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Scientists have learned a great deal about MS and MS symptom treatment in recent years; still, its cause remains elusive. Many investigators believe MS to be an autoimmune disease-one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus.
MS Symptom Treatment
Causes
Symptoms
Exams and Tests
Diagnosis
Managing MS
Self-Care for MS Patients
Caring for those with MS
MS Symptom Treatment
Scientists continue their extensive efforts to create new and better MS symptom treatment therapies. There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. Naturally occurring or spontaneous remissions make it difficult to determine therapeutic effects of experimental treatments; however, the emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new MS symptom treatment therapies.
In the past, the principal medications physicians used for MS symptom treatment were steroids possessing anti-inflammatory properties. No strong evidence exists to support the use of these drugs to treat progressive forms of MS. Also, there is some indication that steroids may be more appropriate for people with movement, rather than sensory, symptoms.
While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. The mechanism behind this effect is not known; one study suggests the medications work by restoring the effectiveness of the blood/brain barrier. Because steroids can produce numerous adverse side effects (acne, weight gain, seizures, psychosis), they are not recommended for long-term use as an MS symptom treatment.
One of the most promising MS symptom treatment research areas involves naturally occurring antiviral proteins known as interferons. Three forms of beta interferon (Avonex, Betaseron and Rebif) have now been approved by the Food and Drug Administration for relapsing-remitting MS symptom treatment. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. In addition, MRI scans suggest that beta interferon can decrease myelin destruction.
Investigators speculate that the effects of beta interferon may be due to the drug's ability to correct an MS-related deficiency of certain white blood cells that suppress the immune system and/or its ability to inhibit gamma interferon, a substance believed to be involved in MS attacks. Alpha interferon is also being studied as a possible treatment for MS. Common side effects of interferons include fever, chills, sweating, muscle aches, fatigue, depression and injection site reactions.
In addition to beta interferon, the FDA has approved a synthetic form of protein called copolymer I for the treatment of relapsing-remitting MS. This product is available under the name Copaxone® (glatiramer acetate). Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third when used as an MS symptom treatment.
Scientists continue their extensive efforts to create new and better MS symptom treatment therapies for MS. Goals of therapy are threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease progression.
Source: Amended National Institutes of Health
Causes of MS
To understand what is happening when a person has MS, it is first necessary to know a little about how the healthy immune system works. The immune system - a complex network of specialized cells and organs - defends the body against attacks by "foreign" invaders such as bacteria, viruses, fungi and parasites. It does this by seeking out and destroying the interlopers as they enter the body. Substances capable of triggering an immune response are called antigens.
T cells, so named because they are processed in the thymus, appear to play a particularly important role in MS. They travel widely and continuously throughout the body patrolling for foreign invaders. In order to recognize and respond to each specific antigen, each T cell's surface carries special receptor molecules for particular antigens.
Helper T cells are essential for activating the body's defenses against foreign substances. Yet another subset of regulatory T cells acts to turn off, or suppress, various immune system cells when their job is done. Killer T cells, on the other hand, directly attack diseased or damaged body cells by binding to them and bombarding them with lethal chemicals called cytokines. Since T cells can attack cells directly, they must be able to discriminate between "self" cells (those of the body) and "non-self" cells (foreign invaders). To enable the immune system to distinguish the self, each body cell carries identifying molecules on its surface. T cells likely to react against the self are usually eliminated before leaving the thymus; the remaining T cells recognize the molecular markers and coexist peaceably with body tissues in a state of self-tolerance.
In autoimmune diseases such as MS, the detente between the immune system and the body is disrupted when the immune system seems to wrongly identify self as non-self and declares war on the part of the body (myelin) it no longer recognizes. Through intensive research efforts, scientists are unraveling the complex secrets of the malfunctioning immune system of patients with MS.
Investigators are also looking for abnormalities or malfunctions in the blood/brain barrier, a protective membrane that controls the passage of substances from the blood into the central nervous system. It is possible that, in MS, components of the immune system get through the barrier and cause nervous system damage.
Scientists have studied a number of infectious agents (such as viruses) that have been suspected of causing MS, but have been unable to implicate any one particular agent. Viral infections are usually accompanied by inflammation and the production of gamma interferon, a naturally occurring body chemical that has been shown to worsen the clinical course of MS. It is possible that the immune response to viral infections may themselves precipitate an MS attack. There seems to be little doubt that something in the environment is involved in triggering MS.
