Multiple Sclerosis

The following discussion is for general informational purposes only and is not meant to provide the reader with specific medical advice. Please consult with your personal physician, or with a neurologist, for specific advice, guidance and information regarding your particular circumstances.

Description: 

Multiple Sclerosis is a disease of the central nervous system (brain, spinal cord, and optic nerve) that interferes with the brain's ability to send and receive messages. It is believed to result from immune-system dysfunction. Inflammation results in the breakdown of myelin, the protective insulation surrounding the nerve fibers of the central nervous system. Myelin is destroyed and replaced by scars of hardened patches of tissue. When the myelin is damaged, nerve impulses are not quickly and efficiently transmitted.

Symptoms: 

Symptoms of multiple sclerosis vary widely among individuals. They may include: abnormal fatigue, impaired vision, loss of balance and muscle coordination, slurred speech, tremors, stiffness, bladder and bowel problems, difficulties with gait (balance or walk), and in severe cases, paralysis.

The cause of MS is not yet known. There is a belief that exposure to a triggering agent, such as a virus may initially activate MS. There is research that indicates MS is the result of the person's immune system attacking his own central nervous system.

Disease Characteristics: 

Multiple Sclerosis affects twice as many women as men. Most people are diagnosed between the ages of 20 and 40. Infrequently, some are diagnosed in their late forties or fifties or in their teens. There seems to be a larger number of northern Europeans diagnosed as well as a higher incidence in populations that live in temperate climates.

MS is not contagious. It is believed that there is a genetic predisposition to the disease, though it is not directly inherited. Those with advanced disease states can have more complications and can be more susceptible to infections. Despite this, the projected life span for most people with MS is 93% of the non-MS population.

There are several disease patterns to MS.

Relapsing-Remitting: Clearly defined acute (sudden) attacks with full recovery or with a residual deficit upon recovery. Period between disease relapses are characterized by a lack of disease progression.

Primary Progressive: There can be occasional plateaus or remissions, but the disease and symptoms increasingly worsen in a progressive fashion.

Secondary Progressive: This pattern begins with a relapsing-remitting course for awhile, but then the disease progressively worsens as evidenced by gradually increasing disabilities.

Progressive-relapsing: Signs of progression are evident from the beginning of diagnosis, but there are clear acute relapses as well, with or without full recovery.

Diagnosis: 

The diagnosis of MS is based upon the clinical history, physical examination, and imaging studies, mainly a magnetic resonance imaging (MRI) scan. A lumbar puncture is often done to detect characteristic abnormalities of the cerebrospinal fluid. Computer-assisted electrodiagnostic tests, known as evoked responses, may also be helpful in diagnosing MS.

Diagnosis is difficult as there is no single test which diagnoses MS. It is estimated that about 350,000 people in the U.S. have MS.

Treatment: 

There are no cures currently available for MS, but several medical therapies have been developed and approved for the treatment of MS. In addition, patients can be treated for various symptoms, such as muscle stiffness, pain, bladder and bowel dysfunction and sexual dysfunction.

There are medications available to treat an acute exacerbation with the objective of modifying the attack and shortening its duration. These include corticosteroids.

The most common medications available to modify disease activity are interferons (Betaseron, Avonex and Rebif) and copolymer 1(Copaxone). These medications are given by injection and are self-administered at home. There are drugs available that have not been thoroughly tested in MS that are sometimes used, especially when the more common drugs seem to be ineffective.

Outlook: 

There is much research going on in this disease. It is hoped that in the next several years a major breakthrough will occur in understanding the cause of the disease, leading to a real cure.

Related Tests

Although there is no one test that will diagnose multiple sclerosis, we may run the following tests during your visit:

  • Magnetic Resonance Imaging (MRI)
  • Spinal Tap
  • Evoked Potential Test - This test measures activity in the brain.

Related Links

Use these links to find out more information about this condition.

  • National Multiple Sclerosis Society
  • International Organization of Multiple Sclerosis Nurses
  • Local Support Group
  • New Link

A Diverse Practice

Dr. Kalpana Hari Hall received her Doctor of Medicine from Eastern Virginia Medical School in Norfolk, VA and completed her internship and residency in neurology at Georgetown University in Washington, D.C. She additionally completed a Clinical...More
Kalpana Hari-Hall, M.D.