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Multiple Sclerosis

Multiple sclerosis (MS) is a strong disease that affects a person emotionally, physically
and also sexually. This disease usually appears in premature adulthood and leads to major
physical disability and emotional sorrow. The person that has MS will need a lot of support from
health and social professionals as well as family and friends.
The World Health Organization (WHO) defines MS as: A chronic inflammatory disease
of the central nervous system that typically presents in the third or fourth decade of life (WHO,
2008). Multiple sclerosis is an illness that affects the brain and spinal cord. It leads to problems
with vision, muscle control, balance and sensation.MS is an autoimmune disease of the central
nervous systema type of disease produced by malfunctioning of the immune system (DArcy,
2012). The immune systems goal is to protect the body by destroying dangerous matter such as
viruses and bacteria. In autoimmune disease, the immune system attacks the bodys own tissues.
In MS, the immune system attacks the brain and spinal cord which are formed of nerve cells
called neurons. Neurons communicate with each other to allow us to receive information from
our body and the environment and also send information to each part of the body. Information is
carried from neuron to neuron along an axon. The axon is protected by a fatty protective sheath
known as the myelin sheath (DArcy, 2012). The myelin sheath encloses the nerves and helps
facilitate the transmission of messages (nerve impulses) from neuron to neuron. In MS, the body
attacks and damages the myelin sheath and will eventually degenerate causing scar tissue. The
formation of this scar tissue (sclerosis) is what gives multiple sclerosis its name. Demyelination
(destruction of the myelin sheet) causes disruption or complete interruption of electrical signals

from the brain to the other parts of the body. The type of symptoms experienced, the severity of
symptoms and the course of the disease vary according to the location of the scar tissue and the
extent of the demyelination (Nazarko, 2013). Therefore, impulse transmission is distorted, shortcircuited, or even absent. This results in muscle weakness, imbalance and possibly muscle
spasms with sometimes paralysis. Multiple sclerosis also can result in visual impairment and
alteration of cognitive abilities, as well as pain, numbness, or tingling sensations (Ruto, 2013).
The cause of MS is still uncertain, and its evolution is typically variable. There are not
available any diagnostic tests or procedures to help catch this disease early. Yet, there are a few
current theories that explain the cause of MS such as interaction of environmental and genetic
factors. These factors are geographical, genetic, viral, infective and maybe related to a shortage
of vitamin D (DArcy, 2012).
Multiple sclerosis affects approximately 400,000 people in the United States, more than
50,000 people in Canada, and 2.5 people million worldwide. Multiple sclerosis is at least two to
three times more common in women than in men, which suggests that hormones may play a vital
role in determining an individuals susceptibility (Miller, D. H. et all 2008). Also, the risk of
getting MS is greater in siblings, twins and children of the patients that have MS.
The areas with the highest rate of MS are northern United States, southern Canada, northern
Europe, and New Zealand-most cases of MS occur in places above 40 degrees north. MS is
related to northern latitudes where sunlight is limited and Vitamin D (made by the body when
exposed to sunlight) deficiency is common. Scientists consider that vitamin D deficiency may
activate MS in some people. In addition, it is believed that certain bacterial infection, viruses
and fungi may help the development of MS.

There are four clinical types of MS: relapsing-remitting, primary-progressive, secondaryprogressive, and progressive-relapsing or benign MS (Ruto, 2013).
About 8 out of 10 people with MS will have the relapsing/remitting type of MS. The patient has
periods of time when symptoms are mild or even absent which is called as a remission. A relapse
is the appearance of a new symptom or the reappearance of an old symptom that persists more
than 24 hours. The relapse may last from 1 to 3 months and the remission can last up to 1 year.
The secondary progressive MS will develop in around 50-60% of the people with
relapsing/remitting MS within 10-15 years. The symptoms usually worsen and there are fewer or
no periods of remission.
The benign MS is the least painful because the patient recovers fully from relapses and does not
become immobilized. About 20% of the people have this type of MS and it takes around 10 years
to determine if it is benign. Sometimes the disease may progress and the patients might develop
secondary progressive MS.
The forth type of MS is the primary- progressive and the most rare of all. It develops in 10-15%
of people with MS; the symptoms get worse in time and there are no periods of remission
(Nazarko, 2013).
The person with MS may experience a variety of symptoms and it is influenced by the
persons age, gender or type of disease. The patients with MS experience physical, emotional,
memory, and sexual problems.
Physical problems include fatigue, visual disturbances, muscle weakness, reduced mobility, heat
intolerance, pain, stiffness, muscle spasm and tremor (Nazarko, 2013). The person may benefit
from physiotherapy to improve strength and balance, occupational therapy to maximize function,
medication to treat symptoms and supportive care. Spasms, pain, muscle weakness and other

