Multiple sclerosis

What is it?

Multiple sclerosis is a chronic, often disabling disease of the central nervous system (brain and spinal cord) involving decreased nerve function associated with the formation of scars on the covering of nerve cells. Symptoms may be mild such as numbness in the limbs, severe paralysis or loss of vision.

What are the causes?

In multiple sclerosis (MS) there are repeated episodes of inflammation of nervous tissue in any area of the central nervous system (brain and spinal cord). This inflammation destroys the covering of the nerve cells in that area (myelin sheath), leaving multiple areas of scar tissue (sclerosis). This results in slowing or blocking the transmission of nerve impulses in that area, leading to the symptoms of MS.Symptoms vary because the location and extent of each attack varies. There is usually a stepwise progression of the disorder, with episodes that last days, or months. Recurrence of symptoms is common.The exact cause of the inflammation associated with MS is unknown. It may be due to a virus-type organism, an abnormality of the genes responsible for control of the immune system, or a combination of both factors. The disorder most commonly begins between 20 to 40 years of age but can happen at any age. Risks include a family history of MS and living in a geographical area with a higher incidence for MS.

What are the symptoms?

Symptoms of multiple sclerosis (MS) may be mild or severe and of long duration or short and appear in various combinations. The initial symptom of MS is often blurred or double vision, or even blindness. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. They also exhibit abnormal sensory feeling such as numbness or "pins and needles." People with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and judgment. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared. Heat may cause temporary worsening of many MS symptoms. Fever can trigger or worsen attacks, as can hot baths, sun exposure, and stress. Other symptoms include:walking/gait abnormalitiesmuscle spasms (especially in the legs)dizzinessvertigoslurred speechurinary hesitancy, difficult to begin urinatingfrequent need to urinatedepression

How is the diagnosis made?

The doctor will conduct a neurological examination and take a medical history. Imaging technologies such as MRI, which provides an anatomical picture of lesions, and MRS (magnetic resonance spectroscopy), which yields information about the biochemistry of the brain. They also may study the patients' cerebrospinal fluid and an antibody called immunoglobulin G. No single test unequivocally detects MS. A number of other diseases produce symptoms similar to those seen in MS.

What is the treatment?

There is, as yet, no cure for MS. Until recently, steroids were the principal medications for MS. While steroids do not affect the course of MS, they can reduce the duration and severity of attacks in some patients. Treatment is aimed at controlling the symptoms and maintaining function to give the maximum quality of life. Other medicines include Baclofen, Tizanidine can be used to reduce muscle spasticity. Cholinergic medications may be helpful in reducing urinary problems. Antidepressant medications may be helpful for mood or behaviour symptoms. Amantadine may be given for fatigue.Physical therapy, speech therapy, occupational therapy, or similar forms of therapy may be helpful. This may improve the person’s outlook, reduce depression, maximize function, and improve coping skills. A planned exercise programme early in the course of the disorder helps to maintain muscle tone. Social work, counselling, and support groups may aid in coping with the disease. A healthy lifestyle is encouraged, including good general nutrition. Adequate rest and relaxation help to maintain energy levels. Attempts should be made to avoid fatigue, stress, physical deterioration, temperature extremes, and illness to reduce factors that may trigger an MS attack.         

What is the prognosis?

The cause of MS remains elusive, but most people with MS have a normal life expectancy. The vast majority of MS patients are mildly affected, but in the worst cases, MS can render a person unable to write, speak, or walk.

DoctorNDTV Team

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