Multiple Sclerosis: description, symptoms, tests, treatment, duration, prognosis

 Description : What is Multiple Sclerosis -MS
An autoimmune disorder of the central nervous system that affects the brain and spinal cord. Nerve cells normally are surrounded by an insulating sheath made of a fatty substance called myelin that helps to transmit nerve impulses. In MS, this myelin sheath is inflamed or damaged. This disrupts or slows nerve impulses and causes nerves to malfunction. Scarring (sclerosis) occurs in the white matter of the brain and spinal cord. These areas of myelin damage and scarring are called MS plaques. The disease periodically flares up with episodes of increased symptoms. The disease can be mild, and non-progressive disease can slowly get worse, or get worse rapidly. It is slightly more common in women between the ages of 20 to 40.
Symptoms of MS
Symptoms vary widely. They may come and go or remain permanently. Symptoms include

•  Impaired vision (complete or partial vision loss and double vision)—optic neuritis, nystagmus or diplopia.
•  Numbness ( Changes in sensation (in arms, legs or face such as prickling, or “pins and needles”
• Muscle weakness
•  Decreased coordination
•  Poor balance (ataxia).
•  Halting speech
•  Muscle spasms (especially in the legs)
•  Muscle spasticity
• Depression
• Cognitive impairment. (thinking and memory disturbances.
• Severe fatigue
• Overheating, and pain.
• Bladder and bowel difficulties.
• Impaired mobility and disability in more severe cases.
  Tests and  Workup:
  A history and physical exam will be performed. Diagnosis is made by ruling out other conditions. Tests that are used to confirm multiple sclerosis include: Head MRI scan, spine MRI, lumbar puncture (spinal tap), cerebrospinal fluid tests including CSF (cerebrospinal fluid) oligoclonal banding.

Type of Tests:  CT Scan ,MRI, Other Specific Tests: Lumbar puncture (spinal tap), cerebrospinal fluid tests including CSF oligoclonal banding
 Treatment of MS
There is no definitive cure, but new treatments can help slow the progression of the disease. Medications that alter the immune response include: immune modulators such as interferon (Avonex, Betaseron, or Rebif), monoclonal antibodies (Tysabri), and glatiramer acetate (Copaxone). Short courses of a corticosteroid (prednisone) can decrease the severity of attacks. Medicines to reduce muscle spasms include baclofen (Lioresal), tizanidine (Zanaflex), or a benzodiazepine such as diazepam (Valium). For more information contact: Multiple Sclerosis Association of America: (800)532-7667 Multiple Sclerosis Foundation (888)673-6287
Duration : How long will this condition last?
MS is a lifelong illness that can follow one of several different patterns. The three most common patterns are: Relapsing remitting MS, Primary progressive MS, Secondary progressive MS. Progressive-relapsing MS is a rare form.

1. Relapsing remitting MS: In this form of MS, there are relapses (episodes when symptoms suddenly get worse), followed by remissions (periods of recovery). Between relapses, the patient’s condition usually is stable, without deterioration. While this type accounts for up to 90% of cases at disease onset, many people with relapsing remitting MS enter a secondary progressive phase (described below) over time.
2. Primary progressive MS: In this form, symptoms worsen gradually and continuously. There are no episodes of relapses and remissions. This type accounts for about 10% of cases.
3. Secondary progressive MS: In this form, someone who originally had relapsing remitting MS begins to have gradual deterioration in nerve function, with or without relapses. Secondary progressive MS ultimately affects 50% of people with relapsing remitting .
4. Progressive-relapsing MS: a rare form, affecting fewer than 5% of patients. It is progressive from the start, with intermittent flare-ups of worsening symptoms along the way. There are no periods of remission.
   Prognosis of MS
   A minority of those with MS have a relatively harmless form of the illness, but the majority of patients suffer from some type of neurological disability over time. In general, MS is a progressive illness that can last 30 to 40 years, but the degree of progression and eventual disability varies from patient to patient. There is great hope that newer forms of treatment will have significant long-term effects in improving the lives of MS patients.

Causes of Multiple Sclerosis
Most likely MS occurs as a result of some combination of genetic, environmental and infectious factors, and possibly other factors like vascular problems. Epidemiological studies of MS have provided hints on possible causes for the disease. Theories try to combine the known data into plausible explanations, but none has proved definitive.

Genetics : HLA region of Chromosome 6. Changes in this area increase the probability of suffering MS.
MS is not considered a hereditary disease. However, a number of genetic variations have been shown to increase the risk of developing the disease.
The risk of acquiring MS is higher in relatives of a person with the disease than in the general population, especially in the case of siblings, parents, and children. The disease has an overall familial recurrence rate of 20%. In the case of monozygotic twins, concordance occurs only in about 35% of cases, while it goes down to around 5% in the case of siblings and even lower in half-siblings. This indicates susceptibility is partly polygenically driven. It seems to be more common in some ethnic groups than others. From Wikipedia, the free encyclopedia)

Factors triggering a relapse

Multiple sclerosis relapses are often unpredictable and can occur without  any warning and with no obvious precipitating factors. Some attacks are however preceded by some common triggers. In general , relapses  may occur more frequently during spring and summer than during autumn and winter. Infections such as common cold , influenza and gastroenteritis  can increase the risk of the relapse.
Some emotional and physical stress may also trigger an attack. Statistically there is no good evidence that either trauma or surgery trigger the relapses. People with MS can participate in sports but they should avoid extremely strenuous exertion because heat can increase the symptoms. This is known as Uhthoff’s phenomenon [is the worsening of neurologic symptoms in multiple sclerosis (MS)]  This is the reason why some people avoid saunas or even hot showers if suffering from MS.

Pregnancy can directly affect the susceptibility for relapse. The last three months of pregnancy offer a natural protection against  relapses. However, during the first few months after delivery, the risk for a relapse is increased 20 % – 40 % . Pregnancy does not  seem to influence long term disability . Children born to mothers  with MS are not at  increased risk for birth defects or other problems.