What is multiple sclerosis? Multiple sclerosis, or MS, is a disease of the central nervous system, the main network of nerves that carry electrical impulses throughout the body. The central nervous system is made up of the brain and spinal cord. Both have nerve fibers that transport electrical messages from the brain to the rest of the body. The nerve fibers are wrapped in a fatty tissue called myelin, which helps transmit the messages. In multiple sclerosis, the myelin sheath becomes inflamed and gradually is destroyed, leaving patchy scarred areas that disrupt communication between the brain and other parts of the body. In addition, the underlying nerve fibers can also be damaged or destroyed. This destruction of the myelin sheath and the damage to the underlying nerves can lead to a wide variety of symptoms that include numbness or tingling, balance problems, weakness, muscle spasms and blurred vision. MS is a complex and unpredictable disease. In some people it can cause relatively few symptoms. Others experience intermittent attacks. In the worst cases, people who have multiple sclerosis can lose the ability to speak, walk or write. However, the disease does not seem to significantly shorten a person's life and many people with multiple sclerosis are able to remain active. Anyone can develop MS. But many patients share these characteristics: The majority experience their first symptoms between the ages of 20 and 40. Caucasians are more than twice as likely as other races to develop MS. MS is two to three times more common in women as in men. MS is five times more common in temperate climates - like those of the northern United States, Canada, and Europe - than in tropical climates. People whose close relatives have MS are more susceptible to developing the disease, but there is no evidence the disease is directly inherited. How is multiple sclerosis diagnosed? No single test detects multiple sclerosis, which makes the disease difficult to diagnose. Symptoms can mimic those of a number of other conditions and they can change depending on the area of the central nervous system that loses myelin. Symptoms can also vary from person to person, and from day to day in the same person. Some early symptoms of MS are: Numbness or tingling in parts of the body, usually an arm or leg Unexplained weakness, dizziness and fatigue Blurry vision, double vision or blindness Other symptoms include: Muscle spasms Impairment of the sense of touch and the ability to feel temperature changes and pain Problems with balance and coordination Tremor Slurred speech Bladder and bowel problems Sexual problems Depression Mild difficulties with concentration, attention, memory, and poor judgment Moderate to severe pain Heat sensitivity To diagnose the disease, healthcare providers use a number of tools and tests that often help rule out other possible causes. Medical history: Doctors ask for details about personal health history, family health history and question patients carefully about symptoms, their duration, and their onset. Physical examination: A physical exam will most likely include tests to determine the health of nerves and muscles. Doctors may look for weakness in specific parts of the body, uncoordinated eye movements, and problems with balance, vision, and speech. Magnetic resonance imaging (MRI): If doctors possibly suspect MS after a physical exam, they will probably order additional diagnostic tests, starting with an MRI. During an MRI, a patient's body is placed within a magnetic field and scanned by radio waves. This combination creates detailed pictures of the part of the body being examined. In MS, doctors take scans of the brain or spine depending on the symptoms and physical exam. The resulting pictures can show patches, or scars, in the central nervous system where myelin has been destroyed. These areas are referred to as plaques. Since other disorders can cause these patches, an MRI scan can't provide definitive evidence of multiple sclerosis. But doctors rely primarily on MRIs to see evidence of the disease. MRIs are also important in tracking the progress of the disease, and doctors may order new tests from time to time to monitor a patient's condition. Researchers also use the test to see if experimental treatments have an affect on scarring in the central nervous system. Cerebrospinal fluid collection (CSF collection): If the diagnosis is still not clear, doctors may take a sample of spinal fluid. Patients typically lie on their sides with their knees bent up. The doctor administers a local anesthetic in the lower spine, and, using another needle, takes out a sample of the spinal fluid. Doctors examine the sample for abnormalities associated with MS, such as increases in white blood cells and high amounts of an antibody called immunoglobulin G. Evoked response tests (ERTs): These electronic tests, sometimes called evoked potential tests, measure the speed of brain connections. The most common ERTs are: the visual evoked response test (VER), the brainstem auditory evoked response test (BAER), and the sensory evoked response test (SER). In