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Multiple Sclerosis (MS) Frequently Asked Questions (FAQ) What is Multiple Sclerosis? Multiple Sclerosis is a chronic often disabling disease of the central nervous system. In young adults, it is one of the most common central nervous system diseases. Sclerosis are "scars" such as plaques or lesions in the brain and spinal cord. Multiple Sclerosis is a progressive disease in which scattered patches of the protective myelin sheath covering of the nerve fibers in the brain and spine (the central nervous system) are damaged or destroyed. Myelin is a fatty material around nerves that acts like the insulation around electrical wires. When the myelin sheath is damaged, the electrical impulses along the nerves are disrupted. This disruption affects many functions of the body. Symptoms may be mild (e.g., numbness in the limbs) or severe (e.g., paralysis or loss of vision). The progress, severity and specific symptoms of Multiple Sclerosis in any one person cannot yet be predicted, but advances in research and treatment are giving hope to those affected by the disease. Who Gets Multiple Sclerosis Multiple Sclerosis affects women 50% more than men or, if you prefer ratios, 3 to 2. Most people with Multiple Sclerosis are diagnosed between the ages of 20 and 40. Multiple Sclerosis is rarely found in people younger than 12 or older than 55. Multiple Sclerosis is more common among Caucasians than other races. This is particularly true with those of Northern European ancestry). In some populations, such as Eskimos, Multiple Sclerosis is practically unheard of. Multiple Sclerosis is more common farther from the equator. Some studies have reported that Multiple Sclerosis is as much as five times more likely in North America and Europe than in the tropics. Within the U. S., a "dividing line" runs along the 37th parallel, from Newport News, Virginia, to Santa Cruz, California, along the northern border of North Carolina, the northern border of Arizona and across the top part of California. Below the 37th parallel the Multiple Sclerosis is 57 to 78 cases per 100,000 people; above the 37th parallel is almost double that: 110 to 140 cases per 100,000 people. How Many People Have Multiple Sclerosis There are approximately one third of a million Americans with Multiple Sclerosis, and every week some 200 people are diagnosed with the disease. That is more than one person an hour. Across the world, about 2.5 million people have the disease. How Can I Catch Multiple Sclerosis Multiple sclerosis is not contagious. You cannot "catch" Multiple Sclerosis. Is Multiple Sclerosis Hereditary? Studies indicate that genetic factors may make certain individuals more susceptible to the disease, but there is no evidence that Multiple Sclerosis is directly inherited. Is Multiple Sclerosis Fatal? No. Multiple Sclerosis is not a fatal disease and individuals can be expected to have normal or near normal life expectancy. In fact, the majority of people with Multiple Sclerosis do not become severely disabled. Two-thirds of people with Multiple Sclerosis are able to walk with or without the use of aides and continue to lead productive and satisfying lives. However, although the life span is not significantly affected by multiple sclerosis, the unpredictable physical and emotional effects of multiple sclerosis can be lifelong. Can Multiple Sclerosis Be Cured? There is are no drugs or treatment protocols that can cure Multiple Sclerosis. There are currently treatments which can modify the course of the disease no cure yet. However, research is ongoing to find both effective means of preventing and arresting the disease, as well as developing better ways of treating those who have Multiple Sclerosis. In recent years there have been advances on many fronts. Treatments have been developed that reduce the number and severity of relapses in some people with Multiple Sclerosis. In addition, there are therapies to relieve many symptoms and improve the quality of life of people with Multiple Sclerosis. How Can Multiple Sclerosis Be Diagnosed? Magnetic Resonance Imaging (MRI) is currently the most definitive tool for diagnosing Multiple Sclerosis. A new MRI technique called "Turbo FLAIR" is particularly useful. (MRI is better able to "see" damaged nerves than CAT scans.) However, because other disease may cause the same symptoms as Multiple Sclerosis, there is not a single laboratory test, symptom, or physical finding which, when present or positive, always means a person has Multiple Sclerosis. Multiple Sclerosis diagnosis generally relies on two accepted criteria:
What Causes Multiple Sclerosis? We do not yet know what causes Multiple Sclerosis. However, scientific research has uncovered a number of candidates:
What Role Might Trauma Play? The role of trauma with Multiple Sclerosis is a controversial subject. It has been largely based on both anecdotal reports or information gathered based on patient memories. Controlled studies were few to none. A study, published in 1991 ((Sibley, W. A., et. al., Journal of Neurology, Neurosurgery, and Psychiatry, V54, pp 584-9) and conducted at the University of Arizona, concluded that except for electrical injuries, there was no evidence of a direct relationship between traumatic injury and a Multiple Sclerosis exacerbation. (Exacerbation is the term for a Multiple Sclerosis flare-up, attack or manifestation of symptoms.) A second study, published in 1993 (Siva, A., et. al., Neurology, V43, pp 878-82), and conducted confirmed the Arizona study findings. Although both studies found more traumatic events among Multiple Sclerosis sufferers than in