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Multiple Sclerosis

What is Multiple Sclerosis?

Multiple sclerosis (MS) is a potentially disabling autoimmune disease in which one’s own immune system repeatedly attacks and damages the myelin cover of neural cells within one’s brain and spinal cord. The brain and the spinal cord, jointly referred to as the central nervous system, are responsible for integration and control of virtually all processes occurring in the body. These processes include movements, sensation, balance control, coordination, respiration, etc.

Multiple Sclerosis Symptoms and signs.

Over 90% of people with multiple sclerosis have the relapsing-remitting variety of the disease, while the remaining percentage have other forms such as the primary progressive variety. Those with the relapsing-remitting variety typically present with acute symptoms called relapses. Common symptoms of MS relapse include:

  • Sudden painful partial or total loss of vision occurring over few days, known as optic neuritis
  • Numbness or weakness in the limbs
  • Tingling in the face
  • Electric-shock-like sensation going down the neck and lower back after certain neck movements, known as Lhermitte’s sign.

Most people recover from MS relapses though some have residual deficits which accumulate over a long time to produce disabilities such as:

  • Tremors and unstable gait
  • Gradual fatigue
  • Gradual loss of independent ambulation
  • Stiffness in the legs and/or arms
  • Loss of sphincter control.

 

Multiple Sclerosis risk factors

The exact cause of multiple sclerosis remains unknown. However, experts believe that MS develops from the combined influence of genetic susceptibility and environmental factors. Some clearly identified risk factors include:

  • Age under 40
  • Female gender
  • Family history in first-degree relations.
  • Race – Caucasian people are at a higher risk
  • Low levels of vitamin D
  • Cold climate
  • Low levels of sun exposure
  • Obesity

 

Multiple Sclerosis Diagnosis

Diagnosis of multiple sclerosis often requires excluding other specific conditions that might produce similar symptoms. This usually requires skillful documentation of medical history and physical examination. The clinical assessment will often be followed by other tests that help to clarify the nature of underlying diagnosis. Some of these tests include:

  • Blood tests. To help rule out other diseases with symptoms similar to MS. This will usually include inflammatory markers, autoimmune antibodies, work-up for vasculitides, etc.
  • Lumbar puncture. During this procedure, a small amount of your spinal fluid will be taken through a needle placed in your spinal canal in your lower back. The fluid obtained will be examined for the presence of special proteins called oligoclonal bands which tends to be positive in up to 90% of patients with MS.
  • Magnetic resonance imaging (MRI). This is gradually becoming the most important test for diagnosing and monitoring MS. It has the capacity to reveal areas of damage to myelin in the brain and spinal cord.

Multiple Sclerosis Treatment

There is still no definitive cure for multiple sclerosis. However, there are several treatment options available both to treat MS relapses and curb the progression of the disease.

Treatment for multiple Sclerosis relapses/attacks

  • Corticosteroids. Intravenous corticosteroids are usually administered to reduce the flare in level of inflammation that occurs during relapses.
  • Plasmapheresis. During this procedure, your plasma (which is the liquid portion of your blood) is exchange in order to remove the mediators of inflammation. This procedure is considered in rare circumstances when relapses do not respond to corticosteroids.

Disease modifying treatments for Multiple Sclerosis

These medications are given regularly independent of relapses and help to significantly slow down the progression of multiple sclerosis. They include:

  • Beta interferons. They are one of the first injectable drugs developed to treat this condition and remain one of the safest and most commonly prescribed MS medications till now.
  • Glatiramer acetate. Needs to be injected beneath the skin.
  • Fingolimod. An oral treatment that should be taken once per day.
  • Ocrelizumab. This is a new and promising humanized immunoglobulin antibody that works for more severe and resistant multiple sclerosis cases. It also works for the progressive form of MS.
  • Natalizumab. This drug helps block the movement of potentially damaging immune cells from your bloodstream to your nervous system. Usually, it’s used as a second-line treatment option for aggressive forms of MS.
  • Alemtuzumab. This medication helps by reducing the immune response of white blood cells and thus limiting the damage caused by the disease.

 

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