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Introduction to MS
Multiple Sclerosis
(MS) is the most common disabling neurological disease of young adults. It most
often appears when people are between 20 to 40 years old. However, it can also
affect children and older people.
The course of MS is
unpredictable. A small number of those with MS will have a mild course with
little to no disability, while another smaller group will have a steadily
worsening disease that leads to increased disability over time. Most people
with MS, however, will have short periods of symptoms followed by long
stretches of relative relief, with partial or full recovery.
There is no way to
predict, at the beginning, how an individual person’s disease will progress.
Researchers have
spent decades trying to understand why some people get MS and others don't, and
why some individuals with MS have symptoms that progress rapidly while others
do not. How does the disease begin? Why is the course of MS so different from
person to person? Is there anything we can do to prevent it? Can it be cured?
There is no single test for MS. Doctors use a medical history, physical exam, neurological exam, MRI, and other tests to diagnose it. There is no cure for MS, but medicines may slow it down and help control symptoms. Physical and occupational therapy may also help.
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What is Multiple Sclerosis?
It damages the myelin sheath, the material that surrounds and protects your nerve cells. This damage slows down or blocks messages between your brain and your body, leading to the symptoms of MS. They can include
- Visual disturbances
- Muscle weakness
- Trouble with coordination and balance
- Sensations such as numbness, prickling, or "pins and needles"
- Thinking and memory problems
No one knows what causes MS. It may be an autoimmune disease, which happens when your immune system attacks healthy cells in your body by mistake.
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What are plaques made of and why do they develop in MS?
Plaques, or lesions,
are the result of an inflammatory process in the brain that causes immune
system cells to attack myelin. The myelin sheath helps to speed nerve impulses
traveling within the nervous system. Axons are also damaged in MS, although not
as extensively, or as early in the disease, as myelin.
Under normal
circumstances, cells of the immune system travel in and out of the brain
patrolling for infectious agents (viruses, for example) or unhealthy cells.
This is called the "surveillance" function of the immune system.
Surveillance cells
usually won't spring into action unless they recognize an infectious agent or
unhealthy cells. When they do, they produce substances to stop the infectious
agent. If they encounter unhealthy cells, they either kill them directly or clean
out the dying area and produce substances that promote healing and repair among
the cells that are left.
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What are the signs and symptoms of Multiple Sclerosis?
A diagnosis of MS is
often delayed because MS shares symptoms with other neurological conditions and
diseases.
The first symptoms of
MS often include:
- vision problems such as blurred
or double vision or optic neuritis, which causes pain in the
eye and a rapid loss of vision.
- weak, stiff muscles, often with
painful muscle spasms
- tingling or numbness in the
arms, legs, trunk of the body, or face
- clumsiness, particularly
difficulty staying balanced when walking
- bladder control problems,
either inability to control the bladder or urgency
- dizziness that doesn't go away
MS may also cause
later symptoms such as:
- mental or physical fatigue which
accompanies the above symptoms during an attack
- mood changes such as depression
or euphoria
- changes in the ability to
concentrate or to multitask effectively
- difficulty making decisions,
planning, or prioritizing at work or in private life.
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Neuro-myelitis optica
is a disorder associated with transverse myelitis as well as optic nerve
inflammation. Patients with this disorder usually have antibodies against
a particular protein in their spinal cord, called the aquaporin channel. These
patients respond differently to treatment than most people with MS.
Most individuals with
MS have muscle weakness, often in their hands and legs. Muscle stiffness and
spasms can also be a problem. These symptoms may be severe enough to affect
walking or standing. In some cases, MS leads to partial or complete paralysis.
Many people with MS find that weakness and fatigue are worse when they have a
fever or when they are exposed to heat. MS exacerbations may occur following
common infections.
Tingling and burning
sensations are common, as well as the opposite, numbness and loss of sensation.
Moving the neck from side to side or flexing it back and forth may cause
"Lhermitte's sign," a characteristic sensation of MS that feels like
a sharp spike of electricity coursing down the spine.
