About multiple sclerosis (MS)

Multiple sclerosis (MS) is a disease that affects the central nervous system (the brain and the spinal cord) by disrupting communication between the brain and the body. The disease may have little effect initially, but ultimately may severely disable a person. MS is not contagious or fatal, although in some cases people have a severe type that can lower their life expectancy.

MS is caused by destruction of the myelin sheath, produced by a wrapping of cells with insulation that coats nerve fibers. When this myelin sheath is destroyed, the brain can no longer send messages to the body successfully.

Who gets MS
MS is usually diagnosed when patients are between 20 and 40 years old, although researchers believe its impact may start earlier than changes in the brain can be seen.  Women are affected at almost twice the rate of men, but of those who are diagnosed at later ages, men and women are affected in about equal numbers. MS is five times more prevalent in temperate climates, such as United States, Canada and Europe, than in tropical regions.

Because of the geographic factor, researchers have developed several theories about the disease. One is that patients are exposed to a virus around puberty, and its effects are only seen as they mature. Another theory is that genetic, racial or ethnic predisposition causes the disease to appear in specific locations. Researchers have not been able to explain clusters such as one in Scotland.

What is the cost of MS?
Because MS is a progressive long-term illness that strikes people who are relatively young, it is costly to treat. It’s estimated to cost the United States economy more than $2.5 billion a year. About 350,000 people nationwide have MS. That includes 20,000 people in eastern Kansas and western Missouri.

What are the symptoms of MS?
Symptoms of MS begin when a focus of inflammation begins, then a scar (or plaque) forms in the central nervous system.   This plaque, or lesion, can permanently interfere with motor and sensory control. Symptoms vary depending upon where in the central nervous system the plaque occurs.

Common symptoms include: weakness, numbness, lack of coordination, loss of balance, visual problems, loss of bladder or bowel control, mood swings, cognitive problems, difficulty speaking and fatigue.

An exacerbation, also known as an attack, relapse, or flare, is a sudden worsening of symptoms, or the appearance of new symptoms, which lasts at least 24 hours and is separated from a previous exacerbation by at least one month.

Though MS nearly always silently progresses, the disease can take one of three courses:

Relapsing-remitting (RRMS) – characterized by partial or total recovery after attacks (also called exacerbations, relapses, or flares). Relapsing-remitting multiple sclerosis is the most common form of MS in its early stages.

*Secondary progressive (SPMS) – usually follows a relapsing-remitting course; as MS becomes steadily progressive, patients have fewer relapses, but disability and multiple sclerosis symptoms increase.

*Primary progressive (PPMS) – this course of the disease is the most rare — accounting for less than 15 percent of cases; the patient’s multiple sclerosis symptoms and disability progress without remission.

There are two types of treatment for MS:

•Symptomatic therapy –  used to treat the different symptoms of MS directly, such as incontinence, uncomfortable physical sensations, loss of memory, tremor, fatigue, and depression; does not treat the disease itself.

•Disease-modifying therapy – is used to treat the actual disease, the cause of the symptoms instead of the symptoms themselves

Approved disease-modifying therapies include Betaseron, Avonex, Rebif, Novantrone, and Copaxone.   These therapies influence the peripheral immune system to decrease its activity against brain antigens, but do not act inside the central nervous system.  Several other treatments are being clinically tested at locations around the country.  One of these is a unique therapy developed at the MidAmerica Neuroscience Institute; it is the only therapy which actually crosses the blood- brain barrier to destroy the abnormal immune cells present in the central nervous system in patients with MS.

What are some of the tools for diagnosing MS?
Evoked potentials: This test uses electrodes attached to a patient’s scalp to evaluate problems in the nervous system.

Analysis of the cerebrospinal fluid (CFS): CFS analysis allows us to sample the fluid surrounding the brain and spinal cord. We use a need to perform a lumbar puncture (or spinal tap) to draw fluid.

Multiple Sclerosis Functional Composite (MSFC): The MSFC is a standardized assessment instrument often used in clinical studies of MS. It included several different functional tests that may offer more information than the standard MS tests.