It may begin with an acute flare-up of symptoms within few hours to few days, which is called a relapse or attack. A sudden discomfort in normal physical activities can be experienced by the person. The symptoms in the early stage often resolve themselves spontaneously, after a few days or months. This situation is known as 'relapsing remitting'. Even when the symptoms subside, further nerve damage can continue in relapsing-remitting people. In such cases, focus is laid on the treatment for multiple sclerosis prevention. Regarding multiple sclerosis prognosis, diagnosing the severity of the disease and assessing whether the disease is progressive, remains a daunting task for the doctors. Due to the unpredictable flare-ups, relapses and remissions; predicting 'multiple sclerosis life expectancy' is quite difficult. Aggressive multiple sclerosis, that reduces the life span quickly, is noticed in very few cases. In majority of the cases, it is observed that patients live a near-normal life expectancy, with some limitations in the normal activities.

Progressive Multiple Sclerosis


The age of onset of multiple sclerosis is broad, the range is 20-40 years. About 10% of all multiple sclerosis patients experience chronic progression without relapses. This is called primary progressive condition of multiple sclerosis. In progressive multiple sclerosis, symptoms slowly accumulate over time. When new symptoms occur in discrete attacks, it is called relapsing forms of multiple sclerosis. Between two consecutive attacks, symptoms may go away completely. But the patients have to face permanent neurological problems, especially when the disease advances. Majority of patients with multiple sclerosis do not become severely disabled; but quality of life is definitely affected.

Unfortunately, there is no cure for multiple sclerosis. Suicide rates among multiple sclerosis patients are higher than average. After an attack, doctors try their best to prevent the recurrence of an attack in future and lower the risk of disability. The prognosis depends on the age, sex, overall mental and physical health of the patient, type of the disease, the individual's specific symptoms, the early stage symptoms and the degree of disability the person experiences as time advances. Progression of multiple sclerosis in a particular person cannot be exactly predicted; but it has been observed that the life expectancy of the patients is nearly the same as that of the normal population. For almost all multiple sclerosis patients, the life expectancy is about 27 years after the appearance of the symptoms. Studies show that if multiple sclerosis symptoms are noticed in the earlier stages, then the progression of the disease can be slowed down with the help of disease-modifying drugs. In 10% of patients, initial disease is primary progressive and the life expectancy is not greatly affected.

Secondary Progressive Multiple Sclerosis


Patients who have had relapsing or remitting multiple sclerosis pass into a secondary progressive stage of multiple sclerosis, usually 6-10 years after the onset of the disease. In this phase, a gradual worsening of the disease between relapses is noticed. With the help of the studies conducted so far, it can be stated that after 10 years, 50% of people with relapsing-remitting multiple sclerosis would develop secondary progressive multiple sclerosis and by 25 to 30 years, that figure would rise to 90%. Generally, the disease takes more than 30 years to reach the final stage.

Aggressive Multiple Sclerosis


Multiple sclerosis is called aggressive multiple sclerosis when the disease progresses very rapidly from the onset, leading to severe disability within a relatively short period. It can lead to death within a few weeks. Fortunately, this form of multiple sclerosis is extremely rare. The acute form of multiple sclerosis or aggressive multiple sclerosis can almost immediately result in death. Otherwise, multiple sclerosis is not considered a fatal disease and the symptoms of multiple sclerosis do not typically lead to death. multiple sclerosis affects the body systems and the risk of catching infections like pneumonia and suffering due to other diseases increases.

Facts about multiple sclerosis inform us that the life expectancy for this disease is actually identical to the life expectancy of everyone else - almost 80 years in the U.S. So take care of those patients and help them to live as best as they can with multiple sclerosis, because they'll be dealing with it for a long, long time.

What is the Outlook for People With Multiple Sclerosis?


The 1990s-proclaimed the "Decade of the Brain" in 1989 by President Bush and Congress-have seen an unparalleled explosion of knowledge about neurological disorders. New technologies are forcing even complex diseases like multiple sclerosis to yield up their secrets. These burgeoning opportunities in the field of neurological research have prompted the National Advisory Neurological Disorders and Stroke Council to suggest that an effective treatment for and the cause of multiple sclerosis may be found during the Decade of the Brain. The former has already been achieved; scientists continue to diligently search for the latter. Their dedication is the best hope for a cure, or, better yet, a way to prevent multiple sclerosis altogether.