While it is rare for
pain to be the first sign of MS, pain often occurs with optic neuritis and
trigeminal neuralgia, a neurological disorder that affects one of the nerves
that runs across the jaw, cheek, and face. Painful spasms of the limbs and
sharp pain shooting down the legs or around the abdomen can also be symptoms of
MS.
Most individuals with
MS experience difficulties with coordination and balance at some time during
the course of the disease. Some may have a continuous trembling of the head,
limbs, and body, especially during movement, although such trembling is more
common with other disorders such as Parkinson’s disease.
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Urinary symptoms,
including loss of bladder control and sudden attacks of urgency, are common as
MS progresses. People with MS sometimes also develop constipation or sexual
problems.
Depression is a
common feature of MS. A small number of individuals with MS may develop more
severe psychiatric disorders such as bipolar disorder and paranoia, or
experience inappropriate episodes of high spirits, known as euphoria.
People with MS,
especially those who have had the disease for a long time, can experience
difficulty with thinking, learning, memory, and judgment. The first signs of
what doctors call cognitive dysfunction may be subtle. The person may have
problems finding the right word to say, or trouble remembering how to do
routine tasks on the job or at home. Day-to-day decisions that once came easily
may now be made more slowly and show poor judgment. Changes may be so small or
happen so slowly that it takes a family member or friend to point them out.
Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations. Some may also experience pain. 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. Depression is another common feature of MS.
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. Depression is another common feature of MS.
How many people have Multiple Sclerosis?
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As with most
autoimmune disorders, twice as many women are affected by MS as men. MS is more
common in colder climates. People of Northern European descent appear to be at
the highest risk for the disease, regardless of where they live. Native
Americans of North and South America, as well as Asian American populations,
have relatively low rates of MS.
What causes Multiple Sclerosis (MS)?
The ultimate cause of
MS is damage to myelin, nerve fibers, and neurons in the brain and spinal cord,
which together make up the central nervous system (CNS). But how that happens,
and why, are questions that challenge researchers. Evidence appears to show
that MS is a disease caused by genetic vulnerabilities combined with
environmental factors.
Although there is
little doubt that the immune system contributes to the brain and spinal cord
tissue destruction of MS, the exact target of the immune system attacks and
which immune system cells cause the destruction isn't fully understood.
Researchers have
several possible explanations for what might be going on. The immune system
could be:
- fighting some kind of
infectious agent (for example, a virus) that has components which mimic
components of the brain (molecular mimickry)
- destroying brain cells because
they are unhealthy
- mistakenly identifying normal
brain cells as foreign.
The last possibility
has been the favored explanation for many years. Research now suggests that the
first two activities might also play a role in the development of MS. There is
a special barrier, called the blood-brain barrier, which separates
the brain and spinal cord from the immune system. If there is a break in the
barrier, it exposes the brain to the immune system for the first time. When
this happens, the immune system may misinterpret the brain as “foreign.”
Susceptibility to MS
may be inherited. Studies of families indicate that relatives of an individual
with MS have an increased risk for developing the disease. Experts estimate
that about 15 percent of individuals with MS have one or more family members or
relatives who also have MS. But even identical twins, whose DNA is exactly the
same, have only a 1 in 3 chance of both having the disease. This suggests that
MS is not entirely controlled by genes. Other factors must come into play.
Current research
suggests that dozens of genes and possibly hundreds of variations in the
genetic code (called gene variants) combine to create vulnerability to MS. Some
of these genes have been identified. Most of the genes identified so far are
associated with functions of the immune system. Additionally, many of the known
genes are similar to those that have been identified in people with other
autoimmune diseases as type 1 diabetes, rheumatoid arthritis or lupus.
Researchers continue to look for additional genes and to study how they
interact with each other to make an individual vulnerable to developing MS.
A number of studies
have suggested that people who spend more time in the sun and those with
relatively high levels of vitamin D are less likely to develop MS. Bright
sunlight helps human skin produce vitamin D. Researchers believe that vitamin D
may help regulate the immune system in ways that reduce the risk of MS. People
from regions near the equator, where there is a great deal of bright sunlight,
generally have a much lower risk of MS than people from temperate areas such as
the United States and Canada. Other studies suggest that people with higher
levels of vitamin D generally have less severe MS and fewer relapses.
