Multiple sclerosis (MS) is an inflammatory autoimmune disease * of the nervous system that disrupts communication between the brain and other parts of the body, resulting in episodes of weakness, paralysis, blindness, fatigue, and other symptoms.
Jacqueline Du Pré (doo-PRAY) was born in England in 1945. On her fifth birthday, her parents gave her a cello, and she started lessons the next year. At 16, Jacqueline made her concert debut in London. In 1967 she married the pianist and conductor Daniel Barenboim, and together the young, talented couple charmed the musical world. Six years later, Jacqueline could no longer feel the strings of her cello. By the mid-1970s she was unable to dress herself or stand without help. In 1987, at the age of 42, she died of multiple sclerosis (MS). Many people with MS are mildly affected, but in the most severe cases, such as Jacqueline Du Pré's, a person may be unable to write, speak, or walk.
MS is an inflammation *
MS is not a common disease. Estimates of the number of people worldwide with MS vary, but the National Multiple Sclerosis Society estimates that about 400,000 people in the United States are living with the disease and about 10,000 Americans are newly diagnosed with MS each year. The disease is most frequently diagnosed in people between 20 and 40 years of age, and it affects about twice as many women as men. The prevalence of the disease is higher in colder climates, with twice as many cases in the northern half of the United States compared to the southern United States.
As of 2015, scientists did not know exactly what causes MS, but many thought that it is an autoimmune disease triggered by exposure to something in the environment in some individuals who have genes that make them susceptible to developing the MS plaques. In a healthy body, the immune system * is continually on guard to defend against foreign disease-causing invaders, such as bacteria, viruses, fungi, and parasites. Normally the body is able to distinguish its own cells from foreign cells and attack only foreign cells. Sometimes the mechanism for distinguishing self from nonself goes awry. Some scientists think that, with MS, the body no longer recognizes the myelin as “self” and begins to attack it.
It is not clear what underlying changes occur that cause the body to attack the myelin in people with MS. Some scientists believe that a virus triggers a malfunction of the immune system. Because the incidence of MS is not spread evenly throughout the world, others believe that factors in the environment (colder temperatures, for instance) may trigger the disease. Both of these may play a role, as may other unknown environmental factors. Genes * appear to influence who gets MS. Generally, a person's chances of getting MS are very low. If a member of a family has MS, then that member's parents, children, and sisters and brothers still have a very low chance of getting the disease, but it is about 5 percent higher than in people who do not have family members with MS. It also seems likely that more than one gene is involved in a person's susceptibility to MS. The understanding as of 2015 was that many different factors, both environmental and genetic, have to come together for a person to develop MS. Scientists continue to explore how genes interact with one another and with the environment, in relation to MS, in the hope of finding new ways to treat or cure it.
MS manifests differently in different cases, but usually the disease follows one of several patterns. The most common pattern is called relapsingremitting MS, in which symptoms come and go, sometimes with periods of remission (when the affected person is fine). About three-fourths of all people diagnosed with MS have this type of the disease. In about half of all people with relapsing-remitting MS, the disease eventually returns permanently with no periods of relapse. When this happens, it is called secondary progressive MS. About 10 percent of people with MS have what is called primary progressive disease, which means that the disease does not go away after the first attack. Patients with primary progressive MS tend to be older (around 40 to 60 years old). A rare form of MS is called progressive-relapsing disease in which disease symptoms are always present, more or less at a constant level, but there are periods during which they worsen.
MS may begin abruptly, or the initial symptoms may be so mild and gradual that a person barely notices them. In the early stages of MS, people may find that simple motions such as opening a window or climbing a few stairs tire their arms and legs. Although everyone occasionally feels numbness or “pins and needles” in their hands and feet, these feelings are much more frequent in people with mild MS. Patients often experience blurring and double vision, or they may lose vision in one eye or both eyes. Sometimes eye movement becomes painful. A person may become uncoordinated. In about 75 percent of patients with MS, many of these early symptoms disappear only to reappear months or years later.