In addition, increasing scientific evidence suggests that genetics may play a role in determining a person's susceptibility to MS. Some populations, such as Gypsies, Eskimos, and Bantus, never get MS. Native Indians of North and South America, the Japanese, and other Asian peoples have very low incidence rates. It is unclear whether this is due mostly to genetic or environmental factors.
In the population at large, the chance of developing MS is less than a tenth of one percent. However, if one person in a family has MS, that person's first-degree relatives-parents, children, and siblings-have a one to three percent chance of getting the disease.
Further indications that more than one gene is involved in MS susceptibility comes from studies of families in which more than one member has MS. Several research teams found that people with MS inherit certain regions on individual genes more frequently than people without MS. Of particular interest is the human leukocyte antigen (HLA) or major histocompatibility complex region on chromosome 6. HLAs are genetically determined proteins that influence the immune system.
These studies strengthen the theory that MS is the result of a number of factors rather than a single gene or other agent. Development of MS is likely to be influenced by the interactions of a number of genes, each of which (individually) has only a modest effect. Additional studies are needed to specifically pinpoint which genes are involved, determine their function and learn how each gene's interactions with other genes and with the environment make an individual susceptible to MS. In addition to leading to better ways to diagnose MS, such studies should yield clues to the underlying causes of MS and, eventually, to better treatments or a way to prevent the disease.
Source: National Institutes of Health
Symptoms of MS
Symptoms of MS may be mild or severe, of long duration or short, and may appear in various combinations, depending on the area of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70 percent of MS patients.
The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Inexplicably, visual problems tend to clear up in the later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as retrobulbaror optic neuritis. Fifty-five percent of MS patients will have an attack of optic neuritis at some time or other and it will be the first symptom of MS in approximately 15 percent. This has led to general recognition of optic neuritis as an early sign of MS, especially if tests also reveal abnormalities in the patient's spinal fluid.
Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Spasticity-the involuntary increased tone of muscles leading to stiffness and spasms-is common, as is fatigue. Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness.
Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling or "pins and needles" sensations; uncommonly, some may also experience pain. Loss of sensation sometimes occurs. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it is often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared.
Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. Scientists do not yet know whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both. Types of memory problems may differ, depending on the individual's disease course (relapsing-remitting, primary-progressive, etc.), but there does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction.
Source: National Institutes of Health
Exams and Tests for MS
Multiple Sclerosis is a difficult condition to test for. In most people with MS many tests are needed before a diagnosis is determined. Testing for Multiple Sclerosis is done in many ways. It can take several years from the time your first symptoms of MS appear to confirm a diagnosis. Doctors typically make a diagnosis by ruling out other conditions. As a primarily symptomatic condition, MS is typically identified by the series of physical and mental observations.
Doctors can conduct neurological examinations that can sometimes be enough to determine a true diagnosis of MS. If these tests are not conclusive, other tests can help further eliminate other possible conditions that cause the same side effects.
If a doctor suspects that a person may have MS, he or she may conduct a series of physical and mental exams such as a MRI, spinal tap or evoked potential testing before making their final diagnosis.
Some tests might reveal the symptoms are being caused by another condition that is potentially treatable by other means.
MS Diagnosis
Physicians use a variety of tools to rule out other possible disorders and perform a series of laboratory tests that can confirm the diagnosis of MS. When faced with a patient whose symptoms, neurological examination, and medical history suggest MS, physicians use a variety of tools to rule out other possible disorders and perform a series of laboratory tests that, if positive, confirm the diagnosis.
Imaging technologies such as MRI-often used in conjunction with the contrast agent gadolinium, which helps distinguish new plaques from old on MRI can help locate central nervous system lesions resulting from myelin loss. However, since these lesions can also occur in several other neurological disorders, they are not absolute evidence of MS. Magnetic Resonance Spectroscopy (MRS) is a new tool being used to investigate MS. Unlike MRI, which provides an anatomical picture of lesions, MRS yields information about the biochemistry of the brain in MS.
Evoked potential tests, which measure the speed of the brain's response to visual, auditory and sensory stimuli, can sometimes detect lesions the scanners miss. Like imaging technologies, evoked potentials are helpful but not conclusive because they cannot identify the cause of lesions.
The physician may also study the patient's cerebrospinal fluid (the colorless liquid that circulates through the brain and spinal cord) for cellular and chemical abnormalities often associated with MS. These abnormalities include increased numbers of white blood cells and higher-than-average amounts of protein, especially myelin basic protein and an antibody called immunoglobulin G. Physicians can use several different laboratory techniques to separate and graph the various proteins in MS patients' cerebrospinal fluid. This process often identifies the presence of a characteristic pattern called oligoclonal bands.