each, doctors attach wires to a patient's scalp. Then, depending on the test, they give patients visual, auditory, or sensory stimulation. These stimuli are a checkerboard pattern patients see on a monitor, a series of clicks they hear through earphones, or short electrical impulses they feel on an arm or leg. The tests measure the speed of visual, hearing, and sensory pathways and can detect damaged areas in the brain. Because the symptoms of multiple sclerosis may be caused by so many other conditions, doctors must make three findings before definitively diagnosing MS: Patients must have experienced at least two attacks - defined as a sudden appearance or worsening of MS symptoms - each of which lasts at least 24 hours. The attacks must be separated by at least one month. There must be no other explanation for the attacks. There must be documented signs of damage in more than one area of the brain or spinal cord. It should be clear by now that MS is difficult to diagnose with certainty. For that reason, doctors may tell patients who don't fulfill all of the diagnostic criteria for definitive MS that they have possible MS. If the patient's symptoms persist and tests either rule out other causes or point more clearly toward definitive MS, the diagnosis may change to probable or definite MS. How does multiple sclerosis progress? Scientists don't know what causes multiple sclerosis. But there is increasing evidence that the body's immune system plays a prominent role in its development. Some scientists think MS is an autoimmune disease. They believe the immune system, which usually protects the body by fighting germs and foreign bodies, may attack the myelin in the central nervous system. Some researchers suspect that these attacks may be triggered by certain kinds of viral infections. Researchers have also observed that some groups of people are much more susceptible to MS than others. This suggests that there may be a genetic component to the disease. The exact course of the disease in individual patients is uncertain, too. MS affects people in a variety of ways. In general, though, the disease follows several known patterns. Doctors group four of the patterns together under the heading "chronic progressive MS": Relapsing-remitting MS (RRMS): In this pattern, the patient experiences MS as a series of actively symptomatic periods, called attacks, exacerbations, or relapses. These attacks are followed by quiet periods called remissions during which symptoms become much less severe and no obvious progression of the disease is observed. Patients may have a period of stability that lasts months or even years before the pattern of relapses and remissions returns. According to the National Multiple Sclerosis Society, about 85 percent of people with MS are diagnosed with a relapsing-remitting course of the disease. Secondary-progressive MS (SPMS): This pattern begins after a relapsing-remitting course. The disease advances progressively, punctuated by acute attacks. The National Multiple Sclerosis Society estimates that more than half of patients who start out with relapsing-remitting disease will develop SPMS within 10 years, with the number rising to 90 percent within 25 years. Primary-progressive MS (PPMS): This pattern is marked by a gradual worsening of symptoms. Patients generally do not experience acute exacerbations. While there are no distinct remissions, patients with PPMS may have temporary plateaus during which symptoms lessen somewhat. According to the National Multiple Sclerosis Society, about 10 to 15 percent of people with MS are diagnosed with PPMS. Progressive-relapsing MS (PRMS): In this pattern, patients experience gradual progression of disease that is accompanied by acute exacerbations as well. According to the National Multiple Sclerosis Society, about 5 percent of people with MS have PRMS. In addition, the National Institute of Neurological Disorders and Stroke estimates that up to 20 percent of people with MS have a benign form of the disease. After the initial attacks, symptoms progress very little over the course of a person's lifetime. A small number of patients have malignant MS, which is marked by a rapid decline that leads to disability and possibly death. MS is rarely fatal, however, and most people with the disease have a normal life expectancy.   How is multiple sclerosis treated? MS is a complex disease, and so is its treatment. While there is no cure for multiple sclerosis, dozens of drugs and other therapies exist to treat the disease's many symptoms. Standard practice had been to wait until a person suffered two or more MS attacks before starting drug treatment. But recent studies suggest that treating MS early can lessen damage to the central nervous system and possibly slow the progress of the disease. In the last decade, drug therapies that reduce the number of attacks and may even slow progression of MS have become common. The National Multiple Sclerosis Society's medical advisory board now recommends that therapy with disease-modifying drugs begin as soon as possible after a definite diagnosis of relapsing-remitting