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Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). The body’s own immune system attacks the protective sheath (myelin) that covers nerve fibres and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. MS can only be diagnosed after 2 or more episodes of relapse.
Signs and symptoms
Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms. The following is a list of possible signs and symptoms:

  • Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
  • Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
  • Prolonged double vision
  • Tingling or pain in parts of your body
  • Electric-shock sensations that occur with certain neck movements, especially bending the neck forward
  • Tremor, lack of coordination or unsteady gait
  • Slurred speech
  • Fatigue
  • Dizziness
  • Problems with bowel and bladder function
Disease course
Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms / relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years. Small increases in body temperature can temporarily worsen signs and symptoms of MS, but these aren’t considered disease relapses.

  • About 60 to 70 % of people with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, known as secondary-progressive MS.
  • The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly from person to person.
  • Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses. This is known as primary-progressive MS.
Causes
The cause of multiple sclerosis is unknown, although MS appears predominantly as an autoimmune system malfunction destroying myelin (the fatty substance that coats and protects nerve fibres in the brain and spinal cord).

Myelin can be compared to the insulation coating on electrical wires. When the protective myelin is damaged and the nerve fibre is exposed, the messages that travel along that nerve may be slowed or blocked. The nerve may also become damaged itself.

It isn’t clear why MS develops in some people and not others, although a combination of genetics and environmental factors appears to be responsible. The following are possible risk factors for MS:

  • Age. MS can occur at any age, but most commonly affects people between the ages of 15 and 60.
  • Sex. Women are about twice as likely as men are to develop MS.
  • Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
  • Some infections. A variety of viruses have been linked to MS, including Epstein-Barr.
  • Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.
  • Climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe.
  • Some autoimmune diseases. There is a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.
  • Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.
Complications
People with multiple sclerosis also may develop:

  • Muscle stiffness or spasms
  • Paralysis, typically in the legs
  • Problems with bladder, bowel or sexual function
  • Mental changes, such as forgetfulness or mood swings
  • Depression
  • Epilepsy
Treatment for Recovery from Attacks
There’s no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.

  • Corticosteroids, such as oral prednisone and intravenous methylprednisolone, are prescribed to reduce nerve inflammation.
  • Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into your body.
Treatments to modify progression
Treatment options for relapsing-remitting MS may include some of the options listed below.However the options will need to be discussed with your specialist:

  • Beta interferons. These medications are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses.
  • Ocrelizumab (Ocrevus). This humanized immunoglobulin antibody medication is the only immunosuppressive medication approved by the Food and Drug Administration (FDA) to treat both the relapse-remitting and primary progressive forms of MS and is given via drip.
  • Glatiramer acetate (Copaxone). This medication may help block your immune system’s attack on myelin and must be injected beneath the skin.
  • Dimethyl fumarate (Tecfidera). This twice-daily oral medication can reduce relapses.
  • Fingolimod (Gilenya). This once-daily oral medication reduces relapse rate.
  • Teriflunomide (Aubagio). This once-daily medication can reduce relapse rate.
  • Natalizumab (Tysabri). This medication is designed to block the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord. It may be considered a first line treatment for some people with severe MS or as a second line treatment in others.
  • Alemtuzumab (Lemtrada). This drug helps reduce relapses of MS by targeting a protein on the surface of immune cells and depleting white blood cells. This effect can limit potential nerve damage caused by the white blood cells, but it also increases the risk of infections and autoimmune disorders.
  • Mitoxantrone. This immunosuppressant drug can be harmful to the heart and is associated with development of blood cancers. As a result, its use in treating MS is extremely limited.
Treatments for the signs and symptoms of MS
Physiotherapy / Physical therapy

  • A physical therapist / physiotherapist can teach you stretching and strengthening exercises and show you how to use devices to make it easier to perform daily tasks.
    Physical therapy along with the use of a mobility aid when necessary, can also help manage leg weakness and other gait problems often associated with MS.

Muscle relaxants.

  • You may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex) may help.

Medications to reduce fatigue.

Other medications.

  • Medications also may be prescribed for depression, pain, sexual dysfunction, and bladder or bowel control problems that are associated with MS.
Lifestyle Changes
To help relieve the signs and symptoms of MS, try to:

  • Get plenty of rest.
  • Exercise. If you have mild to moderate MS, regular exercise can help improve your strength, muscle tone, balance and coordination. Swimming or other water exercises are good options if you’re bothered by heat. Other types of mild to moderate exercise recommended for people with MS include walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi. All these options should be discussed with your physiotherapist / physical therapist and /or occupational therapist prior to commencing the activity.
  • Cool down. MS symptoms often worsen when your body temperature rises.
  • Eat a balanced diet. Results of small studies suggest that a diet low in saturated fat but high in omega-3 fatty acids, such as those found in olive and fish oils, may be beneficial. But further research is needed. Studies also suggest that vitamin D may have potential benefit for people with MS.
  • Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai chi, massage, meditation or deep breathing may help.

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