Multilple Sclerosis (MS) is a chronic, inflammatory process that involves differerent areas of the

Central Nervous System (CNS) at various points in time. It is characterized as a neurologic dysfunstion
caused by lesions in the CNS. The lesions are muliple areas of demyelination that effect the brain, optic
nerves and spinal cord.

The CNS processes information from our environment and controls voluntary muscle movements to
allow the body to do certain things. MS is one of the diseases that can affect the pathways of the CNS
to help transmit the information in a timely manner. The nerves are surrounded and protected by a fatty
substance called myelin. Myelin helps the neurons carry electrical signals in a fraction of a second. MS
results in gradual destruction of myelin. This destruction is caused by attacks of the body's immune
system on the nervous system and is subsequently referred to as an autoimmune disease. People with
MS suffer in two ways, lack of protection for the CNS and a loss in ability to properly transmit nerve
signals. The name Multiple Sclerosis comes from the multiple scars left on the myelin sheath from the
attacks. These scars/plaques disrupt the transmittion of information in the CNS and lead to the
symptoms common in MS.

MS affects 62 people out of 100,000 in the white population and half that amount in the non-white
population. It is rarely seen in Asian descent. There are 250,000 to 350,000 patients with MS in the
United States. Twenty percent of affected patients have primary progressive multiple sclerosis, which is
characterized by a gradually progressive course with similar incidence between men and women.
Relapsing-remitting MS is present in 80% of patients. It is twice as common in women then men. It is
seen between the ages of 20 to 50, with the average age of 34. At one time MS was attributed to living
in a colder climate, but research has suggested that family history plays a much larger role in
developing MS than geographic location.

Many symptoms are seen in patients with MS. The initial attacks are often short termed, mild or
asymptomatic and self-limited. They are usually only identified in hindsight once the diagnosis is made
based on further attacks. For some people, initial MS attacks are preceded by infection, trauma or
demanding physical effort. Symptoms and signs in relapsing MS typically evolve over a period of days,
stabilize and then often improve, spontaneously or in response to corticosteroids, within weeks.
Corticosteroids tend to speed up the recovery from relapses but this effect diminishes with time. Signs
of CNS dysfunction may develop after a relapse and the disease may progress in between relapses.
Relapsing – remitting MS starts most often with sensory disturbances such as a tingling sensation or a
lack of feeling in an area of the body. These symptoms are usually asymmetrical, appearing in one leg
or one arm and sometimes in scatterd areas of the torso. Unilateral optic neuritis, an inflammation of
the optic nerve that may cause complete or partial blindness, and diplopia, seeing double, are of the
more common symptoms in MS pateints usually resulting in dizzines and involuntary rapid backward
movement of the eyes while looking sideways. Dizziness, or vertigo, is usually a result of a damaged
sense of balance and can be associated with feeling faint, experiencing an unpleasant feeling of
spinning or staggering. Lhermitte's sign, feeling of an electric current running down the back, usually
evoked by neck flexion, is another symptom. Limb weakness - that can result in paresis, clumsiness,
gait ataxia and neurogenic bladder and bowel symptoms are common as well. Coordination disorders
are usually a result of damaged nerve fibers located in the cerebellum, these disorders can lead to
difficulties in carrying out certain simple actions. Vocal disturbances, known as dysarthria, can been
seen as well. Another increasingly common symptom that appears as the disease progresses is the
inability to move limbs freely. This motor disturbance results in the lack of muscular power, tone or
tension. The most common motor disturbance is spasticity, which can be defined as the quality of
moving or acting in spasms. Minor symptoms occur during walking when legs begin to feel heavy and
after long periods of walking, movements become slower and harder to do at a fast pace. Major
symptoms are seen as the legs growing increasingly stiff and weak leading to drop foot and balancing
problems on uneven ground, muscles tire unexpectedly and stiffness and weakness increase. Some
pateints also suffer from painful nighttime leg cramps or spasms.
Cognitive impairments are also common, such as multitasking, following detailed instructions, short-
term memory loss emotional instability, sexual disturbances and fatigue. Many pateints describe a
fatigue that worsens in the afternoon and is accompanied by an increase in body temperature. In most
patients it is experienced at some time during the course of the disease and is described as excessive
physical and mental tiredness.
Emotional symptoms are common as well and are considered to be a normal response to having a
incapacitating disease that has damaged nerves that normally generate and control emotions. The most
common condition, clinical depression, is an outcome of both causes. Suicide is a very real threat as are
feelings of anger, frustration, anxiety and hopelessness. MS pateints may also experience many
different types of acute and chronic pain syndromes.

