Multiple sclerosis: The unpredictable disease

By Henrylito D. Tacio

Six years ago, Arman suffered symptoms that doctors initially diagnosed as a stroke. The left side of his body was paralyzed. The 45-year-old former mechanic also had difficulty breathing. He was brought to a hospital where a computed tomography scan showed that his brain had no blood clots or bleeding often seen in stroke cases.

After spending a few weeks in the hospital, he recovered some of the movement on the left side of his body. His doctors were only able to figure out his actual diagnosis when a magnetic resonance imaging test was requested. They found out that the reason for his paralysis and inability to walk is a form of damage in the lining of his spinal cord. They concluded that he had multiple sclerosis (MS).

In the Philippines an estimated 8,400 people suffer from MS. “This is a small number compared to the recent estimates of 388,000 people affected in the United States every year,” the Asian Hospital and Medical Center says.

MS has been described as a disease of young adults as most patients experience their first symptoms of MS between the ages of 20 and 40.  The symptoms rarely manifest before the age of 15 or after 60 years old. Women are almost twice as likely to get multiple sclerosis as men, especially in their early years.

MS infrequently occurs in people who grow up in countries near the equator, like the Philippines.  It is more common in colder countries.  According to the most extensive survey of the disease to date, the number of people living with MS around the world has increased by 10 percent in the past five years to 2.3 million.

“Multiple sclerosis is a disease of the central nervous system, typically slow and fitful in its progress, with effects that can range from relatively minor physical annoyances to major disabilities,” The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments infroms.

The root problem is electrical. Normally, most nerves in the body are insulated by a fatty substance called myelin, which permits the efficient transmission of electrical impulses—the nerve signals.  “MS occurs when this protective sheath becomes inflamed and ultimately destroyed in places, short-circuiting the electrical flow,” the Medical Advisor points out.

Researchers believe MS may be an autoimmune disease, meaning the patient’s immune system attacks parts of the body as if they were a foreign substance.  Through time, the disease can slow or block the nerve signals controlling muscle coordination, sensation and strength, among others.

Like most autoimmune diseases, symptoms of MS are unpredictable.  They vary from person to person and from time to time in the same person.  Signs and symptoms may include numbness or weakness in one or more of the body at a time or the bottom half of the body; partial or complete loss of vision, usually in one eye at a time, often with pain during eye movements; double vision or blurring of vision; tingling or pain in numb areas of the body; electric-shock sensations that occur with certain head movements; tremor; lack of coordination or unsteady gait; fatigue; and dizziness.

In some cases, people with MS may also develop muscle stiffness, slurred speech, paralysis, or problems with bladder, bowel or sexual function.  Mental changes, such as forgetfulness or difficulties with concentration, can also occur.  While some symptoms will come and go over the course of the disease, others may be more lasting.

Stressful life events can worsen the symptoms of MS, finds a study published in the British Medical Journal.  Dutch researchers, who followed 73 patients, found that during periods of stress, patients were twice as likely to develop new symptoms, or a more severe form of their existing symptoms.  Although the reason for the apparent link is unclear, it is possible that stress triggers the release of hormones that affect the immune system.

Doctors recognize four basic categories of MS: benign, relapse-remitting, relapse-progressive and chronic-progressive.

In benign, the cases are typically limited to one attack, and there is no permanent disability.  The most common symptoms are limb numbness and temporary vision problems caused by inflammation of the optic nerve.  About 20 percent of MS cases are of the benign type.

Relapse-remitting refers to on-again, off-again cycles of attacks and remissions.  Cases of this type involve sudden and strong debilitating attacks followed by periods of almost total remission.  About 25 percent of MS cases are of this kind.

Relapse-progressive has the on-again, off-again cycles but the attacks are less severe, and the recovery is less complete.  The cumulative effect of many cycles of attacks slowly leads to some degree of disability.  This is the most common form of MS, accounting for about 40 percent of all cases.

In chronic-progressive, the MS quickly becomes disabling and has no periods of remission.  It accounts for about 15 percent of cases.

Until now, medical science is still trying to ascertain the causes of MS, which was first described in 1868 by French neurologist Jean-Martin Charcot. While there are no known causes for MS, research is making progress. There has been a genetic link shown that those with a first-degree relative who has MS have a 3 percent to 5-percent higher risk of developing MS, according to research completed at the Cleveland Clinic in the United States.

The genetic link is still under extensive research, but previous studies have shown that MS involves the autoimmune process. The immune system has an abnormal response that is directed to myelin. Myelin is a fatty substance that surrounds and protects nerve fibers in the central nervous system. These nerve fibers can be damaged resulting in myelin forming scar tissues.

Some researchers suspect environmental factors.  The list of possible culprits includes lead, pesticides, diesel fumes, chemicals in tap water, solvents and carbon-monoxide pollution.

While “there is as yet no cure for multiple sclerosis,” according to the US National Institute of Neurological Disorders and Stroke, MS medicine has seen a number of advances in recent years.  Among the new generation of oral therapies include Novartis’s Gilenya, Biogen Idec’s Tecfidera and Sanofi’s Aubagio. “These medicines offer an effective alternative to older disease-modifying treatments that are given by injection,” Reuters said in a report.


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