What is MS

What is MS?

Multiple Sclerosis (MS) is an inflammatory disease of the Central Nervous System (CNS) - that's the brain and spinal cord. Predominantly, it is a disease of the white matter tissue. The white matter is made up of nerve fibers which are responsible for transmitting communication signals both internally within the CNS and between the CNS and the nerves supplying rest of the body. In people affected by MS, patches of damage called plaques or lesions appear in seemingly random areas of the CNS white matter. At the site of a lesion, a nerve insulating material, called myelin, is lost.. Clinically, MS is a hard condition to characterise because it is very unpredictable and variable. Depending on which areas of the CNS are affected and how badly they are damaged, the type and severity of symptoms can vary greatly. No two people get MS in exactly the same way and the expression of each individual's disease is as unique as their fingerprints. However, the different courses of the disease, both within an individual and within the whole population, principally differ in their timing, location and severity. Underneath similar processes (including demyelination and sometimes other forms of nerve degeneration) are going on. Although recent research indicates that the biochemical make-up of lesions may vary between different forms of the disease, this is not the reason why people with MS have such widely differing symptoms - it's because nerve damage to one site usually causes completely different symptoms than damage to another. In general, people with MS can experience partial or complete loss of any function that is controlled by, or passes through, the brain or spinal cord.

Symptoms of MS

Visual Symptoms and Descriptions

Optic Neuritis… Blurred vision, eye pain, loss of color vision, blindness

Diplopia… Double Vision

Nystagmus… Jerky Eye Movements

Movement and sound phosphenes… Flashing lights when moving eyes or in response to a sudden noise

Aferent Pupillary Defect… Abnormal pupil responses

Motor Symptoms and Description

Paralysis… Muscle weakness - partial or mild paralysis Plegia, Paraplegia, Hemiplegia, Tetraplegia, Quadraplegia Paralysis - Total or near total loss of muscle strength

Spasticity… Loss of muscle tone causing stiffness, pain and restricting free movement of affected limbs

Dysarthria… Slurred speech and related speech problems Muscle Atrophy Wasting of muscles due to lack of use Spasms, Cramps Involuntary contraction of muscles Hypotonia,

Clonus… Problems with posture

Myoclonus… Jerking and twitching muscles, Tics Restless Leg Syndrome Involuntary Leg Movements, especially bothersome at night Footdrop Foot drags along floor during walking Dysfunctional Reflexes

Sensory Symptoms and Description

Paraestesia… Partial numbness, tingling, buzzing and vibration sensations

Anaesthesia Complete numbness/loss of sensation

Neuralgia, Neuropathic and Neurogenic pain

Pain without apparent cause, burning, itching and electrical shock sensations L'Hermitte's, Electric shocks and buzzing sensations when moving head

Proprioceptive Dysfunction Loss of awareness of location of body parts

Trigeminal Neuralgia… Facial pain

Coordination Symptoms and Description

Ataxia… Loss of coordination

Intention Tremor… Shaking when performing fine movements Dysmetria… Constant under- or overshooting limb movements

Vestibular Ataxia… Abnormal balance function in the inner ear

Vertigo

Nausea/vomitting/sensitivity to travel sickness from vestibular ataxia

Speech Ataxia Problems coordinating speech, stuttering

Dystonia Slow limb position feedback

Dysdiadochokinesia Loss of ability to produce rapidly alternating movements, for example to move to a rhythm

Bowel, Bladder and Sexual Symptoms and Description

Bladder Spasticity …Urinary urgency and incontinence Flaccid Bladder, Detrusor-Sphincter

Dyssynergia… Urinary hesitancy and retention

Erectile Dysfunction Male and female impotence… Anorgasmy Inability to achieve orgasm Frigidity Inability to become sexually aroused

Constipation Fecal Urgency Bowel urgency Fecal Incontinence Bowel incontinence

Cognitive Symptoms and Description

Depression

Cognitive Dysfuntion… Short-term and long-term memory problems, forgetfulness, slow word recall