A number of studies
have found that people who smoke are more likely to develop MS. People who
smoke also tend to have more brain lesions and brain shrinkage than
non-smokers. The reasons for this are currently unclear.
Infectious factors and viruses found in MS patients
A number of viruses
have been found in people with MS, but the virus most consistently linked to
the development of MS is Epstein Barr virus (EBV), the virus that causes
mononucleosis.
Only about 5 percent
of the population has not been infected by EBV. These individuals are at a
lower risk for developing MS than those who have been infected. People who were
infected with EBV in adolescence or adulthood and who therefore develop an
exaggerated immune response to EBV are at a significantly higher risk for
developing MS than those who were infected in early childhood. This suggests
that it may be the type of immune response to EBV that predisposes to MS,
rather than EBV infection itself. However, there is still no proof that EBV
causes MS.
Autoimmune and inflammatory processes for MS patients
Tissue inflammation
and antibodies in the blood that fight normal components of the body and tissue
in people with MS are similar to those found in other autoimmune diseases.
Along with overlapping evidence from genetic studies, these findings suggest
that MS results from some kind of disturbed regulation of the immune system.
How is MS diagnosed?
There is no single
test used to diagnose MS. Doctors use a number of tests to rule out or confirm
the diagnosis. There are many other disorders that can mimic MS. Some of these
other disorders can be cured, while others require different treatments than those
used for MS. Therefore it is very important to perform a thorough investigation
before making a diagnosis.
In addition to a
complete medical history, physical examination, and a detailed neurological
examination, a doctor will order an MRI scan of the head and spine to look for
the characteristic lesions of MS. MRI is used to generate images of the brain
and/or spinal cord. Then a special dye or contrast agent is injected into a
vein and the MRI is repeated. In regions with active inflammation in MS, there
is disruption of the blood-brain barrier and the dye will leak into the active
MS lesion.
Doctors may also
order evoked potential tests, which use electrodes on the skin and painless
electric signals to measure how quickly and accurately the nervous system
responds to stimulation. In addition, they may request a lumbar puncture
(sometimes called a "spinal tap") to obtain a sample of cerebrospinal
fluid. This allows them to look for proteins and inflammatory cells
associated with the disease and to rule out other diseases that may look
similar to MS, including some infections and other illnesses. MS is confirmed
when positive signs of the disease are found in different parts of the nervous
system at more than one time interval and there is no alternative diagnosis.
What is the course of MS?
The course of MS is
different for each individual, which makes it difficult to predict. For most
people, it starts with a first attack, usually (but not always) followed by a
full to almost-full recovery. Weeks, months, or even years may pass before
another attack occurs, followed again by a period of relief from symptoms. This
characteristic pattern is called relapsing-remitting MS.
Primary-progressive
MS is characterized by a gradual physical decline with no noticeable
remissions, although there may be temporary or minor relief from symptoms. This
type of MS has a later onset, usually after age 40, and is just as common in
men as in women.
Secondary-progressive
MS begins with a relapsing-remitting course, followed by a later
primary-progressive course. The majority of individuals with severe
relapsing-remitting MS will develop secondary progressive MS if they are
untreated.
Finally, there are
some rare and unusual variants of MS. One of these is Marburg variant MS (also
called malignant MS), which causes a swift and relentless decline resulting in
significant disability or even death shortly after disease onset. Balo’s
concentric sclerosis, which causes concentric rings of demyelination that can
be seen on an MRI, is another variant type of MS that can progress rapidly.
Determining the
particular type of MS is important because the current disease modifying drugs
have been proven beneficial only for the relapsing-remitting types of MS.
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What is an exacerbation or attack of MS?
An exacerbation—which
is also called a relapse, flare-up, or attack—is a sudden worsening of MS
symptoms, or the appearance of new symptoms that lasts for at least 24 hours.