physical problems might affect the desire to maintain a sexual relationship. In addition, about
half of the people with MS experience impossibility to learn and remember, to concentrate or
make plans. This happens usually because of the disease, the treatment prescribed or depression.
Currently, there are five injectable DMTs licensed for first-line treatement of RRMS:
interferon beta 1a (Avonex and Rebiff), interferon beta 1b (Betaferon and Extavia), and
glatiramer acetate (Copaxone) (Ward-Abel, et all 2014). All of these treatments need to be
administered by intramuscular or subcutaneous injection. Interferons are made in the body and
are intercellular messengers that are generally of two categories: type 1- includes interferons
alpha and beta, and type 2- interferon gamma. All of these have different roles in defending the
body against viruses and infections. Early scientists acknowledged that gamma interferon was
implicated in destructing myelin during relapses. Even though it is still not totally understood
how the interferon benefits MS, it is supposed that beta interferon diminishes relapses by
decreasing the permeability of the BBB, preventing T-cell activation and inducing T-cell
apoptosis. (Ward-Abel, et all 2014).
Glatiramer acetate is a artificial copolymer that resembles a constituent of
myelin. It is believed to work by obstructing T-cells from attacking myelin,
stimulating the body to create matter that reduces infection and it is
supposed that glatiramer acetate also stimulates mechanism involved in
neuroprotection. Studies for all first-line DMTs determined that they reduced
relapse circa 30% per year, effected positively MRI measurement of disease
activity and lesion accrual, and reduced disability by 12-37%.
Even if there is still no cure, there are many therapies and treatments for MS that seem to
make it easier for the patients to endure this disease and maybe some that actually can slow the

disease development. It was never so much hope for the people infected with MS, many that
have beautiful and active lives; it is heartbreaking that the young people are victims of this
disease and is even harder when there is somebody close that is struggling with this disease. I
hope that treatment for MS may become more reachable to patients in the future and scientists
can find methods and techniques to prevent the disease. I am hopeful that there will finally be
found treatments that will be efficient and the proverb multiple sclerosis is "The great crippler of
young adults" (Perkins), would be ended indefinitely.

Reference

D'Arcy, C. (2012). Multiple sclerosis: an overview. Nursing & Residential Care, 14(7), 335-337.
Dobson, R., & Giovannoni, G. (2013). Autoimmune disease in people with multiple sclerosis and
their relatives: a systematic review and meta-analysis. J Neurol, 260(5), 1272-1285.
Miller, D. H., Weinshenker, B. G., Filippi, M. M., BanweII, B. L., Cohen, I. A., Freedman, M. S.,
& ... Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: a
consensus approach. Multiple Sclerosis (13524585), 14(9), 1157-1174.
Nazarko, L. (2013). Multiple sclerosis: offering care tailored to the person's needs. British
Journal Of Healthcare Assistants, 7(12), 594-599.
Perkins Frederick M., Moxley R., Papciak A. Pain in Multiple Sclerosis and the Muscular
Dystrophies. Handbook of Pain Syndromes: Biopsychosocial Perspectives . University
of Rochester- Google Books. (n.d.). Retrieved from http://books.google.com/books?
id=S_DElnlqRZwC&pg=PT413&lpg=PT413&dq=The+Great+Crippler+of+Young+Adul
ts
Ruto, C. (2013). Special Needs Populations: Care of Patients With Multiple Sclerosis. AORN
Journal, 98(3), 281-293.
Ward-Abel, N., Vernon, K., & Warner, R. (2014). An exciting era of treatments for relapsingremitting multiple sclerosis. British Journal Of Neuroscience Nursing, 10(1), 21-28.
World Health Organization (WHO) (2008). Atlas Multiple Sclerosis Resources In The World
2008. Retrieved from
http://www.who.int/mental_health/neurology/Atlas_MS_WEB.pdf.