• Multiple Sclerosis—Adult

    (MS—Adult)

    Definition

    Multiple sclerosis (MS) is a disease of the central nervous system. It is a chronic condition that can be disabling.
    There are several types of MS:
    • Relapsing-remitting MS—Symptoms suddenly reappear periodically. They last for a few weeks or months, then go back into remission (a period with no symptoms). Symptoms may get worse with each occurrence.
    • Primary progressive MS—Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
    • Secondary progressive MS—After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
    • Progressive relapsing MS—Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.
    Nerve Fiber (Neuron)
    Myelin Sheath Damage
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The immune system normally attacks viruses or bacteria that should not be in the body. With MS, a problem with the immune system causes it to attack healthy nerves. In particular, MS attacks the nerve fibers in the brain, spinal cord, and the nerves of the eye. The exact cause of these immune problems is unknown.
    The following may contribute to the development of MS:
    • Viral or other infection
    • Genetic factors (heredity)
    • Environmental factors
    • Breaking down of parts of the nervous system

    Risk Factors

    Factors that increase your chance of MS include:
    • Sex: female
    • Age: 15-50 years old
    • Being exposed to certain viruses
    • Having family members who have MS or other autoimmune disorders
    • Being of Northern European descent
    • Growing up in a colder climate, as opposed to a tropical climate
    • Having certain immune system genes
    • Having inflammation of the optic nerve
    Other factors that may play a role include:

    Symptoms

    Symptoms may range from mild to severe and may include:
    • Numbness or tingling in the face or limbs
    • Impaired vision in one or both eyes, including:
      • Blurred vision
      • Double vision
      • Loss of vision
    • Eye pain
    • Fatigue
    • Dizziness
    • Muscle stiffness
    • Muscle spasms
    • Muscle weakness
    • Incoordination or falling
    • Trouble walking or maintaining balance
    • Weakness in one or more limbs
    • Bladder problems including:
    • Bowel problems, including constipation
    • Sexual dysfunction
    • Slurred speech
    • Difficulty swallowing
    • Forgetfulness, memory loss, and confusion
    • Difficulty concentrating or solving problems
    • Depression
    Symptoms may worsen with:
      Heat, including:
      • Hot weather
      • Hot baths or showers
      • Fever
    • Overexertion—intense physical activity
    • Infection

    Diagnosis

    The doctor will ask about your symptoms and medical history, and perform a physical exam.
    Tests may include:
    • MRI scan—a test that uses magnetic waves to make pictures of structures inside the brain and spinal cord
    • Sensory evoked potentials—a test that records the electrical responses evoked after a sensory stimulus
    • Lumbar puncture (spinal tap)—removal of a small amount of cerebrospinal fluid (CSF) from around the spinal cord to check for white blood cells, antibodies, and proteins
    • Blood tests to rule out other diseases that may mimic MS (such as, B12 deficiency, Lyme disease, autoimmune disease)
    • Visual evoked potential test—to look for problems in the brain that affect vision

    Treatment

    The goals of MS treatment are to relieve symptoms, prevent relapses, delay disability, and slow disease progression.
    Treatments include:

    Medications

    Medicines may include:
    • Interferon beta (such as Betaseron, Avonex, Rebif)—(a protein that naturally occurs in the body)—used to suppress the immune system
    • Glatiramer acetate (Copaxone)—to help prevent MS relapses by modifying the function of the immune system
    • Other immunosuppressive drugs, such as:
      • IV immunoglobulin (IVIG)
      • Cyclophosphamide (Cytoxan)
      • Mitoxantrone (Novantrone)
      • Azathioprine (Imuran, Azasan)
      • Methotrexate (Rheumatrex, Trexall)
    • Natalizumab (Tysabri)—for relapsing-remitting MS (This medicine is under a mandatory registration program.)
    • Muscle relaxants—to treat muscle spasms or stiffness
    • Fingolimod (Gilenya)—a new oral medicine to reduce relapses and slow the progression of MS
    Other medications may also be given to treat symptoms:
    • Corticosteroids—to reduce nerve tissue inflammation and shorten MS flare-ups
    • Dalfampridine (Ampyra)—a medicine to improve walking in patients with MS
    • Botox injections may be used to treat spasticity in the arms and legs
    • Other drugs to treat:
      • Fatigue
      • Depression
      • Pain
      • Bladder or bowel problems