MS is not an ordianry disease and does not progress in an orderly manner. The course of the disease,
the severity and type of symptoms or impairments differ from person to person and are impossible to
predict in an accurate fashion at the time of diagnosis. Since the disease is so unpredictable it is hard to
know who will proceed to a more advanced form of MS and who will stay stable. Most people,
however, can expect a normal life expectancy. There are forms of medicine that do help someone live a
full life with MS by alleviating some of the daily pain and other symptoms and by slowing down the
progression of the disease. The below diagram shows the different degrees of disability seen in the four
different types of MS, Relapsing – Remitting, Secondary Progressive, Primary Progressive and Benign.

Destinctive signs of MS include deterioration and materialization of a new symptom, lasting for more
than 24 hours. Generally, symptoms develop over the course of a few days, remain constant for 3-4
weeks and are resolved in a month's time. Relapsing – Remitting MS is the most common form and
people experience unpredictable attacks or symptoms. These pateints most often go through a state of
remission (return to normal) between attacks. Most often enough, the individual will return to normal in
between attacks or at least partially recover from the symptoms. For people with Relapsing – Remitting
MS the disease is progressive and after 10-15 years the patients usually progress to Secondary
Progressive MS (SPMS). SPMS develops in about half of the patients who suffered from RRMS and
neglected to get proper treatment. People with this form of MS experience a gradual and continuous
increase in symtoms and disability. After 15 years of SPMS, most individuals will need to use walkers,
canes or wheelchairs. Primary Progressive MS (PPMS) is seen to induce upon its sufferers a steadily
worsening of symptoms from the start of their disease. They do not experience relapses during the
course of the disease and their disability worsens over time and may or may not plateau at some point
throughout the years. The age for the onset of this form of MS is older than the rest of the forms. PPMS
affects men and women at the same rate and usually those in their 40s and older. First signs of this type
of MS are seen as gait disturbances, which lead to a decreasing ability in walking quality. The
prognosis for PPMS is worse then other types of MS and deterioration is usually quicker. MRIs are not
as helpful in diagnosing PPMS as in other forms of the disease. The plaque is seen usually in the spinal
cord and not directly in the brain, so it is very important to do a spinal MRI for proper diagnosis.
Benign MS is the least common type of MS. It is usually hard to distinguish because of the lack of
lasting disability or progression, the most likely time of diagnosis is only 15 years later when there is
evidence of slight disability. There are those pateints who suffer from Benign MS and do experience
progression of the disease. Within 10-15 years these patients will experience onsets of symptoms of
Progressive MS. There is no standard form of MS however, there are certain factors that are helpful in
knowing the future of the disease in that patient. These factors can be favorable, like sensation or vision
disturbances, complete remission of these disturbances and lack of impairment after five year's time; or
they can be less favorable, like paralysis at the very beginning of the disease, age of the patient, and a
high frequency of attacks through the course of the disease. Only few people die from advanced
symptoms of MS, life expectancy for MS patients is the same as people without MS. Most people who
do have MS go on to lead normal functioning lives.
Diagnosis of MS is a difficult task to accomplish in the early stages of the disease. The diagnosis is
based on clinical, laboratory and radiologic data. Definite diagnosis of MS cannot be made unless there
is evidence of at least two attacks in the course of 30 days. Clinical data may be enough to make a
diagnosis of MS. If a pateint has suffered two separate episodes and also presents consistent
abnormalities on physical examinations, MS can be diagnosed without any further testing. Some people
seek medical attention after one attack and therefore further testing is needed to make a diagnose
sooner and allow for an earlier start of therapy. MRI (magnetic resonance imaging) of the brain and
spine is often used to assess if MS is present in the individual. CT scans, lumbar punctures and blood
tests are also helpful in the diagnoses of MSThe expertise of a neurologist is very crucial in the
diagnosis of MS, inorder to rule out other diseases with similar symptoms. Relapses are recurrance of
old symptoms or the onset of a new symptoms that last for over 24 hours. Relapses usually occur over a
few days and last for about a month and then slowly subside. Common tests for MS are neurological
testing, examinations of the cerebral nerves, reflex exams and muscular strength. It is also common to
test psychological assessment of awareness, orientation, concentration attention and overall mood of
the pateint as well.
Treating MS