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Multiple Sclerosis

.. cians believe that the earlier MS is diagnosed and treatment begun, the better the outcome will be. Symptoms of MS may be mild or severe, of long duration or short, and may appear in various combinations, depending on the area of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70 percent of MS patients. “The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye.” (Brunnscheiler) Inexplicably, visual problems tend to clear up in the later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as retrobulbar or optic neuritis. Fifty-five percent of MS patients will have an attack of optic neuritis at some time or other and it will be the first symptom of MS in approximately 15 percent.

This has led to general recognition of optic neuritis as an early sign of MS, especially if tests also reveal abnormalities in the patient’s spinal fluid. (National Multiple Sclerosis Society) Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. “Spasticity, the involuntary increased tone of muscles leading to stiffness and spasms–is common, as is fatigue.” (Brunnscheiler) Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness.

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Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or “pins and needles” sensations; uncommonly, some may also experience pain. Loss of sensation sometimes occurs. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. (Brunnscheiler ; National Multiple Sclerosis Society) 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.

In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it is often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared. (Brunnscheiler) “Cognitive symptoms occur when lesions develop in brain areas responsible for information processing.” (Brunnscheiler) These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. Scientists do not yet know whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both.

Types of memory problems may differ depending on the individual’s disease course (relapsing-remitting, primary-progressive, etc.), but there does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction. (National Multiple Sclerosis Society) “Depression, which is unrelated to cognitive problems, is another common feature of MS. (Brunnscheiler) In addition, about 10 percent of patients suffer from more severe psychotic disorders such as manic-depression and paranoia. Five percent may experience episodes of inappropriate euphoria and despair–unrelated to the patient’s actual emotional state known as “laughing/weeping syndrome.” This syndrome is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and emotions, and is usually seen only in severe cases. (National Multiple Sclerosis Society) As the disease progresses, sexual dysfunction may become a problem.

Bowel and bladder control may also be lost. (Health Central) In about 60 percent of MS patients, heat, whether generated by temperatures outside the body or by exercise may cause temporary worsening of many MS symptoms. In these cases, eradicating the heat eliminates the problem. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For the same reason, “swimming is often a good exercise choice for people with MS.” (Wenzel) The erratic symptoms of MS can affect the entire family as patients may become unable to work at the same time they are facing high medical bills and additional expenses for housekeeping assistance and modifications to homes and vehicles.

The emotional drain on both patient and family is immeasurable. Counseling may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause. (Lambert) “There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks.” (Health Central) Naturally occurring or spontaneous remissions make it difficult to determine therapeutic effects of experimental treatments; however, the emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new therapies. Until recently, the principal medications physicians used to treat MS were steroids possessing anti-inflammatory properties; these include adrenocorticotropic hormone (better known as ACTH), prednisone, prednisolone, methylprednisolone, betamethasone, and dexamethasone. Studies suggest that intravenous methylprednisolone may be superior to the more traditional intravenous ACTH for patients experiencing acute relapses; no strong evidence exists to support the use of these drugs to treat progressive forms of MS.

Also, there is some indication that steroids may be more appropriate for people with movement, rather than sensory, symptoms. (Mayo Clinic) While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. The mechanism behind this effect is not known; one study suggests the medications work by restoring the effectiveness of the blood/brain barrier. “Because steroids can produce numerous adverse side effects (acne, weight gain, seizures, psychosis), they are not recommended for long-term use.” (Bernard) One of the most promising MS research areas involves naturally occurring antiviral proteins known as interferons. Two forms of beta interferon (Avonex and Betaseron) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting MS.

A third form (Rebif) is marketed in Europe. 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, MRI scans suggest that beta interferon can decrease myelin destruction. (Mayo Clinic) Investigators speculate that the effects of beta interferon may be due to the drug’s ability to correct an MS-related deficiency of certain white blood cells that suppress the immune system and/or its ability to inhibit gamma interferon, a substance believed to be involved in MS attacks. Alpha interferon is also being studied as a possible treatment for MS.

(Mayo Clinic) “Common side effects of interferons include fever, chills, sweating, muscle aches, fatigue, depression, and injection site reactions.” (Health Central) Scientists continue their extensive efforts to create new and better therapies for MS. Goals of therapy are threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease progression. In conclusion, MS is a disease that is well known but poorly understood by the medical and nursing community as well as the general public. It has no known cure and the genes that are accountable for it have yet been pin pointed. The United States is capable of finding a cure for this disease; over the years, medical researchers have found cures for many diseases that were thought incurable.

