Multiple Sclerosis has always been considered not only a disease of unknown cause, but one that is unpredictable in its clinical course. Also called MS, it is a disease that attacks the brain and spinal cord, gradually destroying the myelin covering in scattered areas, affecting the victim's senses and muscle control. Myelin is found within the deep cerebral white matter of the central nervous system; it insulates the nerves, speeding the electrical conduction through the fibers. Although the actual nerve axons remain intact, they no longer conduct impulses adequately; therefore causing scattered neurological signs.
MS occurs worldwide, but is mostly common in the Northern Hemisphere. It occurs twice as often in females as in males, in as many as 50 to 100 people per 100,000 and is usually diagnosed between the ages of 20 and 40.
The most common symptoms include:
- weakness of limbs
- loss of vision or double vision
- disturbances of sensation
- eye pain
- speech disturbance
- facial numbness
- increased tendon reflexes
- defective bladder control.
After a time, these symptoms seem to go into remission, but reoccur at intervals of months or years. Eventually the symptoms affect the patient permanently and lead to impaired intellect and memory, and paralysis. It is seldom rapidly fatal.
There are several ways to diagnose MS. One concept is the dissemination in time and space. It is a simple concept, but fairly difficult to put into practice because of the difficulty in satisfying the criteria. Even when the criterion has been satisfied, the evidence must be very critically interpreted.
Electrical tests of the central nervous system function, such as Evoked Potentials (EP), CT scans, and Magnetic Resonance Imaging (MRI), have helped greatly in showing abnormalities in the central nervous system disseminated in space, but this still must be interpreted very carefully. MRIs can identify abnormal areas in the spinal cord and brain with great accuracy.
Spinal taps, Myelograms, Evoked Response Tests (ERTs), and radiology are several ways of testing for MS:
A spinal tap measures the amount of IgG (immunoglobulin G) in the spinal fluid. IgG represents increased antibody formation, an increased level of this suggests the presence of an autoimmune phenomenon. Oligoclonal bands (OB) have also been picked up in the spinal taps of MS patients.
Myelograms are used to verify that the results from the spinal tap are not a result of compression, as in a slipped disc or tumor.
ERTs test the response time of different senses. Electrodes are hooked up to an EEG (electroencephalograph) and three common tests are run: visual, auditory, and pain stimulus.
Radiology, such as CAT scans, MRIs, X-rays, and a new technique, NMRs (Nuclear Magnetic Resonance) are used to see any MS lesions that may be present.
The cause of MS remains uncertain. Corticosteroids, immunosuppressants, and avoidance of overfatigue and mental stress are used to ease the symptoms, since prevention of relapse is presently impossible. It has been suggested that MS may be an autoimmune disorder, caused by exposure to a virus to which the immune system reacts faultily by attacking the myelin sheathes. It has also been noticed that people with certain genetically determined immunological characteristics are over-represented among the MS population. There have not yet been any prion or viroid like particles isolated as the cause for MS, but there have been suggestions that the virus of measles or of canine distemper may be responsible. Most MS patients have oligoclonal bands in the gamma-globulin fraction of the protein in their cerebrospinal fluid.
Symptoms may be treated with many different types of drugs. Taking Amantadine may reduce fatigue. S*****city may be treated by a drug called Baclofen. Some experimental drugs change the way the nervous system works and improve neurological function without significant toxicity. Amitriptyline and Imipramine are the two most common drugs for treating depression in MS patients. There are also drugs to treat bladder symptoms.
Acute relapses of MS have been treated with a variety of cortisone drugs, such as ACTH, and Corticosteroids. Immunosuppressives such as Asathioprine, Cyclophosphamide, and Cyclosporine are believed to be able to slow down the clinical course of MS, but this has yet to be proven. Interferon is an immunomodulator that has more selective and specific effects on the immune system than do Immunosuppressives. Immunostimulators have been shown to make MS worse. Drugs that affect the immune system must be very carefully evaluated.
Exercise is very important for MS patients. Warm-ups, back, torso, and limb exercises, as well as head and neck exercises are very beneficial in relieving the symptoms of MS. There are also exercises for bladder control. Yoga, jogging, walking, and swimming are the most recommended exercises for patients of MS.
There is also a peculiar spinal cord disorder resembling MS that occurs in the tropics and in Japan. This disorder is known as Tropical S*****c Paraparesis (TSP) or HTVL1 Associated Myelopathy (HAM). This is a very obscure disease with some biological similarities with the AIDS virus. It is considered as one of the possible candidates for the cause of MS.
There is also an allergic brain disease that has many similarities to MS.
Researchers have recently been finding evidence of the bacterium Chlamydia pneumoniae in the study of MS patients. If this is true, MS may be treated with antibiotics, and a vaccine could be developed. Research has been focused on finding the process that interrupts the immune system. Abnormalities have been noticed in the brain scans of patients who have blood with high levels of Chlamydia pneumoniae antibody. These abnormalities are similar to those found in MS patients. The chlamydia family of bacteria typically causes chronic diseases with cycles of remission and relapse which is the common course of MS. Chlamydia pneumoniae, itself, has been found in 64% of MS patients. In almost all MS patients, their immune system had induced an antibody response to chlamydia pneumoniae. Scientists are now trying to determine whether chlamydia pneumoniae is involved in triggering MS or if it just takes advantage of the lowered defenses of people who already have MS.
Gangliosides and Chemokines have also been suggested to be involved with MS. Recently, stem-cell transplants have been experimented with to try to stop the progression of MS. So far, it has been performed on 50 patients with MS with only one patient dying as a result.
As the years go by and research keeps developing, it is hoped to eventually come up with a vaccine that will eradicate this horrible disease. Understanding how the immune system causes damage to the nervous system will help the production of specific drugs that can modify the immune reaction to either slow down, stop, or prevent MS.