Autoimmune Disease
Multiple sclerosis is a neurological disorder that affects as many as 2.5 million people worldwide. It is an autoimmune disease, meaning it works against the immune system. In particular, it attacks the central nervous system: your nerves, spinal cord and brain. While normally the immune system would defend your body against such an attack, in multiple sclerosis your immune system’s defensive cells get confused, and mistake myelin (a fatty sheath protecting nerve fibers) for something that needs to be destroyed. As a result, in multiple sclerosis, the body attacks itself.
Why the Myelin?
Researchers still don’t understand why the immune system attacks the nervous system, or why it confuses the myelin sheath for a foreign substance. While research does suggest that there may be certain environmental and genetic factors, other researchers also suspect various viruses may be responsible. In short, there is still a tremendous need for further multiple sclerosis research.
How does Multiple Sclerosis Present?
This varies wildly, unfortunately, which is one of the many problems in diagnosing multiple sclerosis. There is no definitive order in which symptoms will appear, nor do the same symptoms appear for all patients.
In some patients, symptoms may be mild and go unnoticed for years, while in other patients, symptoms show up abruptly and uncomfortably. Though the disease can present itself at any age, it most commonly appears between the ages of 20 and 40—ages otherwise generally considered the prime of life.
Symptoms vary, depending on how the central nervous system is affected. Most often, symptoms include: fatigue, balance and coordination issues, tingling sensations, emotional changes, muscle cramps and dysfunction, dizziness, numbness, bladder and bowel issues and even sexual dysfunction. Given that these symptoms can appear during a person’s prime years, it can be especially frustrating and debilitating.
Just as frustrating, there is no clear progression to symptoms. One symptom may appear, persist, and then disappear without explanation. For other patients, multiple symptoms may show up all at once.
Difficulties in Diagnosis
There is no set of tests for multiple sclerosis. In fact, a diagnosis often relies upon ruling out many other things first. For instance, fibromyalgia is similar in enough ways that it often needs to be ruled out first. Additionally, a diagnosis of multiple sclerosis requires multiple episodes and symptoms in order for most doctors to consider diagnosing it as such.
As a result, many patients with multiple sclerosis can suffer for years before a doctor gives a diagnosis, which can additionally complicate their treatment and management plans.
As part of working toward a diagnosis of multiple sclerosis, all other possible causes of the symptoms are generally first ruled out, and a wide array of neurological tests may be required, including imaging, CSF analysis, MRIs and more. MRIs, for instance, can be particularly useful in helping to identify where damage has occurred in the body.
Needless to say, the many steps toward a diagnosis make things difficult for patients just looking for answers.
Causes
The cause of MS is unknown, but it is believed to occur as a result of some combination of immune dysregulation[15] in addition to genetic and environmental factors, such as infectious agents.[1]
- Autoimmune Response: MS is considered an autoimmune disease, where the immune system mistakenly attacks the protective covering of nerve fibers, known as myelin, in the central nervous system (brain and spinal cord). This results in inflammation and damage to the myelin.
- Genetics: There is a genetic component to MS, as individuals with a family history of the disease have a higher risk. Specific genes associated with MS susceptibility have been identified, but having these genes doesn’t guarantee the development of MS.
HLA region of chromosome 6: Changes in this area increase the probability of getting MS. - Environmental Factors: Certain environmental factors may contribute to the development of MS. Factors such as vitamin D deficiency, viral infections (particularly Epstein-Barr virus), and exposure to certain toxins have been studied for their potential role in increasing the risk of MS.
- Geography and Climate: MS prevalence varies geographically, with higher rates observed in regions farther from the equator. This has led to investigations into the potential role of sunlight and vitamin D in MS development.
Geographic risk distribution of MS - Smoking: Cigarette smoking has been identified as a risk factor for developing MS and may also contribute to the progression of the disease.
Management vs Treatment
As there is no curative treatment currently available for multiple sclerosis, current treatment focuses on management of symptoms and lifestyle changes that may make patients more comfortable, therefore improving their quality of life.
Every patient, including the range of symptoms and effective symptom management, is different. This results in a wide range of treatment strategies. For most patients, this may include working with their primary doctor, various specialists and even a support network consisting of family, friends, and other MS patients.
Multiple Sclerosis – An infographic by GeriatricNursing.org
NEW UPDATES!!
Current Treatments: (aimed at mitigating inflammation and resulting symptoms from acute flares and prevention of further attacks with disease-modifying medications).
* Physical Therapy and Occupational Therapy:
Along with patient-centered symptom management, can help with people’s ability to function. The long-term outcome is difficult to predict; better outcomes are more often seen in women, those who develop the disease early in life, those with a relapsing course, and those who initially experienced few attacks. source