Not only time and money are needed to find a cure for this disease, but faith and heart are needed to realize the importance Glossary antibodies — proteins made by the immune system that bind to structures (antigens) they recognize as foreign to the body. antigen — a structure foreign to the body, such as a virus. The body usually responds to antigens by producing antibodies. ataxia — a condition in which the muscles fail to function in a coordinated manner. autoimmune disease — a disease in which the body’s defense system malfunctions and attacks a part of the body itself rather than foreign matter.

blood/brain barrier — a membrane that controls the passage of substances from the blood into the central nervous system. cerebrospinal fluid — the colorless liquid, consisting partially of substances filtered from blood and partially by secretions released by brain cells, that circulates around and through the cavities of the brain and spinal cord. Physicians use a variety of tests–electrophoresis, isoelectric focusing, capillary isotachophoresis, and radioimmunoassay–to study cerebrospinal fluid for abnormalities often associated with MS. cytokines — powerful chemical substances secreted by T cells. Cytokines are an important factor in the production of inflammation and show promise as treatments for MS. demyelination — damage caused to myelin by recurrent attacks of inflammation. Demyelination ultimately results in nervous system scars, called plaques, which interrupt communications between the nerves and the rest of the body. experimental allergic encephalomyelitis (EAE) — a chronic brain and spinal cord disease similar to MS which is induced by injecting myelin basic protein into laboratory animals.

fatigue — tiredness that may accompany activity or may persist even without exertion. gadolinium — a chemical compound given during MRI scans that helps distinguish new lesions from old. human leukocyte antigens (HLAs) — antigens, tolerated by the body, that correspond to genes that govern immune responses. Also known as major histocompatibility complex. immunoglobulin G (IgG) — an antibody-containing substance produced by human plasma cells in diseased central nervous system plaques.

Levels of IgG are increased in the cerebrospinal fluid of most MS patients. immunosuppression — suppression of immune system functions. Many medications under investigation for the treatment of MS are immunosuppressants. interferons — cytokines belonging to a family of antiviral proteins that occur naturally in the body. Gamma interferon is produced by immune system cells, enhances T-cell recognition of antigens, and causes worsening of MS symptoms. Alpha and beta interferon probably exert a suppressive effect on the immune system and may be beneficial in the treatment of MS. lesion — an abnormal change in the structure of an organ due to disease or injury. magnetic resonance imaging (MRI) — a non-invasive scanning technique that enables investigators to see and track MS lesions as they evolve.

myelin — a fatty covering insulating nerve cell fibers in the brain and spinal cord, myelin facilitates the smooth, high-speed transmission of electrochemical messages between these components of the central nervous system and the rest of the body. In MS, myelin is damaged through a process known as demyelination, which results in distorted or blocked signals. myelin basic protein (MBP) — a major component of myelin. When myelin breakdown occurs (as in MS), MBP can often be found in abnormally high levels in the patient’s cerebrospinal fluid. When injected into laboratory animals, MBP induces experimental allergic encephalomyelitis, a chronic brain and spinal cord disease similar to MS.

oligodendrocytes — cells that make and maintain myelin. optic neuritis — an inflammatory disorder of the optic nerve that usually occurs in only one eye and causes visual loss and sometimes blindness. It is generally temporary. paresthesias — abnormal sensations such as numbness, prickling, or “pins and needles.” plaques — patchy areas of inflammation and demyelination typical of MS, plaques disrupt or block nerve signals that would normally pass through the regions affected by the plaques. receptor — a protein on a cell’s surface that allows the cell to identify antigens. retrobulbar neuritis — an inflammatory disorder of the optic nerve that is usually temporary.

It causes rapid loss of vision and may cause pain upon moving the eye. spasticity — involuntary muscle contractions leading to spasms and stiffness or rigidity. In MS, this condition primarily affects the lower limbs. T cells — immune system cells that develop in the thymus gland. Findings suggest that T cells are implicated in myelin destruction.

transverse myelitis — an acute spinal cord disorder causing sudden low back pain and muscle weakness and abnormal sensory sensations in the lower extremities. Transverse myelitis often remits spontaneously; however, severe or long-lasting cases may lead to permanent disability. white matter — nerve fibers that are the site of MS lesions and underlie the gray matter of the brain and spinal cord. Bibliography Bernard, Bobby. “Multiple Sclerosis Continues to Puzzle Scientists.” The Vermillion March 1998. Brunnscheiler, H. “Problems Associated with MS” (July 28, 1999) “Inteli Health” http://www.intelihealth.com/ (28 July 1999). Boyden, Kathleen M.

“Compolmer-1 in the Treatment of Multiple Sclerosis.” Journal of Neuroscience.

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