MS relapses are thought to be associated with the development of new areas of
damage in the brain. Exacerbations are characteristic of relapsing-remitting
MS, in which attacks are followed by periods of complete or partial recovery
with no apparent worsening of symptoms.
An attack may be mild
or its symptoms may be severe enough to significantly interfere with life's
daily activities. Most exacerbations last from several days to several weeks,
although some have been known to last for months.
When the symptoms of the attack subside, an individual with MS is said
to be in remission. However, MRI data have shown that this is somewhat
misleading because MS lesions continue to appear during these remission
periods. Patients do not experience symptoms during remission because the
inflammation may not be severe or it may occur in areas of the brain that do
not produce obvious symptoms. Research suggests that only about 1 out of every
10 MS lesions is perceived by a person with MS. Therefore, MRI examination
plays a very important role in establishing an MS diagnosis, deciding when the disease
should be treated, and determining whether treatments work effectively or not.
It also has been a valuable tool to test whether an experimental new therapy is
effective at reducing exacerbations.
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Is there any treatment for Multiple Sclerosis?
There is as yet no cure for MS.
Treatments for MS attacks
The usual treatment
for an initial MS attack is to inject high doses of a steroid drug, such as
methylprednisolone, intravenously (into a vein) over the course of 3 to 5 days.
It may sometimes be followed by a tapered dose of oral steroids. Intravenous
steroids quickly and potently suppress the immune system, and reduce
inflammation. Clinical trials have shown that these drugs hasten recovery.
The American Academy
of Neurology recommends using plasma exchange as a secondary
treatment for severe flare-ups in relapsing forms of MS when the patient does
not have a good response to methylprednisolone. Plasma exchange, also known as plasmapheresis,
involves taking blood out of the body and removing components in the blood’s
plasma that are thought to be harmful. The rest of the blood, plus replacement
plasma, is then transfused back into the body. This treatment has not been
shown to be effective for secondary progressive or chronic progressive forms of
MS.
MS Treatments to help reduce disease activity and progression
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There is debate among
doctors about whether to start disease modulating drugs at the first signs of
MS or to wait until the course of the disease is better defined before
beginning treatment. On one hand, U.S. Food and Drug Administration
(FDA)-approved medications to treat MS work best early in the course of the
disease and work poorly, if at all, later in the progressive phase of the
illness. Clinical trials have shown convincingly that delaying treatment, even
for the 1 to-2 years that it may take for patients with MS to develop a second
clinical attack, may lead to an irreversible increase in disability. In
addition, people who begin treatment after their first attack have fewer brain
lesions and fewer relapses over time.
On the other hand,
initiating treatment in patients with a single attack and no signs of previous
MS lesions, before MS is diagnosed, poses risks because all FDA-approved
medications to treat MS are associated with some side effects. Therefore, the
best strategy is to have a thorough diagnostic work-up at the time of first
attack of MS. The work-up should exclude all other diseases that can mimic MS
so that the diagnosis can be determined with a high probability. The diagnostic
tests may include an evaluation of the cerebrospinal fluid and repeated MRI
examinations. If such a thorough work-up cannot confirm the diagnosis of MS
with certainty, it may be prudent to wait before starting treatment. However,
each patient should have a scheduled follow-up evaluation by his or her
neurologist 6 to 12 months after the initial diagnostic evaluation, even in the
absence of any new attacks of the disease. Ideally, this evaluation should
include an MRI examination to see if any new MS lesions have developed without
causing symptoms.
Until recently, it
appeared that a minority of people with MS had very mild disease or “benign MS”
and would never get worse or become disabled. This group makes up 10 to 20
percent of those with MS. Doctors were concerned about exposing such benign MS
patients to the side effects of MS drugs. However, recent data from the
long-term follow-up of these patients indicate that after 10 to 20 years, some
of these patients become disabled. Therefore, current evidence supports
discussing the start of therapy early with all people who have MS, as long as
the MS diagnosis has been thoroughly investigated and confirmed. There is an
additional small group of individuals (approximately 1 percent) whose course
will progress so rapidly that they will require aggressive and perhaps even
experimental treatment.
