WHAT IS MS?
Multiple Sclerosis (MS) is a disease
of people. It affects their entire
lives, both physically and
psychologically.
Physically, the brain and the spinal
cord (the central nervous system) are
involved. Specifically, degeneration
of myelin, a material which is
composed mainly of fats and serves
as an insulation for the nerves,
much like the covering of an electric
wire, degenerates.
This fatty insulation allows a nerve to
transmit its impulses with lightning-like
speed, enabling people to move
almost without thinking.
The loss of this myelin insulation
causes what is, in effect, a short-circuiting
so that a person loses the ability to make
smooth, rapid, and coordinated movements.
Thus, MS is a demyelinating disease.
With multiple sclerosis, the loss of myelin
appears to the naked eye as a hardened
sclerotic (scar) area. These areas are
multiple within the central nervous system,
thus the term multiple sclerosis.
Different areas of the brain and spinal
cord are responsible for different
kinds of movements. For example,
the cerebellum, an out-pocketing of the
brain, is responsible for making
coordinated movements.
When an area of demyelination occurs
in the cerebellum, coordinated
movements become difficult.
The neurological deficit is quite
dependent on the region of the
brain or spinal cord that has been affected.
CHARACTERISTICS
Characteristics of multiple sclerosis are:
MS commonly begins between
the ages of 15 and 50
Remissions and exacerbations
(improvement and flareups) occur
Scattered areas in the nervous
system are diseased
MS symptoms vary considerably
from one individual to another and
range from mild disturbances of
gait and vision to severe weakness
and loss of control.
No two cases of multiple sclerosis are alike.
While a number of patients
with the disease are severely affected and
progress to wheelchairs, this is by no means
the rule. In fact, studies have shown that a
majority of patients live fairly normal lives.
Some patients may have only one or two
attacks of neurological deficit in their entire life.
A specific characteristic of MS is the
presence of clinical symptoms
affecting several different functions
within the central nervous system
(CNS), indicating the existence of
multiple sites of damage.
MS symptoms may fluctuate, or they
may progress in severity. However,
many patients have periods of stability
that last many years. Even patients
who ultimately progress to severe
disability may have had long periods
of less difficulty.
Periods during which new symptoms
appear or existing symptoms increase in
severity, or leveling off of symptoms
are termed remissions.
Because of the large amount of
variability in the presentation of the
disease, no predictions as to the
final outcome can be made.
Statistically, however, the MS patient
has every reason for optimism.
CAUSE
While the cause of multiple sclerosis
has not been determined, several
theories have been offered. Over the
years these theories have evolved and
changed.
It was believed that allergies played
a role in MS, and for many years
antihistamines and histamine
desensitizations were used.
It is now known that this type
of allergic response is not involved
in MS, but clearly the system in the
body which is responsible for recognizing
foreign substances (the immune system)
does not operate as it should. It appears
to react strongly to some stimuli
(antigens) and produces large amounts
of antibodies to protect itself.
This may result in a turning against
itself and the development of what is
called an "autoimmune reaction." Certain
immune cells named T cells and others
named B cells appear to behave differently
in the person with MS.
This behavior may well be determined by
the genetic make-up of an individual.
Thus, while MS is not a hereditary disease,
there is a hereditary factor.
While no virus has been consistently isolated
in the MS patient, there are many who
believe a virus is responsible for
"turning on" the immune systm.
Thus, the search for the virus "inducer"
continues.
The search is fueled by the fact that
there appear to be environmental
factors involved in the disease. The
farther away from the equator, north
and south, the more MS is seen. The l
ocation of a person's first fifteen
years of life seems to determine high
risk versus low risk likelihood.
DIAGNOSIS
The diagnosis of multiple sclerosis is
usually made as a result of clinical
symptoms and a neurological examination.
There is no one laboratory test which the
clinician can use to make a firm diagnosis.
However, in two-thirds of the cases of
multiple sclerosis, an elevated gamma
globulin is noted in the spinal fluid.
Special proteins called oligoclonal bands
are found in the spinal fluid of 80 percent
of people with MS. Special studies looking
at Igg production can be performed.
Electrical tests may indicate short-circuiting
in the central nervous system.
These are called evoked response tests
because a response from the nervous system
is evoked with a specific stimulus.
