- by Dr Reginald Varadarajulu Vsm
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- Sep 23 2017
Multiple sclerosis (MS) is a persistent autoimmune, inflammatory neurological disease of the central nervous system (CNS). MS attacks the myelinated axons in the CNS, destroying the myelin and the axons to varying degrees.
The course of MS is highly diverse and uncertain. In most patients, the disease is characterized initially through reversible neurological deficits, which is often followed by progressive neurological deterioration over time.
MS typically presents in adults 20 to 45 years of age and rarely presents in childhood or late middle age. The cause is unknown, but it appears to involve a combination of genetic susceptibility and a nongenetic trigger, such as a virus, metabolism, or environmental factors, that together result in a self-sustaining autoimmune disorder that leads to continuous immune attacks on the CNS.
According to Neurologists patients may be grouped into four major categories based on the course of disease:
Relapsing–remitting MS: the most common form, affecting about 85% of MS patients. It is marked by flare-ups (relapses or exacerbations) of symptoms followed by periods of remission, when symptoms improve or disappear.
Secondary progressive MS: may develop in some patients with relapsing–remitting disease. For many patients, treatment with disease-modifying agents helps delay such progression. The disease course continues to worsen with or without periods of remission or levelling off of symptom severity (plateaus).
Primary progressive MS: affects approximately 10% of MS patients. Symptoms continue to worsen gradually from the beginning. There are no relapses or remissions, but there may be occasional plateaus. This form of MS is more resistant to the drugs typically used to treat the disease.
Progressive-relapsing MS: a rare form, affecting fewer than 5% of patients. It is progressive from the start, with intermittent flare-ups of worsening symptoms along the way. There are no periods of remission (Marvin et.al.; 2012).
There is no as such diagnostic test for MS. The diagnosis is based on evidence of:
(1) At least two different lesions (plaques or scars) in the white matter of the CNS
(2) At least two different episodes in the disease course.
(3) Chronic inflammation of the CNS, as determined by analysis of the CSF.
To make a diagnosis of MS, the physician must:
Find evidence of damage in at least two separate areas of the CNS, which includes the brain, spinal cord, and optic nerves.
Determine that the damaged areas developed at least 1 month apart.
Observe that the symptoms last for more than 24 hours and occur as distinct episodes separated by 1 month or more.
perform an MRI
Perform a spinal tap and examination for oligoclonal bands.
More than 30% of MS patients have moderate-to-severe spasticity, mostly in the legs. Initial clinical findings in MS patients are often sensory disturbances, the most common of which are paresthesias , dysesthesias, diplopia, ataxia, vertigo, and bladder disturbances.
A common manifestation of MS is unilateral numbness affecting one leg that spreads to involve the other leg and rises to the pelvis, abdomen, or thorax.
Bladder dysfunction occurs in more than 90% of MS patients and results in weekly or more frequent episodes of incontinence in one-third of patients. At least 30% of patients experience constipation. Fatigue occurs in 90% of patients and is the most common work-related disability associated with MS. Sexual problems are often experienced as well.
The goals of therapy with disease-modifying agents in patients with MS include shortening the duration of acute exacerbations, decreasing their frequency, and providing symptomatic relief.
MS is a progressive disease with no cure so far. Although treatments are available to manage the disease course, they are only partially effective. Therefore, MS worsens in some patients despite everything they and their physicians do to prevent it. Patients with relapsing–remitting MS, the most common form of MS, experience attacks of worsening neurological functioning, followed by periods of remission characterized by partial or complete recovery.
A combination of drugs and physical, speech, and occupational therapies; exercise; rest; and healthful nutrition may relieve symptoms and promote a satisfactory quality of life.
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