The current
FDA-approved therapies for MS are designed to modulate or suppress the
inflammatory reactions of the disease. They are most effective for
relapsing-remitting MS at early stages of the disease. These treatments include
injectable beta interferon drugs. Interferons are signaling molecules that
regulate immune cells. Potential side effects of beta interferon drugs include
flu-like symptoms, such as fever, chills, muscle aches, and fatigue, which
usually fade with continued therapy. A few individuals will notice a decrease
in the effectiveness of the drugs after 18 to 24 months of treatment due to the
development of antibodies that neutralize the drugs' effectiveness. If the
person has flare-ups or worsening symptoms, doctors may switch treatment to
alternative drugs.
Many patients do
well with no therapy at all, especially since many medications have serious
side effects and some carry significant risks. However, three forms of
beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the
Food and Drug Administration for treatment of relapsing-remitting MS. 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. The FDA also has approved a synthetic form of
myelin basic protein, called copolymer I (Copaxone), for the treatment of relapsing-remitting
MS. Copolymer I has few side effects, and studies indicate that the agent can
reduce the relapse rate by almost one third. Other FDA approved drugs to
treat relapsing forms of MS in adults include teriflunomide and dimethyl
fumarate. An immunosuppressant treatment,Novantrone (mitoxantrone),
is approved by the FDA for the treatment of advanced or chronic MS.
The FDA has also approved dalfampridine (Ampyra) to improve walking in
individuals with MS.
One monoclonal antibody, natalizumab (Tysabri),
was shown in clinical trials to significantly reduce the frequency of attacks
in people with relapsing forms of MS and was approved for marketing by the U.S.
Food and Drug Administration (FDA) in 2004. However, in 2005 the drug’s
manufacturer voluntarily suspended marketing of the drug after several reports
of significant adverse events. In 2006, the FDA again approved sale of
the drug for MS but under strict treatment guidelines involving infusion centers
where patients can be monitored by specially trained physicians.
While steroids do not affect the course of
MS over time, they can reduce the duration and severity of attacks in some
patients. Spasticity, which can occur either as a sustained stiffness caused
by increased muscle tone or as spasms that come and go, is usually treated with
muscle relaxants and tranquilizers such as baclofen, tizanidine, diazepam,
clonazepam, and dantrolene. Physical therapy and exercise can help preserve
remaining function, and patients may find that various aids -- such as foot
braces, canes, and walkers -- can help them remain independent and
mobile. Avoiding excessive activity and avoiding heat are probably the
most important measures patients can take to counter physiological
fatigue. If psychological symptoms of fatigue such as depression or
apathy are evident, antidepressant medications may help. Other drugs that
may reduce fatigue in some, but not all, patients include amantadine
(Symmetrel), pemoline (Cylert), and the still-experimental drug aminopyridine.
Although improvement of optic symptoms usually occurs even without treatment, a
short course of treatment with intravenous methylprednisolone (Solu-Medrol)
followed by treatment with oral steroids is sometimes used.
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How do doctors treat the symptoms of MS?
MS causes a variety
of symptoms that can interfere with daily activities but which can usually be
treated or managed to reduce their impact. Many of these issues are best
treated by neurologists who have advanced training in the treatment of MS and
who can prescribe specific medications to treat the problems.
Vision problems in MS patients
Eye and vision
problems are common in people with MS but rarely result in permanent blindness.
Inflammation of the optic nerve or damage to the myelin that covers the optic
nerve and other nerve fibers can cause a number of symptoms, including blurring
or graying of vision, blindness in one eye, loss of normal color vision, depth
perception, or a dark spot in the center of the visual field (scotoma).
Uncontrolled
horizontal or vertical eye movements (nystagmus) and "jumping vision"
(opsoclonus) are common to MS, and can be either mild or severe enough to
impair vision.
Double vision
(diplopia) occurs when the two eyes are not perfectly aligned. This occurs
commonly in MS when a pair of muscles that control a specific eye movement
aren't coordinated due to weakness in one or both muscles. Double vision may
increase with fatigue or as the result of spending too much time reading or on
the computer. Periodically resting the eyes may be helpful.
