MS is a chronic neurological condition that affects the central nervous system, which is comprised of the brain and spinal cord. In the CNS, nerve fibers (called axons) are protected by a fatty layer of insulation called myelin. Myelin allows nerve signals to travel properly.
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In MS, overactive immune cells cause inflammation, which damages the myelin. This results in a loss of myelin – called demyelination – and some degree of axonal damage. Wherever the myelin is destroyed, a damaged area of white matter known as a lesion (or plaque) will occur. Over time, hardened scar tissue develops at the lesion site. This hardened scar tissue, or sclerosis, may develop at multiple sites throughout the CNS, hence the name multiple sclerosis. This scarring disrupts the transmission of nerve signals that communicate a desired action from the brain, through the spinal cord, to various parts of the body.
A simple illustration
Imagine this: You disconnect your cell phone from its charger as you get ready for a busy day. But even though it has been connected all night, you notice the battery is only partially charged. You look at the cord and notice a spot where the insulation has been stripped away and the wires inside are exposed. Because the path by which the current travels is damaged, not all of the electricity sent from the outlet reached its target, your phone.
This analogy is helpful in understanding MS. When signals from the brain travel along nerves where the insulation has been damaged or lost, those signals may be interrupted or distorted, producing the many symptoms associated with MS.
What Causes MS?
No one knows the direct cause of MS yet. There is a widespread belief among doctors and researchers that there is no single cause of MS. Instead, it is believed that MS is the result of a combination of several different factors. A tremendous amount of research is being done to find out what role these different factors play and just how large their effect might be.
In recent years, researchers have identified the role of certain immune cells that trigger MS attacks, as well as some of the factors that cause these cells to do so. They have also noted some sites (or receptors) on the attacking cells that appear to be drawn to the myelin, beginning the destructive process.
Environmental studies suggest that some factor – probably infectious – must be encountered before the age of 15 in order for MS to develop later in life. Several viruses and bacteria have been, or are being, studied to determine if they may trigger MS, but none have been proven to do so yet. The strongest evidence so far points to some involvement of the Epstein-Barr virus (EBV).
Studies have shown that people born in a geographic location with a high incidence of MS, who move to a geographic location with a lower incidence of MS during childhood, will acquire the lesser risk associated with their new location. This suggests that exposure to some environmental factor or factors prior to puberty may predispose a person to develop MS later in life.
New techniques are being used in an effort to identify the genes that may be involved in MS development. While some autoimmune diseases are caused by one or two malfunctioning genes, MS appears to involve defects in several different genes, each one with only a modest effect.
A feeling of exhaustion that is not caused by lack of sleep or overexertion, and may not improve with rest. Fatigue is the most common and persistent symptom of MS, affecting nearly 80 percent of those with MS.
Treated by: Modifying activities, occupational therapy, and medications.
Up to 55 percent of people with MS experience these altered sensations, including numbness, tingling (a 'pins and needles' feeling), burning, or sensitivity to touch. These sensations are often the earliest symptoms of MS.
Treated by: Medication, exercise, healthy diet, body cooling, or acupuncture.
Difficulties with balance and a person's manner of walking (gait) are common with MS. Balance problems may cause a person to sway or stagger. Gait impairment may make it difficult to lift the foot or leg.
Treated by: Exercises, physical therapy, occupational therapy.
Shaking or trembling of a limb, or occasionally the head. Up to 50 percent report extremity ataxia (shaky movements or unsteady gait) or tremors.
Treated by: Exercise, physical therapy, occupational therapy, adaptive equipment, and medications.
In MS, depression is common both as a symptom of the disease itself, and as a common reaction to the onset of a chronic illness.
Treated by: Medications, counseling.
Affecting up to 60 percent of people diagnosed, this often painful symptom occurs when opposing groups of muscles contract and relax at the same time.
Treated by: Exercise, stretching, physical therapy, mechanical aids, and medications.
Signs of bladder dysfunction can include frequent urination, urgency, dribbling, and incontinence. Conversely, it can also include hesitancy or urinary retention.
Treated by: Modifying activities, medications, catheterization.
About two-thirds of people with MS experience bowel dysfunction, most frequently constipation, but diarrhea and incontinence can also occur.
Treated by: Diet management, adequate fluid intake, and medications.
While it rarely affects both eyes simultaneously, optic neuritis is a common symptom that can cause blurred vision, double vision, or vision loss. Vision often returns, at least to some degree.
Treated by: Medications, eye patch.
Changes in cognition (thinking ability) typically affect short-term memory, verbal fluency, and speed of information processing. Memory and reasoning problems may affect between two-thirds and three-fourths of those diagnosed with MS to varying degrees.
Treated by: Occupational therapy, cognitive rehabilitation, medications
More than 90 percent of men and 70 percent of women with MS report some change in their sexual life after the onset of the disease. Some problems include decreased sexual drive, impaired sensation, diminished orgasmic response, and loss of sexual interest.
Treated by: Counseling, medications.
These are only a few of the dozens of symptoms that MS can present. While they are the most commonly reported symptoms, not every person with MS is guaranteed to experience them. Some individuals may experience many symptoms associated with the disease, others only a few. And the severity of symptoms varies from person to person as well, ranging from mildly bothersome to life-altering. With such an unpredictable condition, what can you do to manage your symptoms? Quite a lot.
- Slow MS down by starting a disease-modifying treatment and sticking to your dosing schedule.
Consider healthy sleep, exercise, and diet habits as an important part of your treatment routine.
- Quit smoking!!
- Bring up new or worsening symptoms with your doctor as early as possible, and follow through with treatment recommendations.
- Reach out for social support. Join a support group or open up to trusted friends.
These common sense steps have been shown time and again to improve outcomes, either by decreasing your chance of relapses and new symptoms, or by giving you the resilience to recover or adapt.
This is what people who have MS need love, strength, power and might. This with constant support from family friends and a caring passionate doctor makes a great recipe for the best possible outcome.
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