The stimulus may be visual, auditory, or
through stimulation of an arm or leg.
If it takes the stimulus an unusually
long time to reach the brain, a
short-circuiting may be the cause.
Magnetic resonance imaging (MRI) allows the
brain to be seen without surgery. MRI is
particularly sensitive to MS, thus it has
become an important aid to diagnosis.
It is important to realize that other
processes can make an MRI abnormal, and
that it can miss MS every now and then.
FREQUENT SIGNS AND SYMPTOMS
SENSORY:
Loss of vibratory sense;
loss of temperature,
pain and touch
sensation;
loss of position sense;
dizziness; numbness;
irritative
sensations;
electrical sensations;
loss of joint sensibility.
VISUAL:
Jerky eyes,
double vision,
loss of color vision,
blurred or dimmed
vision,
blindness.
SPEECH:
Scanning speech,
slurred speech.
MOTOR:
Weakness,
paralysis, c
clumsiness,
intention tremor,
spasticity.
BOWEL/BLADDER:
Frequency,
urgecy,
incontinence,
retention,
constipation.
FATIGUE
MANAGEMENT
GOOD HEALTH HABITS:
Adequate rest, well balanced diet,
prompt treatment of infections,
capabilites conserved and develped to
fullest extent.
DRUGS:
For relief of acute attacks,
spasticity,
bladder/bowel problems,
fatigue and depression.
PHYSICAL THERAPY:
Maintenance of physical function, retraining.
OCCUPATIONAL THERAPY
THERAPEUTIC RECREATION
COUNSELING: As indicated
NURSING CARE: Observation,
positioning,
activities of daily living teaching,
bowel and bladder training, etc.
VOCATIONAL REHABILITATION
COMMON SIGNS AND SYMPTOMS
Of MULTIPLE SCLEROSIS
MOTOR SENSORY
Muscle weakness - heavyness
Impairment of vibratory/position sense
Reflexes (hyperreflexia, Babinski,) I
mpairment of pain
Spasticity - Stiff muscles
Impairment of temperature
Impairment of touch Pain (Moderate to severe)
Lhermitte sign - Electric shock sensation
CEREBELLAR
CRANIAL NERVE/BRAIN STEM
Ataxia - staggering gait Vision
affected - blurred vision
Tremor Ocular disturbances
Nystagmus (brain stem or cerebellar)
Cranial nerves V, VII, VIII
Dysarthria (brain stem or
cerebellar) Bulbar signs
Vertigo
Optic Neuritis
AUTONOMIC
PSYCHIATRIC
Bladder dysfunction Depression
Bowel dysfunction Euphoria
Sexual dysfunction Cognitive abnormalities
Others (Sweating and vascular abnormalities)
MISCELLANEOUS
Fatigue
SYMPTOMS AND SIGNS SEEN
INFREQUENTLY IN MS
Generalized seizures
Tonic seizure
Headache
Trigeminal neuralgia Paroxysmal
dysarthia/ataxia
Chorea/athetosis Myoclonus
Facial hemispasm Myokymia
Spasmodic torticollis/focal dystonia
Lower motor neuron signs-wasting,
decreased tone,
areflexia Restless
legs Hysteria
RARE ASSOCIATIONS
Aphasia Anosmia Hiccoughs Deafness
Horner Syndrome Paroxysmal itching
Cardiac arrhythmias Acute pulmonary
edema Hypothalamic dysfunction
Narcolepsy.
LINKS
TO ADDITIONAL
SITES AND INFO
DOCOR'S GUIDE TO
MS
IMSSF
A non-profit organization for people
with multiple sclerosis and their families
MEDICATION'S
used in MS
SYMPTOMS OF MS
HUBOR
INRODUCTION
TO SCLEROSIS
MS RESOURSES
LIVING WITH
MS
MS SUPPORT &
CENTERS
MA INFO
MS & GENETIC FACTORS
MS LINKS & HELP
GLOSSARY OF TEMANOLOGY
MS AND ME
MY EXPERIENCE WITH MS
m>s>: A JPURNEY THROUGH LIFE!
LIVING AND COPING WITH MS
MS SUPPORT AND PEER SHARING
MS CHAPTER'S,
LINKS & HELP
The Many Faces of Multiple Sclerosis
and Demyelinization Disorders
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