#MarchOn4MSAwareness
Day 1 – Intro to Multiple Sclerosis (MS)
Multiple sclerosis (MS) is a disease
that affects the central nervous system (CNS), which causes the person’s immune
system to attack the myelin sheath, destroying it. The destruction or demyelization
causes problems with the communications between the CNS and the rest of the
body (Slomski & Davidson, 2011, p. 1).
It is an autoimmune disease; multiple sclerosis (MS) gets its name from
the fact that there are areas of plaque or patches of sclerosis caused by the
disease (Stedman, 2012, p. 1099) because of the destruction of the myelinated
areas of axons. A very basic concept is of an electrical cord that has a frayed coating and causes the electricity to run through it to short out and not work properly; myelin would be the outside of the electrical cord that protects the conductivity and the wires inside, the axon.
MS is a chronic disease and causes
patients to have a variety of problems associated with their vision,
balance/coordination, muscle strength, sensations and bodily functions (Slomski
& Davidson, 2011, p. 2); currently its cause is unknown. The disease is typically hard to diagnosis
because symptoms and signs come and go; a magnetic resonance imagining (MRI)
and lumbar puncture (spinal tap) are diagnostic tools used to help physicians
diagnosis this disease. There are four
categories of the disease: Relapsing-remitting MS (RRMS); Secondary progressive
MS (SPMS); Primary progressive MS (PPMS); Progressive-relapsing MS (PRMS)—of
these, the Relapsing-remitting MS (RRMS) is the most common (Multiple
Sclerosis, n.d., p. 2). There is no cure
for this disease, although there are medications to help possibly slow down the
progression; multiple sclerosis (MS) tends to be a very unpredictable and
usually debilitating disease.
A more clinical view of the disease
from Medscape:
Multiple sclerosis (MS) is an immune-mediated
inflammatory disease that attacks myelinated axons in the central nervous
system, destroying the myelin and the axon in variable degrees and producing
significant physical disability within 20-25 years in more than 30% of
patients. The hallmark of MS is symptomatic episodes that occur months or years
apart and affect different anatomic locations. See the image below (Luzzio,
2017).
MRI of the head of a 35-year-old man with
relapsing-remitting multiple sclerosis. MRI reveals multiple lesions with high
T2 signal intensity and one large white matter lesion. These demyelinating
lesions may sometimes mimic brain tumors because of the associated edema and
inflammation.
Background
Multiple sclerosis (MS) is an immune-mediated
inflammatory disease that attacks myelinated axons in the central nervous
system (CNS), destroying the myelin and the axon in variable degrees. In most
cases, the disease follows a relapsing-remitting pattern, with short-term
episodes of neurologic deficits that resolve completely or almost completely. A
minority of patients experience steadily progressive neurologic deterioration.
The cause of MS is not known, but it likely involves a
combination of genetic susceptibility and a presumed nongenetic trigger (eg,
viral infection, low vitamin D levels) that together result in a
self-sustaining autoimmune disorder that leads to recurrent immune attacks on
the CNS (see Etiology). Geographic variation in the incidence of MS (see
Epidemiology) supports the probability that environmental factors are involved
in the etiology.
MS is diagnosed on the basis of clinical findings and
supporting evidence from ancillary tests, such as magnetic resonance imaging
(MRI) of the brain and cerebrospinal fluid examination. (See Workup.)
Traditionally, MS could not be diagnosed after only a single symptomatic
episode, as diagnosis required the occurrence of repeat clinical attacks suggesting
the appearance of lesions separated in time and space; however, recent
guidelines allow diagnosis of MS even with a first clinical episode as long as
ancillary tests support separation of lesions in time or space.
A common misconception is that any attack of CNS
demyelination means a diagnosis of acute MS. When a patient has a first attack
of demyelination, the physician should not rush to diagnose MS, because the
differential diagnosis includes a number of other diseases. For example, MS
must be distinguished from other neuroinflammatory disorders (see DDx.)
Treatment consists of immunomodulatory therapy for the
underlying immune disorder and management of symptoms, as well as
nonpharmacologic treatments, such as physical and occupational therapy (see
Treatment). In the United States, various disease-modifying agents for MS are
currently approved for use in relapsing MS (Luzzio, 2017).
References
Luzzio, C. (2017).
Multiple sclerosis. Medscape. Retrieved from
Slomski, G. & Davidson,
T. (2011). Multiple sclerosis. In L. J.
Fundukian (Ed.), Gale
Encyclopedia
of Medicine, Vol.
4. (4th ed.). Detroit: Gale. Retrieved March 19,
2013, from NRCX via Gale:
Stedman, T. L. (2012). Stedman's
medical dictionary for the health professions and
nursing. (7th ed.). Baltimore,
MD: Lippincott Williams & Wilkins
