MS - Day 1 – Intro to Multiple Sclerosis (MS)

 #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

            http://emedicine.medscape.com/article/1146199-overview

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: 

http://find.galegroup.com.proxy.davenport.edu/nrcx/start.do?prodId=NRC

Stedman, T. L. (2012). Stedman's medical dictionary for the health professions and

            nursing. (7^th ed.).  Baltimore, MD:  Lippincott Williams & Wilkins