Multiple Sclerosis Awareness Month

Did you know March is National MS Education and Awareness Month? Multiple sclerosis affects more than 2.5 million people worldwide and is an unpredictable disease.  I recently sat down with CHAS Health Chief Clinical Officer, Bill Lockwood to learn more about MS and how it affects the body.

What is MS?

A disease which affects mostly young adults – beginning at ages 20-40 and involves the brain and spinal cord. The underlying cause is a patient’s own immune system destroying the “myelin sheath” or insulation which surrounds nerves in the brain and spinal cord. This affects nerves ability to conduct electric signals as usual.

Who can get it?

It is usually diagnosed in people 18-40 years old and affects women approximately 3 times as much as men. There seems to be some genetic predisposition as it more often affects people of Northern European descent and is more common in family members of MS patients.  There seems to be environmental factors as well since it affects people who live in temperate climates more often than those in very cold or very warm climates.

There is no government mandated reporting requirements so estimates of total incidence may be inaccurate but in 2002 it was estimated that 400,000 people in the US had MS.

Symptoms

The damage to the myelin sheath can affect any nerve in the brain or spinal cord so the symptoms are highly variable and tend to come and go (one of the requirements for diagnosing the disease are symptoms separated by space and time. In other words, two or more discreet episodes affecting different parts of the nervous system at different times, for example, double vision which resolves, followed by arm numbness, which ultimately resolves.

Some of the symptoms include fatigue – the most common symptoms, tingling, visual changes (including double vision) balance problems, nerve pain, swallowing difficulties, trouble walking (due to imbalance or ) leg weakness), constipation, bladder problems (incontinence, or inability to empty), and cognitive (thinking) difficulties.

The symptoms tend to come and go early in the course of the disease but as time goes on, most patients will develop progressive disease, the course is different in every individual who has it.

Diagnosis

The disease is diagnosed by history and physical exam followed by an MRI and blood tests. Sometimes a lumbar puncture (spinal tap) is required. Diagnosis is usually made by a physician who specializes in diseases of the nervous system (“neurologist”). Diagnosing the disease in its early stages allows early administration of “disease modifying drugs) which can slow the course of the disease.

Treatment

Overall care of MS is provided by a care team of physicians, nurses, mental health workers, and physical and occupational therapists. Besides social and physical supports,  there are a number of medications used to treat MS.

There are two main types of medications – disease modifying drugs, and drugs to treat symptoms.

The disease modifying drugs affect the immune system and slow the progression and reduce the number and severity of exacerbations (temporary worsenings) of the disease. There are currently 15 FDA approved disease modifying drugs and at least that many in clinical trials. A total of $870 million has been spent so far in MS research.

There are a number of drugs used to  treat the symptoms of MS (as described above) such as muscle relaxers, bladder relaxers, nerve pain medications, and steroids (used to treat sudden temporary worseinings of the disease).

by Matt Grebe and William Lockwood

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