Multiple Sclerosis Information - Causes, Symptoms And Treatment
Multiple sclerosis (MS) is a chronic, degenerative disease that causes demyelination of the white matter of the brain and spinal cord and damage to nerve fibers and their targets. Characterized by exacerbations and remissions, MS is a major cause of chronic disability in young adults. It usually becomes symptomatic between ages 20 and 40 (the average age of onset is 27). MS affects three women for every two men and five whites for every nonwhite. Incidence is generally higher among urban populations and upper socioeconomic groups. A family history of MS and living in a cold, damp climate increase the risk.
The prognosis varies. MS may progress rapidly, disabling the patient by early adulthood or causing death within months of onset. However,70% of patients lead active, productive lives with prolonged remissions.
Several types of MS have been identified. Terms to describe MS types include:
- Relapsing-remitting MS demonstrates definite but unpredictable relapses (or acute attacks or exacerbations) during which new symptoms appear or existing symptoms become more severe and last for varying periods (days to months). Although patients recover fully from these acute attacks, they'll always have MS and its degenerative effects. (Note: The disease doesn't worsen between the attacks.)
- Benign MS involves one or two attacks after which recovery is complete and no any permanent disability remains. However, minimal disability occurs after 10 to 15 years of onset.
- Primary-progressive MS is a steady progression and worsening of symptoms from onset with minor recovery or plateaus. (This forom is uncommon and may involve different brain and spinal cord damage than other forms.)
- Secondary-progressive MS begins as a pattern of clear-cut relapses and recovery with steadily progressive disability that worsens later in the course of the disease between acute attacks.
What causes Multiple sclerosis?
The exact cause of MS is unknown; however, current theories suggest that a slow-acting or latent viral infection triggers an autoimmune response. Other theories suggest that environmental and genetic factors may also be linked to MS.
Certain conditions appear to precede onset or exacerbation, including:
- emotional stress
- fatigue (physical or emotional)
- acute respiratory infections.
In MS, sporadic patches of axon demyelination and nerve fiber loss occur throughout the central nervous system, inducing widely disseminated and varied neurologic dysfunction. New evidence of nerve fiber loss may provide an explanation for the neurologic deficits experienced by many patients with MS. The axons determine the presence or absence of function; loss of myelin doesn't correlate with loss of function.
Signs and symptoms of Multiple sclerosis
Signs and symptoms of MS depend on the extent and site of myelin destruction, the extent of remyelination, and the adequacy of subsequent restored synaptic transmissions. Flare-ups may be transient or last for hours or weeks, possibly waxing and waning with no predictable pattern. The patient may have difficulty describing the symptoms. Clinical effects may be so mild that the patient is unaware of them or so intense that they're debilitating. Typical first signs and symptoms related to conduction deficits and impaired impulse transmission along the nerve fiber and include:
- vision problems
- sensory impairment, such as burning and pins and needles, decreased ability to sense temperatures or vibrations, and decreased strength
Other characteristic changes include:
- ocular disturbances- optic neuritis, diplopia, ophthalmoplegia, blurred vision, and nystagmus from impaired cranial nerve dysfunction and conduction deficits to the optic nerve
- muscle dysfunction - weakness, paralysis ranging from monoplegia to quadriplegia, spasticity, hyperreflexia, intention tremor, and gait ataxia from impaired motor reflex
- urinary disturbances- incontinence, frequency, urgency, and frequent infections from impaired transmission involving sphincter innervation
- bowel disturbances - involuntary evacuation or constipation from altered impulse transmission to internal sphincter
- fatigue- commonly the most debilitating symptom
- speech problems - poorly articulated or scanning speech and dysphagia from impaired transmission to the cranial nerves and sensory cortex.
Complications of MS may include: .
- injuries from falls
- urinary tract infection
- joint contractures
- pressure ulcers
- rectal distention
Because early symptoms may be mild, years may elapse between onset and diagnosis. Diagnosis of this disorder requires evidence of two or more neurologic attacks. Periodic testing and close observation are necessary, perhaps for years, depending on the course of the disease. Spinal cord compression, foramen magnum tumor (which may mimic the exacerbations and remissions of MS), multiple small strokes, syphilis or another infection, thyroid disease, and chronic fatigue syndrome must be ruled out.
The following tests may be useful in diagnosing MS:
- Magnetic resonance imaging reveals multifocal white matter lesions.
- EEG reveals abnormalities in brain waves in one-third of patients.
- Lumbar puncture shows normal total cerebrospinal fluid (CSF) protein but elevated immunoglobulin (Ig) G (gannna globulin); IgG reflects hyperactivity of the immune system due to chronic demyelination. An elevated CSF IgG is significant only when serum IgG is normal CSF white blood cell count may be elevated.
