Multiple Sclerosis—Adult

(MS—Adult)
  • Definition

    Multiple sclerosis (MS) is a disease of the central nervous system. It is a chronic condition that can be disabling.
    There are several types of MS:
    • Relapsing-remitting MS —Symptoms suddenly reappear periodically. They last for a few weeks or months, then go back into remission (a period with no symptoms). Symptoms may get worse with each occurrence.
    • Primary progressive MS —Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
    • Secondary progressive MS —After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
    • Progressive relapsing MS —Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.
    Nerve Fiber (Neuron)
    Myelin Sheath Damage
    Copyright © Nucleus Medical Media, Inc.
  • Causes

    The immune system normally attacks viruses or bacteria that should not be in the body. With MS, a problem with the immune system causes it to attack healthy nerves. In particular, MS attacks the nerve fibers in the brain, spinal cord, and the nerves of the eye. The exact cause of these immune problems is unknown.
    The following may contribute to the development of MS:
    • Viral or other infection
    • Genetic factors (heredity)
    • Environmental factors
    • Breaking down of parts of the nervous system
  • Risk Factors

    MS is more common in women and in people aged 15-50 years old. Other factors may increase your chance of MS include:
    • Exposure to certain viruses
    • Family members who have MS or other autoimmune disorders
    • Being of Northern European descent
    • Growing up in a colder climate, as opposed to a tropical climate
    • Having certain immune system genes
    • Having inflammation of the optic nerve
    • Having low vitamin D levels
    • Smoking
  • Symptoms

    Symptoms may range from mild to severe and may include:
    • Numbness or tingling in the face or limbs
    • Impaired vision in one or both eyes, including:
      • Blurred vision
      • Double vision
      • Loss of vision
    • Eye pain
    • Fatigue
    • Lightheadedness
    • Muscle stiffness
    • Muscle spasms
    • Muscle weakness
    • Incoordination or falling
    • Trouble walking or maintaining balance
    • Weakness in one or more limbs
    • Bladder problems including:
    • Bowel problems, including constipation
    • Sexual dysfunction
    • Slurred speech
    • Difficulty swallowing
    • Forgetfulness, memory loss, and confusion
    • Difficulty concentrating or solving problems
    • Depression
    Symptoms may worsen with:
    • Heat, including:
      • Hot weather
      • Hot baths or showers
      • Fever
    • Overexertion—intense physical activity
    • Infection
  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include:
    • MRI to take pictures of internal structures around the brain and spinal cord
    • Sensory evoked potentials to record the electrical responses evoked after a sensory stimulus
    • Visual evoked potential test to look for problems in the brain that affect vision
    • Lumbar puncture to check the fluid around the brain and spinal cord, which may rule out other diseases
    • Blood tests to rule out other diseases that may mimic MS
  • Treatment

    There is no cure for MS, you can manage the disease with medication, lifestyle changes, and counseling. Treatment will help relieve symptoms, prevent relapses, delay disability, and slow disease progression. Talk with your doctor about the best treatment plan for you. Options include:
    Medications
    Medications include:
    • Interferon betas
    • Immunomodulators
    • Immunosuppressives
    • Muscle relaxants
    • Corticosteroids
    • Potassium channel blockers
    • Botox injections
    Other medications may also be given to treat symptoms, such as:
    • Fatigue
    • Depression
    • Pain
    • Bladder or bowel problems
    Physical Therapies and Lifestyle Changes
    Therapies and changes may include:
    • Regular moderate exercise with your doctor's permission—swimming may be especially beneficial
    • Physical therapy to help maintain muscle strength and tone, dexterity, and walking ability
    • Massage
    • High-fiber diet to prevent constipation
    • Stress reduction techniques
    • Quitting smoking —smoking may worsen MS, causing the condition to progress to a more severe form
    Psychological Therapies
    Individual or group therapy will help you learn coping strategies for physical symptoms and emotional stress.
    If you are diagnosed with MS, follow your doctor's instructions .
    Avoiding Periods of Relapse
    Some forms of MS have periods remissions that alternate with relapses. Take these steps to help you avoid relapses and worsening of symptoms:
    • Adhere to the treatment plan you worked out with your doctor
    • Get adequate rest
    • Avoid hot weather
    • Stay in air-conditioned places during periods of hot weather
    • Avoid hot showers or baths
    • Avoid overexertion and stress
    • Avoid infection by:
      • Using proper hygiene
      • Staying away from people who are sick
      • Thoroughly cooking food
      • Practicing safe sex
  • Prevention

    There are no current guidelines to prevent MS.
  • RESOURCES

    Multiple Sclerosis Association of America http://www.mymsaa.org

    National Multiple Sclerosis Society http://www.nationalmssociety.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Multiple Sclerosis Society of Canada http://mssociety.ca

    References

    About MS. National Multiple Sclerosis Society website. Available at: http://nationalmssociety.org/about-multiple-sclerosis/index.aspx . Accessed September 5, 2013.

    Ascherio A, et al. Vitamin D and multiple sclerosis. Lancet Neurol. 2010;9(6):599-612.

    Cohen JA, Barkhof F, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362(5):402-415.

    FDA approves Ampyra to improve walking in adults with multiple sclerosis. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm198463.htm . Updated April 25, 2013. Accessed September 5, 2013.

    International Multiple Sclerosis Genetics Consortium. Risk alleles for multiple sclerosis identified by a genomewide study. NEJM. 2007;357(9):851-862.

    Kasper DL, Braunwald E, et al. Harrison’s Principles of Internal Medicine . 16th ed. The McGraw-Hill Companies; 2006.

    Kappos L, Radue EW. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Eng J Med. 2010;362(5):387-401.

    Multiple sclerosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated August 5, 2013. Accessed September 5, 2013.

    NINDS multiple sclerosis information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/multiple%5Fsclerosis/multiple%5Fsclerosis.htm . Updated July 5, 2013. Accessed September 5, 2013.

    Rose JW, Carlson NG. Pathogenesis of multiple sclerosis. Continuum Lifelong Learning Neurol. 2007;13:35-62.

    Treatments. National Multiple Sclerosis Society. Available at http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/index.aspx . Accessed September 5, 2013.

    Van der Mae IA, et al. Individual and joint action of environmental risk factors and MS. Neurol Clin. 2011;29:233-55.

    1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Healy B, Ali E, Guttmann C, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66(7):858-864.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : US Food and Drug Administration. FDA approves first oral drug to reduce MS relapses. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm226755.htm . Updated April 19, 2013. Accessed September 5, 2013.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Kang JH, Sheu JJ, Kao S, Lin HC. Increased risk of multiple sclerosis following herpes zoster: a nationwide, population-based study. J Infect Dis. 2011;204(2):188-92.

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