MS Weak muscles, stiff muscles, painful muscle spasms, and weak reflexes
Muscle weakness is
common in MS, along with muscle spasticity. Spasticity refers to
muscles that are stiff or that go into spasms without any warning. Spasticity
in MS can be as mild as a feeling of tightness in the muscles or so severe that
it causes painful, uncontrolled spasms. It can also cause pain or tightness in
and around the joints. It also frequently affects walking, reducing the normal
flexibility or “bounce” involved in taking steps.
MS Tremors
People with MS
sometimes develop tremor, or uncontrollable shaking, often triggered by
movement. Tremor can be very disabling. Assistive devices and weights attached
to limbs are sometimes helpful for people with tremor. Deep brain stimulation& and
drugs such as clonazepam also may be useful.
Multiple Sclerosis (MS) Problems with walking and balance
Many people with MS
experience difficulty walking. In fact, studies indicate that half of those
with relapsing-remitting MS will need some kind of help walking within 15 years
of their diagnosis if they remain untreated. The most common walking problem in
people with MS experience is ataxia—unsteady, uncoordinated
movements—due to damage with the areas of the brain that coordinate movement of
muscles. People with severe ataxia generally benefit from the use of a cane,
walker, or other assistive device. Physical therapy can also reduce walking
problems in many cases.
In 2010, the FDA
approved the drug dalfampridine to improve walking in patients with MS. It is
the first drug approved for this use. Clinical trials showed that patients
treated with dalfampridine had faster walking speeds than those treated with a
placebo pill.
Fatigue in MS Patients
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Fatigue may be
reduced if the person receives occupational therapy to simplify tasks and/or
physical therapy to learn how to walk in a way that saves physical energy or
that takes advantage of an assistive device. Some people benefit from stress
management programs, relaxation training, membership in an MS support group, or
individual psychotherapy. Treating sleep problems and MS symptoms that
interfere with sleep (such as spastic muscles) may also help.
Multiple Sclerosis Pain
People with MS may
experience several types of pain during the course of the disease.
Trigeminal neuralgia
is a sharp, stabbing, facial pain caused by MS affecting the trigeminal nerve
as it exits the brainstem on its way to the jaw and cheek. It can be treated
with anticonvulsant or antispasmodic drugs, alcohol injections, or surgery.
People with MS
occasionally develop central pain, a syndrome caused by damage to the brain
and/or spinal cord. Drugs such as gabapentin and nortryptiline sometimes help
to reduce central pain.
Burning, tingling,
and prickling (commonly called "pins and needles") are sensations
that happen in the absence of any stimulation. The medical term for them is dysesthesias"
They are often chronic and hard to treat.
Chronic back or other
musculoskeletal pain may be caused by walking problems or by using assistive
aids incorrectly. Treatments may include heat, massage, ultrasound treatments,
and physical therapy to correct faulty posture and strengthen and stretch
muscles.
Problems with bladder control and constipation with MS
The most common
bladder control problems encountered by people with MS are urinary frequency,
urgency, or the loss of bladder control. The same spasticity that causes spasms
in legs can also affect the bladder. A small number of individuals will have
the opposite problem—retaining large amounts of urine. Urologists can help with
treatment of bladder-related problems. A number of medical treatments are
available. Constipation is also common and can be treated with a high-fiber
diet, laxatives, and other measures.
Sexual issues with MS
People with MS
sometimes experience sexual problems. Sexual arousal begins in the central
nervous system, as the brain sends messages to the sex organs along nerves
running through the spinal cord. If MS damages these nerve pathways, sexual
response—including arousal and orgasm—can be directly affected. Sexual problems
may also stem from MS symptoms such as fatigue, cramped or spastic muscles, and
psychological factors related to lowered self-esteem or depression. Some of
these problems can be corrected with medications. Psychological counseling also
may be helpful.
Studies indicate that
clinical depression is more frequent among people with MS than it is in the
general population or in persons with many other chronic, disabling conditions.