- CSF electrophoresis detects bands of IgG in most patients, even when the percentage of IgG in CSF is normal. Presence of kappa light chains provides additional support to the diagnosis.
- Evoked potential studies (visual, brain stem, auditory, and somatosensory) reveal slowed conduction of nerve impulses in most patients.
Treatment of Multiple sclerosis
The aim of treatment is threefold: Treat the acute exacerbation, treat the disease process, and treat the related signs and symptoms. These measures include:
- I.V. methylprednisolone (DepoMedrol) followed by oral therapy reduces edema of the myelin sheath (speeds recovery from acute attacks). Other drugs, such as azathioprine (Imuran) or methotrexate (Rheumatrex) and misoprostol (Cytotec) may be used.
- Immune system therapy consisting of interferon beta-1a (Avonex), interferon beta-1b (Betaseron), and glatiramer (Copaxone), (a combination of four amino acids) reduces frequency and severity of relapses and may slow central nervous system damage.
- Stretching and range-of-motion exercises coupled with correct positioning may relieve the spasticity resulting from opposing muscle groups relaxing and contracting at the same time and may be helpful in relaxing muscles and maintaining function.
- Baclofen and tizanidine may be used to treat spasticity. For severe spasticity, botulinum toxin injections, intrathecal injections, nerve blocks, and surgery may be necessary.
- Frequent rest periods, aerobic exercise, and cooling techniques (air conditioning, breezes, water sprays) may minimize fatigue. Fatigue is characterized by an overwhelming feeling of exhaustion without obvious cause that can occur at any time of the day without warning. Changes in environmental conditions, such as heat and humidity, can aggravate fatigue.
- Amantadine (Symmetrel) treats stiffness; pemoline (Cylert) and methylphenidate (Ritalin) serve as antidepressants, which helps manage fatigue.
- Interferon beta-1a, the only proven therapy for the relapsing form of MS, decreases the number of flare-ups and slows the occurrence of the degenerative disabilities associated with MS.
- Bladder problems (failure to store urine, failure to empty the bladder or, more commonly, both) are managed by such strategies as drinking cranberry juice or insertion of an indwelling catheter and suprapubic tubes. intermittent self-catheterization and postvoid catheterization programs are helpful as well as anticholinergic medications for urge incontinence or urinary retention.
- Bowel problems (constipation and involuntary evacuation) are managed by such measures as increasing fiber intake, using bulking agents, and bowel-training strategies, including daily suppositories and rectal stimulation.
- Low-dose tricyclic antidepressants, phenytoin (Dilantin), or carbamazepine (Tegretol) may manage sensory symptoms, such as pain, numbness, burning, and tingling sensations. Selective serotonin reuptake inhibitors may also treat depression.
- Adaptive devices and physical therapy assist with motor dysfunction, such as problems with balance, strength, and muscle coordination.
- Beta-adrenergic blockers, sedatives,or diuretics may be used to alleviate tremors.
- Speech therapy may manage dysarthria.
- Antihistamines, vision therapy, or exercises may minimize vertigo.
- Vision therapy or adaptive lenses may manage visual problems.
- progressive disability
- urinary tract infections
- side effects of medications used to treat the disorder
Special considerations and Prevention
Management considerations focus on educating the patient and family: . Assist with physical therapy. increase patient comfort with massages and relaxing baths. Make sure the bath water isn't too hot because it may temporarily intensify otherwise subtle symptoms. Assist with active, resistive, and stretching exercises to maintain muscle tone and joint mobility, decrease spasticity, improve coordination, and boost morale.
- Educate the patient and her family concerning the chronic course of MS. Emphasize the need to avoid stress, infections, and fatigue and to maintain independence by developing new ways of performing daily activities. Be sure to tell the patient to avoid exposure to infections.
- Stress the importance of eating a nutritious, well-balanced diet that contains sufficient roughage and adequate fluids to prevent constipation.
- Evaluate the need for bowel and bladder training during hospitalization. Encourage adequate fluid intake and regular urination. Eventually, the . patient may require urinary drainage by self-catheterization (or, in men, condom drainage). Teach the correct use of suppositories to help establish a regular bowel schedule.
- Watch for adverse drug effects. For instance, dantrolene may cause muscle weakness and decreased muscle tone.
- Fatigue is a common symptom of MS, and getting your rest may make you feel less tired.
- Promote emotional stability. Help the patient establish a daily routine to maintain optimal functioning. Activity level is regulated by tolerance level. Encourage regular rest periods to prevent fatigue and daily physical exercise.
- Inform the patient that exacerbations are unpredictable, necessitating physical and emotional adjustments in lifestyle.
- Eating a healthy diet and taking the recommended daily dose of vitamins can help keep your immune system strong.