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The National Multiple Sclerosis Society is proud to be a source
of current and accurate information about multiple sclerosis.
Use the Chapter to learn more about the disease, treatment, and symptom management. Call us at (202) 296-9891 for local referrals and support.
Fast facts about MS...
For more detailed information, please visit the National Multiple Sclerosis Society's Web Page.
Also on the National MS Society's website, The Professional Resource Center offers the most comprehensive library of MS information in the world. The Center provides a variety of information and consultation services, and is meant to create a partnership between the National MS Society and healthcare professionals to enhance quality of care and increase access to care for people with MS.
What is Multiple Sclerosis?
Multiple sclerosis is thought to be an autoimmune disease. The body's own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers of the brain, optic nerves, and spinal cord (the central nervous system). The damaged myelin may form scar tissue (sclerosis). Often the nerve fiber is also damaged. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses to and from the brain are distorted or interrupted, producing the various symptoms of MS.
MS is not a fatal disease. Individuals with MS have near-normal life expectancies. MS is not contagious and is not directly inherited. Most people with MS learn to cope with the disease, and live full, productive lives. There is currently no cure for the disease.
People with MS can expect one of four clinical courses of disease, each of which might be mild, moderate, or severe.
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Relapsing-Remitting
Characteristics: People with this most common type of MS experience clearly defined flare-ups (also called relapses, attacks, or exacerbations). These are episodes of acute worsening of neurologic function. They are followed by partial or complete recovery periods (remissions) free of disease progression.
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Primary-Progressive
Characteristics: People with this relatively rare type of MS experience a slow but nearly continuous worsening of their disease from the onset, with no distinct relapses or remissions. However, there are variations in rates of progression over time, occasional plateaus, and temporary minor improvements.
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Secondary-Progressive
Characteristics: People with this type of MS experience an initial period of relapsing-remitting disease, followed by a steadily worsening disease course with or without occasional flare-ups, minor recoveries (remissions), or plateaus. 50% of people with relapsing-remitting MS developed this form of the disease within 10 years of their initial diagnosis, before introduction of the .disease-modifying. drugs. Long-term data are not yet available to demonstrate if this is significantly delayed by treatment.
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Progressive-Relapsing
Characteristics: People with this relatively rare type of MS experience a steadily worsening disease from the onset but also have clear acute flare-ups (attacks or relapses), with or without recovery. In contrast to relapsing-remitting MS, the periods between relapses are characterized by continuing disease progression.
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What causes
MS?
While the exact cause of MS is unknown, most researchers
believe that the damage to myelin results from an abnormal
response by the body's immune system.
Normally, the immune system defends the body against foreign
invaders such as viruses or bacteria. In autoimmune diseases,
the body attacks its own tissue. It is believed that MS is
an autoimmune disease.
In the case of MS, the substance that is attacked is the
myelin, and sometimes the nerve fibers themselves.
Scientists do not yet know what triggers the immune system
to attack nervous system tissues. Most agree that several
factors are involved.
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What are the symptoms
of MS?
No two cases of multiple sclerosis are the same.
Symptoms not only vary greatly from person to person, but
may also vary from time to time in the same person.
The symptoms of MS often begin as mild tingling or numbness
in body parts. They may include slurred speech, blurred or
double vision, tremors, loss of balance, and poor coordination.
Many people with MS experience muscle tightness or "spasticity."
Problems with bladder, bowel, or sexual function may occur.
Severe cases of MS can result in loss of vision and partial
or complete paralysis.
MS may also have more subtle, "invisible" symptoms. These
may include pain, extreme fatigue, and mental changes such
as mood swings, forgetfulness, and confusion. Unpredictability
is the hallmark of MS.
Symptoms may appear in any combination, may come and go,
and may vary from mild to severe.
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What will happen
next?
No one really knows, but you and your doctor can and should
talk over your particular situation. The words you will hear
most often are "unpredictable" and "variable".
MS not only varies widely from person to person, but also
it varies in the same person from time to time. Living with
this unpredictability is part of living with MS.
Many people go through periods of exacerbation. These are
acute attacks, also called relapses, during which new symptoms
appear or existing symptoms become more severe.
Exacerbations are usually followed by remissions which may
bring you back to your pre-relapse level or may leave you
with some remaining disability. This form of MS is usually
called relapsing-remitting MS.
Some people have few or no severe attacks but instead experience
steady worsening of symptoms and disability over time. This
steady pattern can follow an earlier period of relapsing-remitting
MS, in which case it is called secondary-progressive
MS, or this pattern may exist from the outset in which
case it is called primary-progressive MS.
MS may stabilize at any time, regardless of pattern.
Your first several years of experience with MS are likely
to be the best guide you and your physician have to your long-term
outlook. If your physician has a history of caring for other
people with MS, he or she may have additional insights about
your situation.
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Who gets MS?
Multiple sclerosis is often diagnosed in people who
are in their twenties and thirties - young adults just starting
careers, starting families, starting their lives.
Women develop the disease at a rate almost double that of
men. MS occurs most commonly among Caucasians, especially
those of Northern European ancestry, but people of African,
Asian, and Hispanic backgrounds are not immune.
