Multiple Sclerosis Disease

BASICS

DESCRIPTION

Multiple sclerosis (MS) is a recurrent (occasionally progressive) inflammatory progressive demyelinization of the white matter of the brain and spinal cord resulting in multiple and varied neurologic symptoms and signs. Usual course - intermittent, progressive and relapsing. It may pursue an acute course or slowly progressive. It is a major cause of disability in young adults.

System(s) affected: Nervous
Genetics: Appears to be a strong genetic component in determining susceptibility to the disease.
Incidence/Prevalence in USA: 25,000 new cases each year
Predominant age: Young adult (16-40 years)
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Ataxia
Babinski sign
Blurred, double or loss of vision in a single eye; often triggered by retrobulbar neuritis and its visual sequelae
Clonus
Clumsiness
Dysarthria
Emotional lability
Fatigue
Genital anesthesia
Hand paralysis
Hemiparesis
Hyperactive deep tendon reflexes
Hyperesthesia
Incoordination
Loss of position sense
Loss of vibration sense
Monoparesis
Ocular paralysis
Paresthesias
Sexual impotence in men
Urinary frequency, hesitancy, incontinence
Trigeminal neuralgia

CAUSES

Unknown
Autoimmune theory – supported by HLA linkage, hereditary pattern, immunocytes in plaques, changes in peripheral blood immunocytes
Viral theory – supported by increasing incidence of disease at higher latitudes, clusters of cases within families, geographical clusters of cases, animal studies of infectious diseases of myelin
Combined theory – autoimmune disorder triggered by environmental exposure to toxin or virus early in life

RISK FACTORS

Living in temperate zone
Northern European descent
Family history of the disease

DIAGNOSIS

LABORATORY

Cerebrospinal fluid
- Abnormal colloidal gold curve
- Gamma globulin IgG elevated
- Mild mononuclear pleocytosis (less than 40 cells/mL)
- Myelin debris
- Negative serology for syphilis
- Protein normal or slightly elevated 50–100 mg/100 mL (50–100 mg/dL [500–1000 mg/L])
Tests to exclude other disorders
- Fluorescent treponemal antibody absorption (FTA-ABS)
- Sedimentation rate
- Screens for clinically suspected vasculitic disorders
- Human T-lymphotropic virus-1 (HTLV-I) serology

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Destruction of myelin sheaths of nerve fibers and axons, sparing axons, glia, and other structures
Atrophy of optic nerves and cerebral hemispheres
T-cell lymphocytes around venules

SPECIAL TESTS

Visual evoked response (VER) - abnormal in 75-97% of definite MS cases
Somatosensory evoked potentials - abnormal in 72-96% of cases
Brain stem auditory evoked responses - abnormal in 57-65% of cases
CSF
- Oligoclonal bands
- Increased IgG

IMAGING

N/A

MRI (more sensitive than CT) - may show many plaques
CT scan (double-dose, delayed) - plaques

DIAGNOSTIC PROCEDURES

No test specific to diagnose MS
History, physical, CSF analysis, MRI, evoked potential studies, repeated observations over a period of time

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient as long as possible
Long-term care facility for physical therapy or complications such as pyelonephritis

GENERAL MEASURES

No specific therapy. Remissions occur spontaneously and make treatment evaluations difficult.
Emotional support, encouragement, and reassurances are necessary to help avoid a hopeless outlook
Occupational therapy
Urologic evaluation including any sexual dysfunction problems (impotence common in male patients)
Self-catheterizations for inadequate bladder emptying (indwelling catheter may be necessary in a few patients)
Custodial care, if patient cognitively impaired
Physiotherapy to maintain range of movement and strength and to avoid contractures

SURGICAL MEASURES

N/A

ACTIVITY

Maintain activity, avoid overwork and fatigue
Rest during periods of acute relapse

DIET

If constipation a problem, high fluid intake, plus a high fiber diet

PATIENT EDUCATION

For patient education materials favorably reviewed on this topic, contact: National Multiple Sclerosis Society, 205E 42nd Street, New York, NY 10017, (800)624-8236

FOLLOW UP

PREVENTION/AVOIDANCE

No known preventive measures. Avoid factors that may precipitate an attack, particularly stress from hot weather.

POSSIBLE COMPLICATIONS

Coma
Delirium
Emotional lability
Nystagmus
Optic nerve atrophy
Paraplegia
Sexual impotence (men)
Urinary tract infections

EXPECTED COURSE AND PROGNOSIS

Highly variable and unpredictable. Approximately 70% of patients lead active, productive lives with prolonged remissions.
May disable the patient by early adulthood or cause death within months of onset
Average duration exceeds 25 years
30% relapse in one year, 20% in 5-9 years, 10% in 10-30 years

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: Unlikely before puberty.
Geriatric: Remissions less frequent in this age group
Others: N/A

PREGNANCY

A triggering factor for multiple sclerosis in some cases

OTHER NOTES

Since the course is highly variable and unpredictable, avoid a hopeless outlook
30-40% of patients with optic neuritis alone eventually develop other signs

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.