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MULTIPLE Sclerosis, or MS as it is popularly known, is an auto-immune demyelinating (nerve sheath destroying) inflammatory disease of the Central Nervous System (CNS) whose specific cause is still unknown.

The pathology characteristically involves the optic (eye) nerve, periventricular white matter of the cerebellum, brain stem, basal ganglia and spinal cord.

What are the presenting signs and symptoms of MS?

The patient afflicted with MS usually presents with an individual mix of neruopsychological dysfunction, which get worse over years and decades.

The classic presentation includes optic neuritis (swelling of the nerve to the eyes), ophthalmoplegia (paralysis of the eye muscles), paresthesias (abnormal skin sensations) and a variety of other neurologic aberrations noted from the patient’s history and physical examination, like bladder dysfunction, impaired swallowing or cough reflex, spasticity, gait instability, paralysis and other CNS dysfunction.

What test can help establish the diagnosis?

The typical tell-tale findings on MRI (Magnetic Resonance Imaging), together with the above-listed findings, help confirm the diagnosis of Multiple Sclerosis.

Persons suspected to have MS, but who have atypical signs and symptoms, and/or atypical or normal MRI findings, may need evoked potential studies to reveal subclinical (subtle) neurologic abnormalities, or a spinal tab for cerebrospinal fluid for analysis to rule out other neurologic conditions.

What does the spinal tap show?

Also known as lumbar puncture, spinal tap entails collecting samples of CSF (cerebrospinal fluid), blood serum and ordinary blood specimen for analysis (by electrophoresis) and comparing them.

This test does not clinch the diagnosis but the findings can be indicative of MS and help support a clinical diagnosis.

The finding, a phenomenon termed IgG oligoclonal banding, if often corollary to MS.

In 90 percent of MS, the Immunoglobulin-G (IgG) is elevated to 0.7, which results in IgGo banding shown on electrophoresis.

Viral infection and tumors may also exhibit this phenomenon, so clinical correlation and confirmatory tests by the attending physician is essential.

In about 35 percent of MS, CSF helper T-cells is also increased, and in 80 percent of acute relapsing MS, myelin basic protein (MBP) levels are also elevated.

How prevalent is MS?

In the United States, Multiple Sclerosis is the most common debilitating disease in young adult, with an incidence of about 0.5 to 1 per 1,000 people.

An individual, in the general population, has a 0.2 percent lifetime risk of developing MS.

Each year, about 25,000 new cases are diagnosed.

Globally, about 1 per million acquires MS, which appears to be twice as common among the Caucasians than among Native American Indians and Asians, where it is rare, and unknown among Eskimos and Bantus.

MS is also 5 times more in temperate climates than in the tropics.

The risk of having MS is greater among those who have lived in temperate climate before age 15, but not among those to moved to temperate regions after that age.

It is also twice as common among females, and seldom happens before age 20 and after 50.

Does MS kill?

No, the disease itself does not.

MS generally causes disabilities that adversely affect the quality of life of the individual.

It is the worsening disability which leads to other problems that cause mortality.

The fulminant type of MS, which is rare, can cause death, but usually the mortality in MS is secondary to pneumonia, pulmonary embolism (blood clots in the lungs), and infected decubiti (bedsores), and suicide precipitated by depression.

How is MS managed?

Approximately 70 percent of MS is the more favorable type called Relapsing-Remitting (RR), who typically have acute episodes with complete or partial remissions.

The Acute Fulminant MS often results in death or morbidity within days, while the Forme Fruste or benign MS has a very slow progression over decades, if any at all.

The management of MS is a multidisciplinary approach, including careful monitoring, medications to modify the disease, drugs to treat symptoms, such as antiviral meds, steroids, muscle relaxants, pills to reduce fatigue, physical and occupational therapy, and counseling.

For RR, the U.S.-FDA has approved for chronic use the use of beta-interferons and glatiramer acetate (a synthetic form of myelin basic protein (MBP), which has fewer side effects than interferon.

This therapy has reduced about 33 percent the clinical activity and progression of the MS.

For the chronic form of MS, the results are not as good, even with beta-inteferons, though modest response is noted with methotrexate.

The management includes individualization of medical care according to the type of MS and the various complications that may develop.

But research on the optimal form of treatment for each type of MS is still ongoing.

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