    Physical Therapies and Lifestyle Changes

    Therapies and changes may include:
    • Regular moderate exercise with your doctor's permission—Swimming may be especially beneficial.
    • Physical therapy to help maintain muscle strength and tone, dexterity, and walking ability
    • Massage
    • High-fiber diet to prevent constipation
    • Stress reduction techniques
    • Quitting smoking—Smoking may worsen MS, causing the condition to progress to a more severe form.

    Psychological Therapies

    Individual or group therapy will help you learn coping strategies for physical symptoms and emotional stress.
    If you are diagnosed with MS, follow your doctor's instructions.

    Prevention

    There are no guidelines for preventing MS because the cause is unknown.
    To prevent flare-ups or worsening symptoms if you have MS:
    • Take medications as prescribed.
    • Avoid hot weather.
    • Stay in air-conditioned places during periods of hot weather.
    • Get adequate rest.
    • Get regular, moderate exercise with your doctor's permission.
    • Avoid hot showers or baths.
    • Make sure to get enough fiber in your diet.
    • To aid in stress reduction, consider getting regular massages.
    • Try to avoid infection. You can do this by:
      • Practicing good hygiene
      • Staying away from people who are sick
      • Cooking food thoroughly
      • Practicing safe sex

    RESOURCES

    Multiple Sclerosis Association of America http://www.mymsaa.org

    National Multiple Sclerosis Society http://www.nationalmssociety.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Multiple Sclerosis Society of Canada http://mssociety.ca

    References

    About MS. National Multiple Sclerosis Society website. Available at: http://nationalmssociety.org/about-multiple-sclerosis/index.aspx. Accessed August 31, 2012.

    Ascherio A, et al. Vitamin D and multiple sclerosis. Lancet Neurol. 2010;9(6):599-612.

    Berkow R. The Merck Manual of Medical Information. New York, NY. Simon and Schuster, Inc; 2000.

    Bradley WG, Daroff RB, et al. Neurology in Clinical Practice e-dition. 4th ed. Butterworth Heinemann; 2003. Neurology in Clinical Practice website. Available at: http://www.nicp.com/content/default.cfm. Accessed October 25, 2007.

    FDA approves Ampyra to improve walking in adults with multiple sclerosis. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm198463.htm. Published January 22, 2010. Accessed August 30, 2012.

    International Multiple Sclerosis Genetics Consortium. Risk alleles for multiple sclerosis identified by a genomewide study. NEJM. 2007;357(9):851-862.

    Kasper DL, Braunwald E, et al. Harrison’s Principles of Internal Medicine. 16th ed. The McGraw-Hill Companies; 2006.

    Multiple sclerosis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 10, 2012. Accessed August 31, 2012.

    Multiple Sclerosis Society. News item. Multiple Sclerosis Society website. Available at: http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=2568. Accessed August 31, 2012.

    Multiple Sclerosis. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/multiple%5Fsclerosis/multiple%5Fsclerosis.htm. Accessed August 31, 2012.

    Rose JW, Carlson NG. Pathogenesis of multiple sclerosis. Continuum Lifelong Learning Neurol. 2007;13:35-62.

    Van der Mae IA, et al. Individual and joint action of environmental risk factors and MS. Neurol Clin. 2011;29:233-55.

    1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Healy B, Ali E, Guttmann C, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66(7):858-864.

    1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: FDA approves Botox to treat spasticity in flexor muscles of the elbow, wrist and fingers. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm203776.htm. Updated March 9, 2010. Accessed March 19, 2010.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: US Food and Drug Administration. FDA approves first oral drug to reduce MS relapses. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm226755.htm. Published September 22, 2010. Accessed September 24, 2010.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Kang JH, Sheu JJ, Kao S, Lin HC. Increased risk of multiple sclerosis following herpes zoster: a nationwide, population-based study. J Infect Dis. 2011;204(2):188-92.

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