Dementia

Mood swings

emotional lability… euphoria

Bipolar syndrome

Anxiety

Aphasia

Dysphasia Impairments to speech comprehension and production

Other Symptoms and Description

Fatigue…Constant feelings of tiredness

Uhthoff's Symptom… Increase in severity of symptoms with heat Gastroesophageal Reflux…Acid reflux

Impaired sense of taste and smell

Epileptic seizures

Swallowing problems

Respiratory problems

Sleeping Disorders

Inappropriately cold body parts

Autonomic nervous system problems

Prognosis & Disease Course

Predicting the course of MS is difficult because of the unpredictability of the illness. Because of this fact, MS varies greatly in each person. Physicians do have "guidelines" that they utilize to infer prognosis. Individuals who have few exacerbations early in the disease process with long intervals between exacerbations, complete recovery and exacerbations that are sensory in nature tend to do better. Individuals who early in the disease process have symptoms of tremor, incoordination and difficulty in walking or have frequent attacks with incomplete recoveries tend to have a more progressive course of MS.

The following are the four courses of MS:

Relapsing Remitting MS (RRMS) is characterized by partial or total recovery after exacerbations.

Secondary-Progressive MS (SPMS) is characterized when exacerbations occur and partial recoveries tend to occur. Many individuals who are diagnosed with Relapsing Remitting MS will develop Secondary Progressive MS.

Primary Progressive MS (PPMS) is progressive from onset. Symptoms do not remit and while exacerbations are not normally acute disability becomes progressive.

Progressive Relapsing MS (PRMS) is quite rare and is characterized by obvious acute attacks.

DISEASE MODIFYING DRUGS

Avonex: Avonex is an interferon (type of protein) medication. It has been shown to manage Relapsing Remitting MS by slowing progression of disability as well as reducing the number of annual exacerbations. Avonex is injected intramuscularly once a week in the muscles of the thigh, upper arm or hip and recommended that the injection be taken at bedtime. Common side effects are flu-like symptoms (fatigue, muscle aches, fever, sweating, and chills). Taking acetaminophen or ibuprofen prior to injection and during the 24 hours following the injection helps to ease side effects. For further information, visit the Avonex website. The Avonex support line is (800) 456-2255.
Betaseron: Betaseron is an Interferon medication (type of protein). It has been shown to manage Relapsing Remitting MS by slowing progression of disability and reducing the number of annual exacerbations. Betaseron is injected subcutaneously (under the skin) every other day. Common side effects are flu-like symptoms (fatigue, muscle aches, fever, sweating, and chills). The use acetaminophen or ibuprofen prior to injecting will help relieve these side effects. Injection site reactions (redness, pain, swelling, and discoloration) are also common. It's recommended that injection sites be rotated. For further information, visit the Betaseron website. The Betaseron support line is (800) 788-1467.
Copaxone: Copaxone is a synthetic protein that simulates myelin basic protein. It has been shown to manage Relapsing Remitting MS by reducing the number of annual exacerbations. Copaxone is injected subcutaneously (under the skin) once a day. Common side effects are injection-site reactions (redness, swelling, tenderness, itching at the injection site, and lump development), flushing or chest tightness, heart palpitations, fatigue, weakness, and tremor. It is recommended that injection sites be rotated. For further information, visit the Copaxone website. The Copaxone support line is (800) 887-8100.
Novantrone: Novantrone is part of a variety of medications called antineoplastics. Novantrone suppresses the activity of T cells, B cells, and macrophages. It has been shown to help manage secondary-progressive and progressive-relapsing MS by reducing the number of exacerbations. Novantrone is administered intravenously once every three months for a 24 month period. Novantrone is limited to eight to twelve doses over a two to three year period. Common side effects are nausea, temporary hair loss, and menstrual disorders in women. For further information, visit the Immunex website.
Rebif: Rebif is an interferon medication. It has been shown to manage Relapsing Remitting MS by slowing progression of disability and reducing the number of annual exacerbations. Rebif is injected subcutaneously (under the skin) three times per week. Rebif currently has two dosages that can be given - either 22 mcg or 44 mcg. Common side effects include flu-like symptoms (fatigue, muscle aches, fever, sweating, and chills). Taking acetaminophen or ibuprofen prior to injection helps to ease side effects. For further information, visit the Rebif website.

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