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Multiple Sclerosis

Multiple sclerosis (MS) is the most common autoimmune disease that affects the central nervous system. It damages the protective covering around nerves in the brain and spinal cord, causing the nerve impulses to be slowed or blocked. Our nerves have a layer of insulation around them much like today’s electrical wires. If that insulation is removed or degraded, then the wires may touch each other and short out. It is estimated that the USA has about one million people with MS. Worldwide, that number is about 2.8 million. First described in 1868 by French physician Jean-Marie Charcot, it is now recognized that inflammation is a significant factor in MS, as it is in all other autoimmune diseases. Again, as in other autoimmune diseases, the precipitating event(s) are unknown but viral infection is suspected. Age of onset is typically 20 to 30 years of age. Women are nearly three times more likely to develop MS than men, a fact as yet unexplained. Other risk factors include certain genetic factors, low vitamin D levels, low levels of sunlight exposure, prior Epstein-Barr infection, and cigarette smoking.

Symptoms of MS include fatigue, blurred vision and eye pain (optic neuritis), weakness or changes in sensation in parts of the body, dizziness, balance difficulty, impairment in memory or thinking, and problems with bladder control. Also common are depression and anxiety, whether from the disease itself or in response to symptoms. The most common type of MS is relapsing-remitting MS, where symptoms appear rapidly (relapse) followed by a period of complete or near-complete recovery (remission). Over time, periods of remission become shorter, with remission eventually disappearing (secondary progressive MS). Those with primary progressive MS have symptoms that progress over time without relapse or remission.

There is no specific test to diagnose MS (like a biopsy). Diagnosis is usually made using the McDonald criteria, a mix of clinical, laboratory, and radiologic signs. Management and treatment usually require a team approach using neurology, physical therapy, and psychology specialists. Treatment is usually directed at blunting the immune system response, with high-dose steroids used early in sudden relapses, while bearing in mind that MS is incurable. As with other autoimmune diseases, researchers are finding ways to use monoclonal antibodies to lessen the impact of the body’s own immune system. Depending on which treatment is used, disease-modifying therapies can decrease MS relapses by 30 to 70%. It is estimated that up to 50% of MS patients seek alternate means of treatment because traditional medical treatments often have little impact in relieving MS symptoms. People with MS should avoid cigarette smoking (it creates inflammation). They should also be encouraged to engage in physical activity, which is associated with fewer MS symptoms and decreased depression and fatigue. Lastly, pursuit of intellectually challenging activities may be associated with improved cognitive function for those with MS.

For more information go to the website of the National Institute of Neurological Disorders and Stroke

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