MS is often difficult to diagnose, because the symptoms are varied and not specific to the disease. Symptoms of MS can be confused with those that follow a viral infection or other disease. Diagnosis must be preceded by a complete neurological exam that tests functions of the nervous system such as reflexes, muscle tone, and perception of pain, heat, and touch. The accuracy of diagnosis improved with improvements in a diagnostic technique called magnetic resonance imaging * , or MRI, that is able to pinpoint locale(s) of damage that MS has caused in the brain. A spinal tap, also called a lumbar puncture, can also aid in diagnosis. This test removes a small amount of the fluid that surrounds the spinal cord so that it can be examined for certain abnormalities associated with MS. In addition, an evoked potential test can be used to measure how strongly (or weakly) electrical impulses are transmitted from peripheral tissue, along nerve fibers, and to the brain. Abnormalities in this test also suggest MS.
As of 2016, no cure existed for MS and there was no way to prevent the disease. Treatment varies considerably because of the range and severity of MS symptoms. Some people do well for long periods with little or no treatment. Heat seems to make the symptoms of MS worse, but swimming or a cool bath may help to reduce symptoms. Several classes of drugs are used to treat MS, and more were being developed and tested in the early 2000s. Some drugs are more effective for specific types of MS. However, many drugs used to treat MS have the potential to cause serious side effects.
Not all drugs are appropriate for all patients; however, several types of drugs are commonly used to treat MS. These include the following:
In addition to drug treatment, people with MS often benefit from physical therapy and occupational therapy, which help them to better adapt to the difficulties they experience in performing daily tasks. Because MS takes a psychological toll as well as a physical one, counseling and support groups may also be helpful both to the patient and the patient's family.
About one-third of people with MS have very mild symptoms and are able to lead relatively normal lives. However, many people with MS gradually become seriously disabled, and their quality of life is severely diminished. The lifespan of people with MS is, on average, five to seven years shorter than that of persons without the disease. However, MS is rarely the cause of death in persons who have the disease; these individuals usually die of complications associated with the disease, such as paralysis, pneumonia, or some other infection, which are usually a consequence of their being bedridden.
The diagnosis of MS can be devastating because patients are often young adults. Suddenly plans for a career and family must take into account a disease whose course is uncertain. Yet many people with MS continue to lead productive lives. A woman who has MS may still become pregnant and bear a child safely, although she may be instructed to discontinue her MS medications during pregnancy, and the physical limitations of the disease may make it more difficult for her to care for her child.
More mature children who have a parent who has severe MS may find it hard to accept the changes they see happening in a person they remember as capable and independent and on whom they still depend. They may feel guilty about enjoying activities that the parent who has MS can no longer perform, or they may resent having to help with simple actions such as fetching a glass of water or turning on the radio or television for the parent. MS can take a tremendous emotional and financial toll on the entire family. Support groups and counseling can help MS patients and their families achieve the best possible quality of life given the limitations imposed by the disease.
See also Immune System and Other Body Defenses: Overview • Paralysis
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Multiple Sclerosis Association of America. 706 Haddonfield Rd., Cherry Hill, NJ 08002. Telephone: 856-488-4500. Website: http://www.mymsaa.org (accessed November 20, 2015).
Multiple Sclerosis Foundation. 6350 North Andrews Ave., Fort Lauderdale, FL 33309. Toll-free: 888-225-6495. Website: http://www.msfocus.org (accessed October 27, 2015).
National Institute of Neurological Disorders and Stroke. PO Box 5801, Bethesda, MD 20824. Toll-free: 800-352-9424. Website: http://www.ninds.nih.gov (accessed October 27, 2015).
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* autoimmune disease (aw-toh-ih-MYOON) is a disease in which the body's immune system attacks some of the body's own normal tissues and cells.
* inflammation (in-fla-MAY-shun) is the body's reaction to irritation, infection, or injury that often involves swelling, pain, redness, and warmth.
* immune system (im-YOON SIStem) is the system of the body composed of specialized cells and the substances they produce that helps protect the body against disease-causing germs.
* genes (JEENS) are chemical structures composed of deoxyribonucleic acid (DNA) that help determine a person's body structure and physical characteristics such as hair or eye color. Inherited from a person's parents, genes are contained in the chromosomes found in the body's cells.
* lesions (LEE-zhuns) is a general term referring to sore or damaged or irregular areas of tissue.
* incontinence (in-KON-ti-nens) is loss of control of urination or bowel movement.
* magnetic resonance imaging (or MRI) uses magnetic waves, instead of x-rays, to scan the body and produce detailed pictures of the body's structures.
* corticosteroids (kor-tih-ko-STIRoyds) are chemical substances made by the adrenal glands that have several functions in the body, including maintaining blood pressure during stress and controlling inflammation. They can also be given to people as medication to treat certain illnesses.