MS may cause depression as part of the disease process, since it damages myelin
and nerve fibers inside the brain. If the plaques are in parts of the brain
that are involved in emotional expression and control, a variety of behavioral
changes can result, including depression. Depression can intensify symptoms of
fatigue, pain, and sexual dysfunction. It is most often treated with selective
serotonin reuptake inhibitor (SSRI) antidepressant medications, which are less
likely than other antidepressant medications to cause fatigue.
MS is sometimes
associated with a condition called pseudobulbar affect that causes
inappropriate and involuntary expressions of laughter, crying, or anger. These
expressions are often unrelated to mood; for example, the person may cry when
they are actually very happy, or laugh when they are not especially happy. In
2010 the FDA approved the first treatment specifically for pseudobulbar affect,
a combination of the drugs dextromethorphan and quinidine. The condition can
also be treated with other drugs such as amitriptyline or citalopram.
Cognitive changes in Multiple Sclerosis
Half -to
three-quarters of people with MS experience cognitive impairment, which is a
phrase doctors use to describe a decline in the ability to think quickly and
clearly and to remember easily. These cognitive changes may appear at the same
time as the physical symptoms or they may develop gradually over time. Some
individuals with MS may feel as if they are thinking more slowly, are easily
distracted, have trouble remembering, or are losing their way with words. The
right word may often seem to be on the tip of their tongue.
Some experts believe
that it is more likely to be cognitive decline, rather than physical
impairment, that causes people with MS to eventually withdraw from the
workforce. A number of neuropsychological tests have been developed to evaluate
the cognitive status of individuals with MS. Based on the outcomes of these
tests, a neuropsychologist can determine the extent of strengths and weaknesses
in different cognitive areas. Drugs such as donepezil, which is usually used
for Alzheimer’s disease, may be helpful in some cases.
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MS Complementary and Alternative Therapies
Many people with MS
use some form of complementary or alternative medicine. These therapies come
from many disciplines, cultures, and traditions and encompass techniques as
different as acupuncture, aromatherapy, ayurvedic medicine, touch and energy
therapies, physical movement disciplines such as yoga and tai chi, herbal
supplements, and biofeedback.
Because of the risk
of interactions between alternative and more conventional therapies, people
with MS should discuss all the therapies they are using with their doctor,
especially herbal supplements. Although herbal supplements are considered
"natural," they have biologically-active ingredients that could have
harmful effects on their own or interact harmfully with other medications.
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A physician may diagnose MS in some patients
soon after the onset of the illness. In others, however, doctors may not be
able to readily identify the cause of the symptoms, leading to years of
uncertainty and multiple diagnoses punctuated by baffling symptoms that
mysteriously wax and wane. The vast majority of patients are mildly
affected, but in the worst cases, MS can render a person unable to write,
speak, or walk. MS is a disease with a natural tendency to remit
spontaneously, for which there is no universally effective treatment.
What research is being done for MS?
The National Institute of Neurological Disorders
and Stroke (NINDS) and other institutes of the National Institutes of Health
(NIH) conduct research in laboratories at the NIH and also support additional
research through grants to major medical institutions across the country.
Scientists continue their extensive efforts to create new and better therapies
for MS. One of the most promising MS research areas involves naturally
occurring antiviral proteins known as interferons. 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, there are a number of treatments under investigation
that may curtail attacks or improve function. Over a dozen clinical
trials testing potential therapies are underway, and additional new treatments
are being devised and tested in animal models.
In 2001, the National Academies/Institute of
Medicine, a Federal technical and scientific advisory agency, prepared a
strategic review of MS research. To read or download the National
Academies/Institute of Medicine report, go to: "Multiple Sclerosis: Current Status and Strategies for the
Future."
NIH Patient Recruitment for Multiple Sclerosis
Clinical Trials
The above information was from the NIH: National
Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htmhttp://www.ninds.nih.gov/disorders/multiple_sclerosis/detail_multiple_sclerosis.htm#280133215
Read more about MS at these websites:
http://www.nationalmssociety.org/index.aspx
http://www.mayoclinic.com/health/multiple-sclerosis/DS00188
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