Neuroscience Services - Multiple Sclerosis
Multiple Sclerosis (MS) is the most common disabling neurologic disorder affecting young adults. It usually starts between the ages of 15 and 50; 30 is the average age of onset. At least 350,000 Americans have the disease, with women affected twice as often as men. It is also more prevalent among Caucasians and those who reside in colder climates.
The cause is not known, but probably involves a number of factors. MS, while not inherited, is more likely when a patient has a close relative with the disease. Certain environmental factors early in life seem to affect the risk of contracting MS. There is also strong evidence that MS is immune-mediated and that the patient's own immune system attacks the central nervous system.
Symptoms
All types of MS involve episodic inflammation within the central nervous system, accompanied by demyelination (loss of myelin sheaths from adjacent nerve fibers). Multiple, scattered lesions (called plaques) accumulate throughout the brain and spinal cord of MS patients to cause a variety of neurologic abnormalities. During an attack, abnormalities may persist for days to weeks and include:
* Decreased visual acuity, including blind spots, blurred vision or loss of vision in one central spot, lack of depth perception or decreased night vision.
These problems can become worse with tension, eye strain or fatigue.
* Tremors, shakiness and fine motor skill problems.
* Numbness or tingling, 'pins and needles' sensation, heightened sensitivity to touch.
* Weakness, dizziness and coordination problems.
* Unsteady gait, sometimes accompanied by a sense of spinning or swaying. May result in staggering or falling.
* Double vision, or seeing "jumping objects."
* Fatigue (which grows worse in the early afternoon).
* Heat intolerance.
* Electric shock sensations when bending the neck.
* Spasticity, rigidity, stiffness.
* Bowel and bladder dysfunction.
Some patients will experience the gradual onset of problems that steadily worsen; others may have an abrupt onset of symptoms that later spontaneously improve.
Testing
There are several tests which support the diagnosis of MS, but physicians primarily uncover it by conducting a clinical history and a physical exam. And while there is no single reliable diagnostic test for MS, certain laboratory tests may help, including MRI and evoked potential studies that provide information on conduction pathways, measuring how quickly electrical impulses move from the brain to the spinal cord.
* MRI (Magnetic Resonance Imaging): This procedure uses a tunnel-shaped piece of equipment that contains a magnetic field and radio energy; no x-rays are involved. Magnetic signals are fed into a computer which assembles a picture. Because the MRI ignores bone which can obstruct CT images, this device provides a clearer picture of tumors located near the bone, and can provide a wider variety of image angles. It can detect edema (swelling), but has difficulty distinguishing edema from a tumor. MRI imaging takes longer than a CT scan, and is very noisy. Patients with cardiac monitors, pacemakers or surgical clips cannot take an MRI because of conflict with the magnetic fields. MRI also reveals the areas of inflammation and demyelination in the central nervous system.
* Evoked Potential Testing: This form of testing involves presenting the patient with various sensory stimuli * a blinking TV pattern (visual), a clicking noise (auditory), or a mild electrical shock to an extremity (somatosensory). Using electrodes on the scalp, the test measures the time it takes between administering the stimulus to an evoked change in brain wave patterns. This provides evidence of the speed of electrical conduction within the central nervous system. Your nurse will tell you more about what these tests involve and how to prepare for them.
Treatment
Patients with MS can be treated with either inpatient or outpatient therapies, depending on the level of care required. Common treatments for MS include:
* Symptomatic therapy for associated problems of bladder and bowel, spasticity, tremor, pain and sexual dysfunction.
* Corticosteroids to hasten recovery from relapses.
* Various medications (including interferon) to reduce the number and severity of relapses and possibly slow the progress of the disease.
Research
Many promising new immunotherapies and drug therapies to control or prevent MS are currently being developed. In fact, a treatment that may slow the course of the disease has already been found. In addition, there are a number of treatments under investigation in the U.S. that may curtail attacks or improve function in demyelineated nerve fibers. According to the National Institute of Neurological Disorders and Stroke, over a dozen clinical trials testing potential therapies are currently underway.
Prevention
Because we do not know what causes this disease, there is no solid information on how to prevent it. This is the focus of current research, however, and scientists are making significant progress.
Support Groups/Resources
Many patients and families find great comfort and support in talking with other patients, families and caregivers who have had (or are having) similar experiences. Support group meetings are free of charge, and are facilitated by a trained peer.
The MS support groups are held at:
Sentara Leigh Hospital (Norfolk), Classroom One, first Tuesday of each month, 7:00 p.m.
MS support groups are also available in: Gloucester, Williamsburg, Portsmouth/ Norfolk, Suffolk, Chesapeake, Elizabeth City and on the Peninsula.
Please call the local MS Chapter at (757) 490-9627 to determine which support group will best suit your needs, and to get information on the times, dates and locations of these meetings.
For additional information on support groups, call:
The Hampton Roads MS chapter:
(757) 490-9627
National Multiple Sclerosis Society:
1-800-227-3166
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