MS. Exactly which therapies a patient and his or her doctor choose depends on individual factors, including the course and severity of the disease. Drug therapies for MS, and other treatment options, are outlined below. Disease-modifying drugs: So far, six disease-modifying drugs have been approved by the U.S. Food and Drug Administration (FDA) for use against MS: Four therapies have been approved for the treatment of relapsing-remitting MS. They include interferon beta 1-a (Avonex, Rebif), interferon beta 1-b (Betaseron) and glatiramer acetate (Copaxone). Each of these medications reduces the number and severity of attacks and some may slow the onset of disability. The drugs are injected either under the skin (Betaseron, Rebif, Copaxone), or into the muscle (Avonex). These therapies are sometimes referred to as ABCR therapies after the first letter in the names of the approved drugs. Interferons are naturally occurring proteins that fight invading viruses. Scientists aren't sure yet how interferons work, but they seem to protect the central nervous system from the body's own immune system. Glatiramer acetate (Copaxone) is used to combat relapsing-remitting MS. It is a synthetic compound made from substances found in myelin. How Copaxone helps in MS is not completely understood, but it likely helps to alter the body's immune system as well. All these drugs have potentially serious side effects. One therapy, Novantrone (mitoxantrone), has been approved for the treatment of secondary-progressive MS, progressive-relapsing MS and worsening relapsing-remitting MS. Originally developed to fight cancer, mitoxantrone (Novantrone) has been shown to decrease relapses and slow the progression of disability. It is administered intravenously. Scientists are still unclear exactly how this drug combats MS, but they suspect that it involves suppression of the immune system. It has many potentially serious side effects. Tysabri: announcing  the availability of TYSABRI, pronounced (Tie - SAB - ree).  FDA approved on November 23, 2004!  Please visit www.tysabri.com for the exciting scientific clinical based evidence, indication and usage. Steroids: Until the arrival of disease-modifying drugs, steroids were the medications of choice for treating MS. Patients still use the drugs, which reduce inflammation, to manage acute attacks of MS. Often doctors will prescribe high doses delivered intravenously. Commonly prescribed steroids include dexamethasone (Decadron), methylprednisolone (Solu-Medrol), and prednisone (Deltasone). These drugs also have serious side effects. Plasmapheresis (plasma exchange): Doctors usually consider this therapy only for the 10 percent or so of MS patients who do not respond well to treatment of acute attacks with steroids. In plasmapheresis, healthcare providers take blood from the MS patient and replace the liquid part, or plasma, with another fluid. Since plasma contains antibodies, this process removes the antibodies that may attack myelin. (It does not remove red or white cells.) Patients get their plasma-free blood back in a transfusion. Plasmapheresis is used to treat several autoimmune diseases and so far has had mixed success with primary and secondary-progressive MS patients. Complementary and alternative therapies: People with MS may use complementary and alternative therapies to lessen symptoms of the disease. As is often the case with complementary and alternative medicine, it's difficult to say what the value of treatment is, since few scientific studies have been conducted to test safety and effectiveness. Some treatments that are attracting interest are supplementation with vitamin D and antioxidant vitamins, and diets low in saturated fat and high in certain fatty acids. Future treatments: Researchers are looking into several new treatment options that may affect the progression of MS. Clinical trials, which test the safety and effectiveness of potential treatments, may be an option for some patients. For a listing of clinical trials of treatments for MS, see www.Clinicaltrials.gov or www.CenterWatch.com. Some areas of research in MS are: Immunotherapy: As ties between the immune system and MS have become clearer, researchers have been studying whether drugs and techniques that suppress the immune system can control the course of the disease. Some recent clinical trials are promising, but the drugs and therapies have serious side effects. Specifically, agents that suppress the immune system may leave patients open to infections. Remyelination: Scientists are looking into ways to reverse damage to myelin and stimulate the formation of new tissue. So far, studies in animals show that substances called monoclonal antibodies, as well as two drugs that suppress the immune system, may help rebuild myelin. Manipulating the immune system: Investigators are looking at several ways to change the way the immune system operates in patients with MS. These approaches include destroying or disabling the cells that attack myelin.   Information provided by www.healthtalk.com
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