It is most frequently found among people in colder climates.
Scientists don't understand why this is so, but studies strongly
suggest that where a person is born and lives during his or
her first 15 years strongly influences the likelihood of developing
MS.
Studies also indicate that genetic factors make certain individuals
more susceptible to the disease, but there is no evidence
that MS is directly inherited.
Multiple sclerosis is not contagious.
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Is MS easily
diagnosed?
Because no single test can diagnose MS, several tests and
procedures are needed.
These are likely to include:
- A medical history, in which
the physician will look for evidence of past signs and symptoms.
- A thorough neurological exam.
- MRI (magnetic resonance imaging),
a noninvasive form of imaging that produces detailed pictures
of the brain.
- Studies called "evoked potentials"
that measure the response of the central nervous system
to specific stimulation.
Other tests, less commonly used, that may be helpful where diagnosis
is unusually difficult, are:
- Lumbar puncture or spinal tap,
which looks at the composition of the fluid that surrounds
the spinal cord (cerebrospinal fluid or CSF).
- CT scan (computerized axial
tomography), which uses X rays to produce images of the
central nervous system.
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Are there any treatments
for MS?
There is still no known cure for MS, but there are FDA-approved drugs
that can lessen the frequency and severity of attacks and
slow the increase of disability in relapsing-remitting MS.
Four of these disease modifying drug therapies may be especially helpful very early in the
course of the disease as they reduce the number of attacks
(relapses or exacerbations) a person would be expected to
have.
The National MS Society recommends that most people who have been diagnosed
with relapsing-remitting MS begin treatment with one of the
drugs as early as possible.
Three of these medications (Betaseron,
Avonex, and Rebif) are forms of interferon
beta, which is a substance made by the immune system. The
fourth, glatiramer acetate (Copaxone),
is a synthetic which mimics a component of human myelin, perhaps
serving as a decoy for the MS attack on nerve tissue.
Mitroxantrone (Novantrone) was approved by the FDA in October, 2000 for reducing the frequency of relapses in people with secondary-progressive or worsening relapsing-remitting MS.
Tysabri (Natalizumab), was approved by the FDA in 2006, for the treatment of relapsing forms of MS as a monotherapy (meaning, not used in combination with any other immunomodulating therapy). It is generally recommended for patients who have had an inadequate response to, or cannot tolerate, any of the other disease-modifying therapies that are available for treating MS.
Other medications are in various stages of clinical trials
or under review by the FDA.
Physical therapy, occupational therapy, and vocational or
cognitive rehabilitation may help a person remain independent.
Attention to diet, appropriate exercise, and adequate rest
are important for a person with MS, as they are for anyone.
Professional or peer counseling may also prove valuable in
helping people with the disease and their love ones cope with
emotional stress.
The appropriate combination of these treatment elements will
allow a person with MS to attain the highest quality of life
possible.
Prompt management of symptoms is important. They should be
discussed with a knowledgeable physician.
Because treatment for MS is changing so rapidly, itıs a good
idea to be in contact with your doctor for up-to-date advice.
The National MS Society
is also a source of information on new developments. Check
out their web site or call 1-800-FIGHT MS.
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Can MS be cured?
The answer is no - not yet. The new medications do not cure
MS.
The cause and the cure are the subject of intensive worldwide
research. The National Multiple Sclerosis Society is the world's
largest private funder of MS research.
Some 380 research grants and fellowships funded by the Society
go forward each year. The Society will have invested a cumulative $550 million in research by the end of fiscal year 2007.
Knowledge about autoimmune disorders and about diseases of
the central nervous system is growing quickly. Many clinical
trials are in progress, and there is an air of optimism among
MS researchers everywhere.
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Are there any
therapies to relieve symptoms?
Yes. For attacks (also called relapses, exacerbations, or
flares) treatment with corticosteriods, such as prednisone
or methylprednisolone (Solu-medrol), is available. Corticosteriods
are hormones produced in the human body by the adrenal glands.
ACTH (adrenocorticotropic hormone), the substance produced
in the body to stimulate production of corticosteroids, is
another termagant. These drugs may shorten the duration and
intensity of MS attacks.
Therapies are available for day-to-day symptoms, too. For
example, stiffness in the muscles (spasticity)
may be reduced by prescription drugs such as baclofen (Lioresal),
tizanidine (Zanaflex), dantrolene (Dantrium), or diazepam
(Valium). Fatigue may be reduced with amantadine (symmetral),
pemoline (Cylert), or fluoxetine (prozne). Spasticity and fatigue may also be treated
with physical and occupational therapies.
Bladder problems sometimes improve with oxybutynin (Ditropan)
or propantheline (Pro-Banthine). Techniques such as self-catherterization
can be learned. Prompt treatment of urinary tract infections
and adequate intake of fluids may help prevent other bladder
complications. Bowel problems may be managed with diet to
increase bulk, suppositories, or medications.
Burning, painful, or unusual sensations (called paresthesias)
may be managed with medications such as carbamazepine (Tegretol)
or amitriptyline (Elavil). Cognitive problems may be managed
with rehabilitation and training.
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