Central Nervous System Health Article

Multiple sclerosis

Multiple sclerosis (MS) is a common neurological disease that occurs mainly in young adults. The course of the disease varies from person to person and is categorized by type. Relapsing-remitting MS (RRMS) has a course of acute attacks with full or partial recovery during remissions. Secondary progressive MS (SPMS) is initially relapsing-remitting and then becomes progressive. Primary progressive MS (PPMS) has a progressive course from the beginning of the disease with no remissions. Progressive-relapsing MS (PRMS) has a progressive

course from the beginning with acute relapses, with or without full recovery.

MS is believed to be an autoimmune disease, where the immune system targets the myelin in the central nervous system. MS is the most common demyelinating disease. During an attack (exacerbation), inflammation occurs in the white matter of the central nervous system. This process is followed by destruction of myelin causing areas called plaques. Not only is the myelin damaged, but the attack may also damage or sever the nerve fibers underneath the myelin. The nerve cannot conduct or send a signal properly without the myelin sheath.

MS can be difficult to diagnose because there are other diseases with similar symptoms, and there is no specific test to confirm the diagnosis. A process of elimination may be done along with a combination of imaging technologies such as MRI, CSF analysis, evoked potentials (EVP), medical history, and clinical examination.

SYMPTOMS. The symptoms of MS are unpredictable, can vary greatly from person to person, and come and go. The neurological symptoms of MS are the result of demyelination. Symptoms include:

• blurred, double vision, and blind spots
• numbness, tingling, and paresthesias (pins and needles)
• fatigue, dizziness, and vertigo
• difficulties with memory loss, concentration, and attention
• difficulty with coordination, balance, and gait
• muscle and nerve pain, muscle weakness, and tremors
• bladder and bowel problems

There are many conventional and alternative treatment therapies to alleviate the symptoms of MS, but there is no cure. However, four medications have been shown to slow down disease progression. The FDA approved Interferon beta 1b (Betaseron) in 1993, Interferon beta 1a (Avonex) in 1996, and glatiramer acetate (Copaxone) in 1996 for the treatment of RRMS. They were clinically shown to decrease the frequency and severity or attacks by approximately 30%. Mitoxantrone (Novantrone), a chemotherapy agent that suppresses immune function, was FDA approved in 2000 for the treatment of worsening RRMS and SPMS.

Research

Research in neuroscience and the development of new research techniques and technologies offer hope to the millions of patients and families affected by neurological diseases and disorders. Research into new treatments doesn't solve the problem, therefore, scientists are researching areas such as neurogenetics to discover how to prevent certain disorders. New treatment options and the possibility of cures can bring a sense of optimism to patients. However, the research process takes years before a treatment is available to the public. Only controlled clinical trials with human participants can determine if a treatment is safe and effective for patients.

KEY TERMS

Antigen—A substance that stimulates the immune system to produce antibodies.

Autoimmune—The immune system sees self as a foreign antigen and attacks a part of the body.

Cerebrospinal fluid—Fluid surrounding and cushioning the brain and spinal cord.

Cognitive—Information processing functions carried out by the brain that include comprehension, memory, attention, planning, problem-solving, etc.

Dura mater—The outermost layer of meninges.

Exacerbation—The appearance of new symptoms or the aggravation of old symptoms.

Gene—Basic units of heredity in every cell that tell the cell how to put together different proteins.

Interferon—A naturally occuring immune system protein.

Lumbar puncture—A diagnostic procedure that uses a hollow needle to penetrate the spinal canal between the vertebrae to remove cerebrospinal fluid for analysis.

Meninges—Three layers of protective connective tissue covering the brain and spinal consisting of the pia mater, arachnoid, and dura mater.

Myelin—A protective coating made of fat and protein that insulates the nerve and enhances efficient nerve fiber conduction.

Neurotransmitter—A chemical that transmits a nerve impulse at the synapse.

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.

Burks, J. S., and K. P. Johnson. Multiple Sclerosis: Diagnosis, Medical Management and Rehabilitation. New York: Demos, 2000.

Caplan, L.R. Caplan's Stroke: A Clinical Approach. Boston: Butterworth-Heinenmann, 2000.

PERIODICALS

"Recommendations for the Establishment of Stroke Centers: A Consensus Statement from the Brain Attack Coalition." Journal of American Medical Association (June 21, 2000): 3102-3109.

Stroke Council of the American Heart Association. "Primary Prevention of Ischemic Stroke." Circulation (Jan. 2,2001): 163-182.