Multiple Sclerosis

Multiple Sclerosis (MS) is disease of the central nervous system that involves inflammation of the myelin sheath in the brain.

What Causes MS?

MS is an inflammatory demyelination disease affecting central nervous system white matter. Inflammatory cells, mainly activated lymphocytes and monocytes, cross the blood-brain barrier in the white matters surrounding blood vessels, destroying myelin with relative pairing of axons.

Electron microscopic studies have shown that the active role of invading macrophages in myelin destruction. These changes are accompanied by swelling of the astrocyte foot processes and interstitial edema.

MS Symptoms

Most common symptoms include:

  • Extreme fatigue
  • Visual disturbances
  • Altered sensation and difficulties with mobility
  • Blurred vision
  • Loss of balance
  • Poor coordination
  • Slurred speech.
  • Tremors
  • Muscle stiffness
  • Numbness
  • Problems with memory and concentration
  • Paralysis
  • Blindness.

These symptoms are unpredictable and may come and go or worsen over time. They may vary in terms of severity depending on the person.

Although paralysis is a common symptom of MS, the disease does not always lead to paralysis.

Motor symptoms are characteristic of MS, and weakness typically affects the legs and sometimes the arms.

Stages of MS

There are four characteristic clinical courses of MS that describe the stage that an MS patient may currently be in:

  1. Relapsing-remitting – episodes of acute worsening with recovery and a stable course between relapses
  2. Primary progressive – gradual, nearly continuous neurologic deterioration from the onset of symptoms
  3. Secondary progressive – gradual neurologic deterioration with or without superimposed acute relapses in a patient who previously had relapsing-remitting multiple sclerosis
  4. Relapsing-progressive – gradual neurologic deterioration from the onset of symptoms, but with subsequent superimposed relapses.

Early Signs of MS

Early signs of MS include sensory symptoms, such as tingly feelings, numbness, feeling like the inside of your leg is very cold or filled with ice. Sensory complaints are very common in MS patients, with upwards of 55% patients reporting them each year. Over the course of the disease, about 70% of those affected with MS will eventually report experiencing sensory symptoms. A common sensory complaint in MS patients is a rapid electric-like sensation running down the spine and into the limbs.

Facts about MS

  • Most people are usually diagnosed with MS between the ages of 20 and 50
  • MS is the most common cause of chronic neurologic disability in young adults.
  • Siblings of MS parents have a risk of about 2.6%
  • MS is more common in women.
  • The peak age of onset of MS is 24 years old.
  • The cause of MS is still unknown. The CNS pathway involves white matter: immune-mediated destruction of myelin sheaths with relative preservation of axons
  • Onset of MS is typically acute or subacute over several days and is not usually sudden.

Neurologic Aspects of MS

The neurobehavioral aspects of MS consist of both cognitive dysfunction and neuropsychiatric disorders. Cognitive difficulties occur about 60% of MS patients, and are usually the first symptoms to present themselves. These symptoms can include memory retrieval, mental processing speed, reasoning and goal-oriented behavior, verbal fluency, and visuospatial skills.

Neuropsychiatric disturbances mainly consist of mood disorders. They may be present in either relapsing attacks or in a chronic progressive course of the disease. Mood disorders are more common in MS than in other chronic disabilities. Collectively, major depression, bipolar illness, and dysphoria occur in the majority of MS patients, with severe depression occurring in upwards of 54%.

MS patients may experience sudden neurologic deterioration, which can be brought on by elevated body temperature. The temporary worsening that is frequently associated with febrile illnesses also may manifest during physical exercise. Blurred vision is the most commonly reported transient neurological symptom that is brought on by moderate exercise.

If you are just beginning the process of being aware of your MS, you should know that it is common to feel afraid, as if you’re losing your mind. After all, time has passed since you felt fine. Hopefully, you have found an understanding neurologist. More than likely that person will be concerned with your physical symptoms. It is important, as part of your diagnosis, to have a neuropsychological work-up—a diagnostic process designed to reveal problems with reasoning, memory, and other brain functions—to finally pinpoint the source, or sources, of your difficulties. Once that is accomplished, you will almost certainly feel an overwhelming sense of relief that someone understands what you’ve been going through. This affirmation, along with support from medical professionals, friends, and family, can help to head off many of the debilitating psychological responses to MS.

Early diagnosis is extremely important. With early identification, you can have, to a certain degree, the ability to alter the eventual progress of MS. To a great extent, you will have the tools to be able to cope with it better. With your knowledge and means of coping, you will be more resilient and better able to advocate for yourself. You can best help yourself by understanding the nature of your problems, acknowledging your limitations, and making necessary accommodations at home, school or work.

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Within each person shines an inner light that illuminates our path and is the source of hope. Illness, trauma, suffering and grief can diminish the light and shroud hope. I am a catalyst for hope and change, offering a way to rekindle this inner light.

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