Multiple Sclerosis:Managing Complexity

Multiple Sclerosis is a rather enigmatic,chronic disease that damages the nerves in the spinal cord,as well as the brain and optic nerve.Sclerosis means scarring and MS patients develop multiple areas of scar tissue in response to this nerve damage,causing a broad range of potential problems with muscle control,balance,vision and speech,including:
weakness in an arm or leg;
numbness or tingling;
loss of balance;
muscle spasms;
frequent tripping or difficulty walking;
blurred vision,colour blindness,eye pain and usually temporary blindness in one eye;
slurred speech;
trouble swallowing;
decline in mental acuity,meaning difficulty in problem-solving,memory loss and poor concentration;
fatigue;
some loss of bladder control.
Each case is highly individualised as to the exact symptomology and severity,with an episodic rise and subsidence of symptoms being common.*
In MS,the patient's immune system attacks the fatty sheathing of the nerve fibres called myelin.Myelin insulates the nerves and helps them send electrical signals that control movement,speech and other functions.When myelin is destroyed,scar tissue forms and nerve messages are not transmitted properly.The cause of this autoimmune disorder is unknown;but it is more common in northern regions such as Scandinavia and other parts of Northern Europe.These areas get less sunlight,possibly implicating vitamin D deficiency as a factor.Genetics also appear to play a role.MS is twice as common in women as in men,and Caucasians between the ages of 20 and 50 are most at risk of developing it.*
Diagnosis of MS is a sophisticated process that involves considering test results,medical history and a neurological exam.More than 90% of MS patients show scar tissue on an MRI scan.A spinal tap can check for abnormalities in the fluid that bathes the brain and spinal cord.There are also tests to evaluate the electrical activity of the nerves and lab tests to rule out other autoimmune diseases such as HIV or Lyme disease.*
There is no cure for MS,but a full spectrum approach to treatment can improve the prognosis.Disease-modifying drugs such as Avonex,Betaseron,Copaxone and Rebif can lessen the frequency and severity of attacks and partially shield the brain and spinal cord,slowing the progression to disability.Novantrone and Tysabri are also available for more advanced cases.High dosages of corticosteroids can help shorten the attacks.Other medications can manage symptoms such as muscle spasms,incontinence and pain.Physical therapy can help strengthen muscles,combat stiffness and help patients move around better.Speech therapy can aid with speaking and swallowing.Most patients remain ambulatory with the assistance of orthotic shoe inserts;leg braces;canes;and walkers.Wheel chairs are needed by those who are very unsteady or fatigued.
Though multiple sclerosis is sometimes fatal directly or indirectly through aggravation of exisiting conditions,the outlook for optimally treated MS patients is improving through intensive research,with many remaining active in the community for an extended period through a combination of effective medication,peer support,medical devices and physical therapy.