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Multiple Sclerosis (MS)
Thursday, 14 July 2005
Thursday, 14 July 2005

What

Multiple Sclerosis (MS) is a progressive neurological disease that affects the central nervous system (brain and spinal cord). The outer covering of nerve cells (neurons) known as the myelin sheath is specifically destroyed in MS, leading to weakness, sensation loss, and other neurological deficits. This disease most notably affects the brain, spinal cord, and the optic nerve (nerve connecting the eye to the brain, necessary for vision) by causing inflammation, swelling, and demyelination.

Who

Approximately 1 in 1,000 people will develop MS. Most patients will develop their initial symptoms during young to middle adulthood but MS can present at virtually any age. MS is more common in females and often presents at a younger age than males. There is a higher incidence in individuals with a Northern European heritage, those who live in areas of higher latitude, and those who live in a more temperate climate rather than a tropical one. MS is very rare among African blacks, but occurs in African-Americans at a rate of approximately half that of white Americans. Race may also affect the clinical expression of MS, as evident in the Japanese and several other Asian populations who experience a form of MS that commonly involves the optic nerves and spinal cord rather than the brain.

Signs and Symptoms

The course of MS is highly variable and symptoms may be different for each individual. Initial symptoms of MS may include some or all of the following: numbness and tingling of hands or feet, weakness of one or both legs, loss of vision in one or both eyes, facial numbness, vertigo, double vision, problems with speech or language (dysarthria), jerkiness and incoordination (ataxia), or urinary frequency and urgency. L’Hermitte’s symptom is also very common in MS and is characterized by a sensation resembling an electrical shock that occurs with forward flexion of the head. The sensation is most often felt on the front of the thighs but may occur down the spine or in the arms. Other common symptoms include pain, tremor, decrease in vision and color perception in one eye with eye pain, bladder difficulties including the inability to void, bowel difficulties (constipation, incontinence, rarely diarrhea), sexual dysfunction, and cognitive difficulty. Uveitis (inflammation in the eye) is also more common in MS.

Possible Causes

The underlying cause of MS is currently unknown. The two currently favored theories suspect MS to be either an autoimmune disorder or infectious disease. A variety of organisms, mostly viruses, have been proposed as the agent that causes MS but none have been proven. The current viewpoint suggests that the particular virus causing MS produces an autoimmune response in the body. Normally the immune system recognizes the virus as a foreign invader that is not supposed to be in the body. The current theory suggests that the antigen (protein that stimulates the immune system) on this virus is the same as a substance on the myelin sheath of the neurons. Therefore, the immune system binds the virus and destroys it, but also binds the myelin sheath and destroys it too. In addition to a potential viral trigger, the increased rate of MS in certain families points to a genetic component. No specific gene has yet been found, but studies have shown an increased risk for children when MS exists on both of the parents’ sides of the family. Other factors, in addition to infection and genetic predisposition, associated with the onset of MS or recurrent episodes have been suggested as emotional and physical stress, trauma, surgery and anesthesia, diet, heavy metals, overexertion or fatigue, and heat, although none of these have been validated thus far. The effects of pregnancy on MS have been studied extensively and studies show that during pregnancy there is a decline in MS episodes and symptoms. Unfortunately, during the first three months after birth there seems to be an increase in MS episodes.

Diagnosis

Early diagnosis is crucial to treat MS effectively. There is no single test that confirms the diagnosis, but MS can be identified by the characteristic historical and physical findings. If a child is suspected to have MS, a variety of tests will be done to exclude other conditions and make the diagnosis of MS. A blood and cerebrospinal fluid test may be done to rule out infection and determine if the child has laboratory test results consistent with MS. An MRI (magnetic resonance image) of the brain can identify changes consistent with MS. An Evoked Potential test, which measures the time it takes for nerves to respond to stimulation, may also be done to confirm a pattern of central nervous system involvement that is seen in MS. Lastly, neurocognitive tests may be done to document associated cognitive deficits.

Treatment

There is currently no cure for MS. Caring for patients with MS requires a multidisciplinary effort with a pediatric neurologist, neuroradiologist, and physical therapist. The majority of patients will experience symptoms that follow a “waxing and waning” course. When symptoms worsen, there are effective medical therapies that can provide symptomatic relief. Corticosteroids, specifically intravenous methylprednisolone (IVMP), are the main treatment for these acute episodes. Plasmapheresis, in which the patient’s blood is removed, separated into plasma (the fluid portion of blood) and exchanged with normal plasma which is then put back into the patient, may be effective for relapses that are not responsive to other treatments. The main goal of therapy is to prevent relapses and slow the progression of disease. Agents known as “Immune modulators” such as Interferon Beta (examples are Avonex, Betaseron, Copaxone, and Rebif) are now used to reduce the severity and frequency of relapses. Intravenous immunoglobulin has also recently been used and seems to reduce relapse rates, slow disease progression, and may even promote recovery. Since the course of MS is so variable, it is often difficult to determine how aggressively patients should be treated. Patients who often need more aggressive therapy are those with a progressive course of disease, sphincter or motor symptoms at onset, high attack frequency within the first years, the presence of many lesions in the brain (seen on MRI), and of male gender. Research is currently being done to determine the exact cause of the disease in the hope of finding a cure.

Prognosis

Most people will live with Multiple Sclerosis for decades after their diagnosis. MS typically reduces life expectancy after onset by about 10-15 years but this is highly variable. With early diagnosis and proper treatment, progression of symptoms can be delayed, and most individuals can lead relatively normal lives well into adulthood.

Connect with other parents

In the spirit of community and support, Madisons Foundation offers the unique service of connecting parents of children with rare diseases. If you would like to be connected to other parents of children with this disease, please fill out this brief form.

Weblinks

National Multiple Sclerosis Society
This is a great website with links to treatment options, current research, and information about MS.

Multiple Sclerosis Society
This is a good website with chat boards and a chance to communicate with other people who have MS.

The Multiple Sclerosis Foundation
This is an informative website with links to current events involving MS and a number to a national toll-free help line as well as an internet help line and chat rooms for support.

Multiple Sclerosis Association of America
Community driven website focused on support issues.

MS News
Great link for lots of medically relevant articles on multiple sclerosis.

WEB MD
Information relevant to MS and for those who are interested in a very well organized website for the public.

http://www.1800wheelchair.com/news/post/multiple-sclerosis-ms-information-page.aspx 

Excellent site for people living with MS.

Google Search for Multiple Sclerosis (MS)

References and Sources

Miller AE, Lublin FD, Coyle PK (2003). Multiple Sclerosis in Clinical Practice. London: Martin Dunitz Joy JE, Johnston RB (2001). Multiple Sclerosis: Current Status and Strategies for the Future. Washington, DC: National Academy Press Polman CH, Thompson AJ, Murray TJ, McDonald WI (1996). Multiple Sclerosis: The Guide to Treatment and Management. 5th ed. New York: Demos Medical Publishing, Inc. Cook SD (1996). Handbook of Multiple Sclerosis. 2nd ed. New York: Marcel Dekker, Inc.