Multiple Sclerosis (MS)
Multiple sclerosis (MS) affects an estimated 300,000 to 400,000 individuals in the United States and over two million worldwide. Although it is considered a relatively rare disease, MS is of particular interest recently due to new and emerging therapies to manage the disease.
There is increasing urgency around this illness because it strikes people, predominantly women, in the prime of their lives and causes significant morbidity over many years. The chronic nature of most types of MS requires a multi-disciplinary approach that includes healthcare providers, social workers, and community support to deal with the myriad issues that stem from the presence a potentially debilitating illness in a young population.
To understand MS, one can liken the structure of the nerves of the body to telephone wire. Nerves, like wires, consist of two parts: the transmission material and insulation. In a wire, the transmission material is metal and the insulation is plastic. In the nerve, the transmission material is nerve cells and the insulation is a substance called myelin. MS is characterized by damage to the myelin sheath, the covering of the nerves of the central nervous system. Damage to myelin, referred to as “plaques,” can be seen on brain scans. Plaques can be found in the brain, optic nerves, and the spinal cord, all of which can interfere with the transmission of information through nerves and, therefore, a person’s overall function. Damage to the nerve-myelin unit results in irreversible disability.
Causes of and Risk Factors for MS
Although the cause of MS is not clear, researchers believe that there may be a genetic predisposition to develop the disease. This predisposition, combined with a bevy of environmental factors, may lead to disease.
It is speculated that a viral or bacterial infection might be the initial trigger for the development of MS but there is no definitive answer to the question. There is substantial evidence to suggest that damage to the nerves is the result of cells of the immune system inappropriately targeting nerves and myelin.
Symptoms of MS
The symptoms of MS can be classified as primary (directly due to the disease itself), secondary (due to inadequate management of primary symptoms), and tertiary (those that result from complications of the disease). For example, if a person has bladder problems (a primary symptom) that are uncontrolled, he or she can have infections (a secondary symptom) and become socially isolated (a tertiary symptom). He or she may also stop driving or working due to this uncontrolled problem (other potential tertiary symptoms).
In many cases, the initial complaint that leads to MS diagnosis involves changes in vision. From there, the symptoms of MS can be subtle and mild (numbness, tingling) or severe (inability to walk or move) and can vary from time to time and from person to person. Therefore, treatment must be individualized to each person and dynamic, to address ever-changing problems related to the disease. Frequently people with MS require a team approach to manage their disease along with medications, rehabilitation, counseling, and educational services.
MS may take a relapsing course with periods of attacks followed by remissions, or follow a worsening pattern without discrete periods of stabilization. Until the latter part of the 20th century, the diagnosis of MS usually took quite a bit of time. More recently, however, advances in science and technology have improved the sensitivity of diagnoses. Additionally, advances in MS management focus both on both disease modification as well as symptomatic management. While treatment regimens have become more complex and more challenging to the person with MS, there is now a clear message of hope for the future.