HealthyCanada.com

Multiple sclerosis (MS) is a chronic disease characterized by the unpredictable degeneration of the central nervous system - the brain and spinal cord. It is not fatal but it can cause loss of balance impaired speech extreme fatigue double vision and paralysis. It does not affect thought processes or intelligence.

An estimated 50000 Canadians have multiple sclerosis one of the highest rates in the world. It is the most common serious neurological condition in young adults and strikes twice as many women as men.

While there is no cure for MS researchers are working hard to solve the mystery of the disease. In the meantime thanks to improvements in the treatment of symptoms and in other therapies most people who have MS can expect to live a normal or near normal life span.

Causes

The cause of MS is not known. However most researchers believe that it is an autoimmune disease which means that your immune system mistakenly attacks part of your body as if it's a foreign substance. In this case it destroys the cells that produce myelin a fatty substance that coats and protects nerve fibres that carry messages to and from the brainand spinal cord. This causes inflammation and damage to the protective coating and ultimately to the nerves that it surrounds. The result may be multiple areas of scarring (sclerosis). When this happens nerve impulses from the brain to the muscles can no longer be effectively transmitted. The result may be a wide variety of symptoms including a lack of muscle coordination strength sensation and vision.

Heredity. Multiple sclerosis is more common in people of Northern European descent. There also appears to be a genetic component to the condition although it's not directly inherited. Researchers suspect that the tendency to develop MS can be passed down from generation to generation but the disease manifests itself only when environmental triggers are present.

Environmental triggers. Many viruses and bacteria have been suspected of causing MS. Some researchers believe that environmental factors may trigger the disease in susceptible people.

Geographical factors. Multiple sclerosis is more common in countries further away from the equator including Canada and the northern part of the United States.

Visual disturbances - These may include blurring of vision double vision (diplopia) optic neuritis (inflammation of the optic nerve) involuntary rapid eye movement and very rarely total loss of sight.

Extreme fatigue - This is a debilitating kind of fatigue that comes on suddenly or is out of proportion to the activity. It is one of the most common and troubling MS symptoms.

Balance and coordination problems - These may include loss of balance tremor unstable walking (ataxia) dizziness (vertigo) and clumsiness of a limb and lack of coordination.

Stiffness of muscles (spasticity) - Altered muscle tone can produce spasticity or muscle stiffness which can affect mobility. Sometimes the muscles go into spasm which can be painful.

Weakness - The muscles of the legs can feel weak which in turn affects walking.

Altered sensation - These may include tingling numbness (paraethesia) or a burning feeling in one particular area of the body. Facial pain may occur because of trigeminal neuralgia (also known as tic douloureux) which involves a malfunction of one of the major facial nerves.

Sensitivity to heat - Many people with MS find they become sensitive to heat and their symptoms worsen while in a hot environment.

Speech and swallowing problems - These may include slowing of speech slurring of words changes in rhythm of speech and difficulty in swallowing (dysphagia).

Bladder and bowel problems - Bladder problems may include the need to urinate frequently or urgently incomplete emptying of the bladder or emptying at inappropriate times. Bowel problems may include constipation and infrequently loss of bowel control.

Sexuality and intimacy - These can include from time to time impotence diminished arousal and loss of sensation.

Short-term memory and cognitive problems -These may include problems with short-term memory concentration judgment or reasoning.

Initial symptoms appear rapidly and usually disappear within a matter of weeks. They may not develop again for years. However eventually a pattern of recurrent neurological symptoms will emerge.

Before treatment can begin a proper diagnosis must be made. This is not always easy as early MS may consist of vague symptoms which come and go. Your doctor may initially attribute these symptoms to other medical conditions before he or she finally has enough information to say for certain that it is a case of multiple sclerosis. Before confirming a diagnosis of MS your doctor will need to see:

• Signs of disease in different parts of the nervous system
• Signs of at least two separate flare-ups of the disease

Health care professionals rely on a variety of tests and procedures that include:

Medical history
The physician will ask you to recall symptoms that happened in the past.

Neurological examination
The physician tests for abnormalities in nerve pathways. Some of the most common neurological signs involve changes in eye movements limb coordination weakness balance sensation speech and reflexes.

Testing of visual and auditory evoked potentials
When damage to myelin occurs the passage of nerve signals along the nerve fibres may be slowed. Evoked potential tests measure the time it takes for the brain to receive and send signals. Small electrodes are placed on the heads to measure brain waves in response to visual and auditory (hearing) stimuli. If there is demyelination the tests will pick up delays in nerve signals. These tests are not invasive or painful.

Magnetic resonance imaging (MRI)
The MRI scanner takes very detailed pictures of the brain and spinal cord and shows existing areas of MS plaques (lesions). However even an MRI scan isn't conclusive since other conditions can produce similar plaques. The MRI scans plus evidence from the neurological examination the medical history and other tests often confirm the diagnosis of MS.

Lumbar puncture
In this test cerebrospinal fluid (the fluid which flows around the brain and spinal cord) is tested for the presence of antibodies. The fluid is taken from the spinal cord by inserting a needle into the back and withdrawing a small amount of fluid. The procedure is uncomfortable but not usually too painful.

If you are diagnosed with MS your doctor will then want to determine what "type" or "form" of the disease that you have. Some people are minimally affected by the disease (benign MS or relapsing-remitting MS without permanent disability) while others are affected more severely. Most people fit in between these two groups.

The main types of MS are:

relapsing-remitting MS - characterized by clearly defined attacks (relapses) followed by partial or complete recovery (remissions); most common form (70% at the time of diagnosis).

primary-progressive MS - relatively rare (10 to 15% at time of diagnosis) people with this type of MS have a nearly continuous worsening of MS from the beginning with no clear relapses or remissions.

secondary-progressive - about half of people with relapsing-remitting MS start to worsen within 10 years of diagnosis with the possibility of increasing levels of disability.

progressive-relapsing - relatively rare combines attacks with steady worsening and no remissions.

benign MS - few attacks with long periods of remission and little disability after 15 years; about 20 - 25% of people who were diagnosed originally with relapsing-remitting MS have this type.

malignant MS - rapidly progressive disability within five years of diagnosis; quite rare.

Most people are diagnosed with the relapsing-remitting form of MS. Over time some people in this category develop secondary-progressive MS which carries a risk of disability. Others may have mild attacks but do not worsen and are considered to have benign MS.

If your attacks are mild or infrequent your doctor may take a wait-and-see approach. However if you have a relapsing form of the disease he or she may try to minimize flare-ups of symptoms such as spasticity bladder problems pain and fatigue and lessen their impact by prescribing certain medicines. Since 1995 four drugs have been approved in Canada for the treatment of relapsing-remitting MS and one is now available for secondary-progressive MS. The treatments have been shown in clinical trials to actually modify the course of the disease. They decrease the frequency and severity of MS attacks reduce the number of MS lesions in the brain and several have been shown to slow the progression of disability.

In addition to drugs your doctor may recommend physical and occupational therapy and counseling to help relieve emotional stress. Find MS clinics in Ontario.

Here are some tips you might find useful on a daily basis:

Get adequate rest. Getting your rest may help you deal with the fatigue that often comes with MS.

Eat well. A healthy diet can help keep your immune system strong.

Exercise. Regular aerobic exercise will help you build strength muscle tone balance and coordination and help with depression.

Stay cool. Many people with MS experience heat-related worsening of their symptoms. If you live in a hot and humid area consider putting air conditioning in your home. Tepid or cool baths also may provide some relief. Extreme heat may cause extreme muscle weakness.

Multiple Sclerosis Society of Canada