healthy people, the traumas were not precipitating factors in the disease. What Role Might Genes Play? Multiple sclerosis is not hereditary. There is evidence, however, that having a parent or sibling (also called a first-degree relative) with Multiple Sclerosis substantially increases the probability of developing the disease. Studies indicate higher prevalence of Multiple Sclerosis among certain racial groups (e.g., Northern Europeans) and almost no Multiple Sclerosis among other groups (e.g., Eskimos). There are theories that Multiple Sclerosis develops within a person who is born with a genetic predisposition to the disease or with a genetic predisposition to react to some external, environmental agent. The National Multiple Sclerosis website has more information on the role of genetics in Multiple Sclerosis at www.nationalmssociety.org/sourcebook-genetics.asp. What Role Might Environment Play? As noted above, geography plays a role in the statistical occurrence of Multiple Sclerosis. Studies of migration patters (and a boatload of other factors) seem to indicate that people who are born in a high risk are and move to a low risk area, "acquire" the lower risk if they move before the age of 15. This suggests that there may be some environmental agent and that exposure to this agent before puberty may play a factor in the development of Multiple Sclerosis. What Role Might Viruses Play? We know that viruses can cause demyelination (removal of myelin from the nerves) and inflammation of the nerves. The theory is that a virus might be either the cause, or perhaps a trigger, for Multiple Sclerosis. More than a dozen viruses including measles, canine distemper, and herpes (HHV-6) have been studied. At this time, there is no definitive links between viruses and Multiple Sclerosis. The National Multiple Sclerosis website has more information on the role of viruses in Multiple Sclerosis at www.nationalmssociety.org/sourcebook-viruses.asp. What Role Might the Immune System Play? The most commonly accepted theory about Multiple Sclerosis is that it is an auto-immune response. That is, that somehow the body's immune system, instead of fighting a foreign infection, directs the "attack" against the central nervous system (CNS). The "target" of the attack (the antigen that the immune system locks onto) has not been identified. Research has been able to identify:
Research continues on the possibility of stopping this abnormal response without interfering with normal immune cells. The National Multiple Sclerosis website has more information on the role of the immune system and the autoimmune response in Multiple Sclerosis at www.nationalmssociety.org/sourcebook-autoimmune.asp. What Are the Symptoms of Multiple Sclerosis? The initial symptoms of Multiple Sclerosis typically include:
Other initial symptoms include:
The Multiple Sclerosis community distinguishes among:
Primary Symptoms Multiple Sclerosis involves demyelination: the destruction of the fatty myelin sheath that surrounds nerve fibers and insulates them like the insulation around wires. The loss of myelin results in disruption of the nerve impulses to the body. Symptoms include:
Secondary Symptoms Examples include:
Tertiary Symptoms Examples include:
Does Multiple Sclerosis Always Progress the Same? No. Each person's experience is different. The course of the disease is completely unpredictable. In some people the disease has only minimal impact. In other people it progresses very rapidly to total disability. Despite these unique progressions, researchers (in their obsessive/compulsive drive to categorize observations) have identified four major 'groupings" of the disease:
Benign The characteristics are:
It is not possible to identify this form of Multiple Sclerosis until after the fact because the symptoms are a lack of progression. At the onset of this type of Multiple Sclerosis, it would have been identified as relapsing-remitting. Relapsing-remitting The characteristics are:
The attacks (more formally called exacerbations) can last days or months. The recovery periods may be months or years. Ten to fifteen years without an attack are required for the disease to be considered in complete remission. Secondary progressive The characteristics are:
Primary progressive The characteristics are:
The accumulation of disability may eventually level off or may continue to worsen. How Is Multiple Sclerosis Treated? Again, there is no cure (yet). However, treatment protocols address four primary areas of the disease:
Reducing the effects of an attack The most common therapy for an attack, also called an exacerbation, is the use of steroids. Steroids reduce the swelling and permit more rapid healing. Addressing long term symptoms Long term symptoms (e.g., fatigue, bladder and sexual dysfunction, depression) can be addressed with medications and therapies, many of which are not specific to Multiple Sclerosis. Slowing the progress of the disease Research continues on drugs that might be effective in slowing the progress of the disease. Two drugs being investigated include (a) Beta Interferon and (b) Copolymer 1. Minimizing the impact of the disease Areas of therapy include:
Sources for this FAQ includes the websites of the National Multiple Sclerosis Society, the Multiple Sclerosis Society of America, the Multiple Sclerosis Foundation, the International Federation of Multiple Sclerosis Societies, the International MS Support Foundation, and Imaginis.net. The information is believed to be accurate. However, individuals should not rely on this information for diagnosis or treatment of disease.
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