Multiple Sclerosis (MS)

Definition

Multiple sclerosis (MS) is a chronic disease that affects the nerves causing it to malfunction. It is believed to be a disease arising from abnormal immune activity. The nerve tissue is damaged and destroyed causing impaired nerve signal transmission. Ultimately the nerve’s ability to function is compromised. The disease is more prominent between 20 to 40 years of age with comparatively higher incidence in women. It drastically hampers a person’s lifestyle and affects their ability to carry out routine activities.

Since no preventive measures are available for multiple sclerosis and the disease is not fully curable, rehabilitative measures from an important aspect of management of MS patients. Therefore MS patients should be encouraged to continue their usual activities and occupation. Depression and apathy about life can quickly set in but it is important for MS patients to realize that there are millions of sufferers living productive lives with the disease.

Symptoms

The symptoms of MS depend on which part of the nervous system system is involved. Involvement of the optic nerve, spinal cord, brain stem and cerebellum is commonly seen. Optic nerve impairment is one of the most commonly affected sites in multiple sclerosis.

  • The vision is one eye becomes rapidly reduced with the patient being able to detect only moving light or motion.
  • Double vision is common.
  • Difficulty in speech and tremors may also be present.
  • A feeling of unsteadiness is another common features of multiple sclerosis.
  • Spinal cord involvement may cause weakness in one or more limbs or paralysis.
  • Tingling and numbness are frequently seen.
  • Urinary problems often arise with time.

The first attack of multiple sclerosis may be difficult to diagnose and it is often confused with other diseases. Tests such as MRI, evoked potential test and lumbar puncture studies help in the diagnosis of multiple sclerosis as the symptoms alone may not be a reliable indicator.

Causes

The autoimmune response is triggered supposedly by environmental, genetic or due to some viral agent. It may not always damage the nerve directly but can cause a disruption in the immune activity. The immune system causes nerve tissue damage thereby producing the symptoms of multiple sclerosis.

The course of the disease is extremely variable. Some people may have symptoms so trivial that they may not seek medical advice and the disease may go unrecognized. The interval between the first manifestation and first relapse may vary considerably. In majority of the patients, the progress of the disease is marked by relapses of increasing severity and duration. Some patient may remain without any significant disability in the first few years of the disease while some may develop partial disability and some severe handicap. It entirely depends on the degree of nerve tissue damage.

MS is more common in the certain parts of the world and most prominent in the Western nations. The disease has shown familial inheritance.

Treatment

There is yet no specific therapy to prevent or cure the disease as the cause and pathology involved in MS is still unknown. Since MS appears to be an autoimmune disturbance, corticosteroids and other immunosuppressants are used effectively. These drugs are of limited value in chronic cases. Other immunosuppressive agents like azathioprine and cyclophosphamide may be used for patient who do respond to the more common immunosuppressants and corticosteroids.

Plasmapheresis is also useful which involves the process of replacing the body plasma completely. The whole blood is removed from the body and the cellular components are separated by centrifuge and then reinfused in the body suspended in saline or some other plasma substitute. This is helpful in severe acute attacks or in patients unresponsive to other treatments.

Associated muscle spasms can be reduced by the use of diazepam and drugs such as baclofen. Palliative treatment for symptoms may vary depending on the symptoms present in each individual case and the intensity of these symptoms. The progression of disease is slowed by the use of chronic medication. Drugs like fingolimod, interferons, glatiramer acetate, natalizumab and mitoxantrone are used which reduce the rate of relapse by half but are to be used cautiously due to serious side effects.

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