Multiple Sclerosis

What is Multiple Sclerosis?
An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. Many investigators believe Multiple Sclerosis to be an autoimmune disease -- one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of Multiple Sclerosis, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus.

Most people experience their first symptoms of Multiple Sclerosis between the ages of 20 and 40; the initial symptom of Multiple Sclerosis is often blurred or double vision, red-green color distortion, or even blindness in one eye. Most Multiple Sclerosis 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 Multiple Sclerosis 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 Multiple Sclerosis 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 Multiple Sclerosis.

 


Is there any treatment?
There is as yet no cure for Multiple Sclerosis. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. In the past, the principal medications used to treat MS were steroids including adrenocorticotropic hormone (better known as ACTH), prednisone, prednisolone, methylprednisolone, betamethasone, and dexamethasone. While steroids do not affect the course of Multiple Sclerosis 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. If psychological symptoms of fatigue such as depression or apathy are evident, antidepressant medications may help.

What is the prognosis?
A physician may diagnose Multiple Sclerosis 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, Multiple Sclerosis can render a person unable to write, speak, or walk. Multiple Sclerosis is a disease with a natural tendency to remit spontaneously, for which there is no universally effective treatment.

What research is being done?
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 Multiple Sclerosis. One of the most promising Multiple Sclerosis 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 Multiple Sclerosis 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.
National Institute of Neurological Disorders and Stroke.



Multiple Sclerosis Symptom

Are Any Multiple Sclerosis Symptoms Treatable?
While some scientists look for therapies that will affect the overall course of the Multiple Sclerosis disease, others are searching for new and better medications to control the symptoms of Multiple Sclerosis without triggering intolerable side effects.

Many people with Multiple Sclerosis have problems with spasticity, a condition that primarily affects the lower limbs. Spasticity can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, especially at night. It is usually treated with muscle relaxants and tranquilizers. Baclofen (Lioresal), the most commonly prescribed medication for this Multiple Sclerosis symptom, may be taken orally or, in severe cases, injected into the spinal cord. Tizanidine (Zanaflex), used for years in Europe and now approved in the United States, appears to function similarly to baclofen. Diazepam (Valium), clonazepam (Klonopin), and dantrolene (Dantrium) can also reduce spasticity. Although its beneficial effect is temporary, physical therapy may also be useful and can help prevent the irreversible shortening of muscles known as contractures. Surgery to reduce spasticity is rarely appropriate in Multiple Sclerosis.

Weakness and ataxia (incoordination) are also characteristic of Multiple Sclerosis. When weakness is a problem, some spasticity can actually be beneficial by lending support to weak limbs. In such cases, medication levels that alleviate spasticity completely may be inappropriate. Physical therapy and exercise can also 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. Occasionally, physicians can provide temporary relief from weakness, spasms, and pain by injecting a drug called phenol into the spinal cord, muscles, or nerves in the arms or legs. Further research is needed to find or develop effective treatments for Multiple Sclerosis-related weakness and ataxia.

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. A trial of oral prednisone in patients with visual problems suggests that this steroid is not only ineffective in speeding recovery but may also increase patients' risk for future Multiple Sclerosis attacks. Curiously, prednisone injected directly into the veins-at ten times the oral dose-did seem to produce short-term recovery. Because of the link between optic neuritis and Multiple Sclerosis, the study's investigators believe these findings may hold true for the treatment of Multiple Sclerosis as well. A follow-up study of optic neuritis patients will address this and other questions.
Fatigue, especially in the legs, is a common symptom of Multiple Sclerosis and may be both physical and psychological. Avoiding excessive activity and heat are probably the most important measures patients can take to counter physiological fatigue. If psychological aspects 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.

People with Multiple Sclerosis may experience several types of pain. Muscle and back pain can be helped by aspirin or acetaminophen and physical therapy to correct faulty posture and strengthen and stretch muscles. The sharp, stabbing facial pain known as trigeminal neuralgia is commonly treated with carbamazapine or other anticonvulsant drugs or, occasionally, surgery. Intense tingling and burning sensations are harder to treat. Some people get relief with antidepressant drugs; others may respond to electrical stimulation of the nerves in the affected area. In some cases, the physician may recommend codeine.

As the disease progresses, some patients develop bladder malfunctions. Urinary problems are often the result of infections that can be treated with antibiotics. The physician may recommend that patients take vitamin C supplements or drink cranberry juice, as these measures acidify urine and may reduce the risk of further infections. Several medications are also available. The most common bladder problems encountered by Multiple Sclerosis patients are urinary frequency, urgency, or incontinence. A small number of patients, however, retain large amounts of urine. In these patients, catheterization may be necessary. In this procedure, a catheter or drainage tube is temporarily inserted (by the patient or a caretaker) into the urethra several times a day to drain urine from the bladder.

Surgery may be indicated in severe, intractable cases. Scientists have developed a "bladder pacemaker" that has helped people with urinary incontinence in preliminary trials. The pacemaker, which is surgically implanted, is controlled by a hand-held unit that allows the patient to electrically stimulate the nerves that control bladder function.
Multiple Sclerosis patients with urinary problems may be reluctant to drink enough fluids, leading to constipation. Drinking more water and adding fiber to the diet usually alleviates this condition. Sexual dysfunction may also occur, especially in patients with urinary problems. Men may experience occasional failure to attain an erection. Penile implants, injection of the drug papaverine, and electrostimulation are techniques used to resolve the problem. Women may experience insufficient lubrication or have difficulty reaching orgasm; in these cases, vaginal gels and vibrating devices may be helpful. Counseling is also beneficial, especially in the absence of urinary problems, since psychological factors can also cause these symptoms. For instance, depression can intensify symptoms of fatigue, pain, and sexual dysfunction. In addition to counseling, the physician may prescribe antidepressant or antianxiety medications. Amitriptyline is used to treat laughing/weeping syndrome.

National Institute of Neurological Disorders and Stroke

Multiple Sclerosis Treatment

Is there any Multiple Sclerosis Treatment?
There is as yet no cure for Multiple Sclerosis. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. Naturally occurring or spontaneous remissions make it difficult to determine therapeutic effects of experimental Multiple sclerosis treatment; however, the emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new Multiple sclerosis treatments.

In the past, the principal medications physicians used for Multiple Sclerosis treatment 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 Multiple Sclerosis. Also, there is some indication that steroids may be more appropriate for people with movement, rather than sensory, Multiple sclerosis symptoms.

While steroids do not affect the course of Multiple Sclerosis over time, they can reduce the duration and severity of Multiple sclerosis 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.

One of the most promising Multiple Sclerosis treatment research areas involves naturally occurring antiviral proteins known as interferons. Three forms of beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting Multiple Sclerosis. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When Multiple sclerosis attacks do occur, they tend to be shorter and less severe. In addition, MRI scans suggest that beta interferon can decrease myelin destruction.

Investigators speculate that the effects of beta interferon may be due to the drug's ability to correct an Multiple Sclerosis 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 Multiple Sclerosis attacks. Alpha interferon is also being studied as a possible treatment for Multiple Sclerosis. Common side effects of interferons include fever, chills, sweating, muscle aches, fatigue, depression, and injection site reactions.

Scientists continue their extensive efforts to create new and better treatment for Multiple Sclerosis. Goals of Multiple Sclerosis treatment are threefold: to improve recovery from Multiple Sclerosis attacks, to prevent or lessen the number of relapses, and to halt Multiple Sclerosis progression.

National Institute of Neurological Disorders and Stroke