March is Multiple Sclerosis Awareness Month. Multiple sclerosis, also known as MS, is a disease of the central nervous system whose exact causes are as yet unknown. It is most often classified as an autoimmune disease, wherein a person’s immune system mistakenly attacks their own body. Multiple sclerosis, which can present in both chronic (characterized by periods of ‘attack’ and ‘remission’) and progressive (a steady worsening of symptoms) forms, disrupts the flow of information within the brain and between the brain and body, and can be debilitating. It affects nearly a million people in the United States and more than 2.3 million worldwide.
Much as nerve fibers in a living creature have some similarity to electrical wires, sending pulses and signals of electricity through their lengths, the fatty tissue that coats and protects them (called the myelin sheath) is akin to rubber or plastic insulation that you might find on actual wires.
When this ‘insulation’ is corroded, the ‘wires’ are exposed, and signals in the brain and nervous system can go awry when they are blocked, slowed or otherwise misdirected as a result of myelin deterioration. Potentially, the faulty impulses can cause a broad variety of symptoms that may affect vision, movement, balance and coordination, sensation, speech and sometimes bowel and bladder control and sexual function.
Risk factors, potential causes and diagnosis Women are more than two-to-three times as likely to suffer from MS, and white people of Northern European descent are also more likely to develop the disease. Other factors that can elevate risk include age (it’s most prevalent in 20- to 50-year-olds), family history, smoking, Vitamin D deficiency and past viral infections, especially in those who have had mononucleosis (Epstein-Barr virus).
As there are many diseases and conditions that affect the central nervous system, it can take some time to isolate MS as the cause of neurological symptoms. Viral and bacterial infections including Lyme Disease, Syphilis and Human Immunodeficiency Virus (HIV) can cause symptoms similar to those of MS; genetic disorders; metastatic cancers originating in the lungs, kidneys, breast and other places or blood cancers such as lymphoma can also spread to the CNS; and some deficiencies can also mimic the effects of the disease, including copper and vitamin B12 deficiencies.
Many of these conditions can be ruled out by relatively simple blood tests, and other possible causes of neurologic dysfunction (such as injury to the brain or spinal cord) are usually self-evident, though an accurate MS diagnosis can still take some time to make. Modern diagnostic tools such as magnetic resonance imaging (MRI) and cerebrospinal fluid analysis can help to speed up an MS diagnosis, but as of the present time there is no direct test that can specifically determine if someone has the disease.
Treatments There is currently no cure for multiple sclerosis, and recommendations for medications, therapies and rehabilitation are prescribed to manage symptoms, control relapses and lessen the length or severity of MS attacks. There are many FDA-approved medications available, in oral, injectable and infusible forms, and The American Academy of Neurology (AAN) has developed guidelines for starting, switching and stopping disease modifying therapies for adults with clinically isolated syndrome, relapsing-remitting MS and progressive forms of MS.
Rehabilitation techniques can include physical therapy to promote sustained mobility, maintain strength and balance, and prescribe exercises to help prevent muscle atrophy and weakness related to disease progression. Pelvic floor exercises can aid in bladder control issues, and speech-language pathology is often useful in addressing speech and swallowing problems that may develop. Occupational therapy may be particularly useful in helping MS patients adapt to progressively limited abilities and help them to best continue functioning in daily tasks involved in work, eating or bathing/hygiene and other personal care necessities.
Further Information The National Multiple Sclerosis Society (www.nationalmssociety.org) is a great resource for people who have been given an MS diagnosis, and includes detailed explanations of the disease and its symptoms, a great video that gives a good overview of the condition, news and research, and a national database of neurologists, speech and physical rehabilitation therapists and other specialist providers that is searchable by region/location. The site also lists non-medical resources including emotional support, financial assistance, legal, home care and housing resources, and ways to access information on medical equipment and independent living.
Well Being is a monthly column written by staff at Cooley Dickinson Hospital in Northampton.