Because there is no single test that unequivocally detects MS, it is often difficult for the physician to differentiate between an MS attack and symptoms that can follow a viral infection or even an immunization. Many doctors will tell their patients they have "possible MS." If, as time goes by, the patient's symptoms show the characteristic relapsing-remitting pattern, or continue in a chronic and progressive fashion, and if laboratory tests rule out other likely causes, or specific tests become positive, the diagnosis may eventually be changed to "probable MS."
A number of other diseases may produce symptoms similar to those seen in MS. Other conditions with an intermittent course and MS-like lesions of the brain's white matter include polyarteritis, lupus erythematosus, syringomyelia, tropical spastic paraparesis, some cancers and certain tumors that compress the brainstem or spinal cord. Progressive multifocal leukoencephalopathy can mimic the acute stage of an MS attack. The physician will also need to rule out stroke, neurosyphilis, spinocerebellar ataxias, pernicious anemia, diabetes, Sjogren's disease and vitamin B12 deficiency. Acute transverse myelitis may signal the first attack of MS, or it may indicate other problems such as infection with the Epstein-Barr or herpes simplex B viruses. Recent reports suggest that the neurological problems associated with Lyme disease may present a clinical picture much like MS.
Investigators are continuing their search for a definitive test for MS. Until one is developed, however, evidence of both multiple attacks and central nervous system lesions must be found-a process that can take months or even years-before a physician can make a definitive diagnosis of MS.
Source: National Institutes of Health
Managing MS
MS patients are best advised to eat a balanced, wholesome diet in conjunction with their MS symptom treatment. With any chronic medical condition it is important to consult your primary physician before starting any diet or fitness program. Many of them will suggest you maintain a normal lifestyle, taking into account that you may have special dietary requirement or physical limitations due to your condition.
A balanced diet can give you added strength to deal with some of the side effects associated with your treatments. Food contains energy needed for your body to stay physically and mentally active.
Some of the side effects of common medicines include the loss of appetite or loss of desire to perform physical activity. You should fight some of these urges and attempt to maintain activities that suit your MS symptom treatment regime. Your doctor or nurse may have materials available for you that can help tailor a program specifically to your needs.
Self-Care for MS Patients
Taking care of yourself is both a mental and physical challenge, but something that can easily be accomplished. Living with a chronic medical disease means that you will need to make several lifestyle adjustments. MS symptom treatment, prescription medications and home healthcare are all essential elements to treating your condition. The most important step in taking care of your needs is learning as much about your condition as possible.
Once you know what you are dealing with you are better able to cope with the possible side-effects of treatments and medications. You should make special notes about any changes in your life or health condition. General observations of your physical and mental health are often invaluable towards your long-term care. The more you know about your own body, the more you will be able to share with your caregivers.
Tracking your medications and treatments against possible side-effects can help your doctor make recommendations for future action.
Mental self-care is vital to your long-term survival. As many chronic conditions bring good and bad days, you will need to learn how to deal with the highs and lows. Professional mental health experts can advise you on the best way to stay positive about your condition. Optimism about your treatments can make a major difference in your long-term care.
Good physical health is dependent upon a balanced diet and as much physical exercise that your condition will allow you to undertake. Be sure that you are not over extending yourself, as that may lead to further health problems.
Additional information can be found at the National Multiple Sclerosis Society website, Healthy living with MS.
Caring for Those With MS
One of the key elements of successfully caring for a person with a chronic medical condition is taking care of yourself first. A major mistake friends and family members make when giving care to another person is forgetting about their own well being. This can lead to conflict, depression, anxiety and a variety of other negative side effects.
It is important for caregivers to maintain a high level of enthusiasm while around the person they are giving care to. This can give the other person the extra energy it might take to combat their illness. By taking care of yourself, you are taking care of them.
Being a caregiver does not mean that your life needs to stop or even be put on hold. You should maintain a healthy balance of diet, exercise and social activity to ensure that you find ways to step outside your role as caregiver. Set some time aside every day for yourself. You will find this method is very effective in preventing guilt, frustration, depression, stress and resentment.
In addition, it is important that you do not give too much assistance to the person you are taking care of. It is necessary to empower them with as many duties as you feel they can safely accomplish. A sense of independence on their part will go a long way towards building confidence and ultimately to their recovery.
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