Multiple sclerosis is an autoimmune inflammatory condition that attacks the myelinated nerve cells in the central nervous system. Myelin is a fatty substance that forms a sheath around the nerve fibers and the nerves. As the immune system attacks and damages these myelinated nerve fibers, scar tissue forms – a process known as sclerosis.
This immune-mediated process occurs because of an abnormal response of the body’s immune system directed against the brain and spinal cord, which results in the disruption of the flow of information within the brain, as well as between the brain and the body. It results in progressive physical disability that occurs within 20 to 25 years in many patients. Multiple sclerosis is characterized by unpredictable, episodic attacks that affect different parts of the body, occurring months or years apart.
It is estimated that up to 95 per 100,000 individuals in the United States are suffering from multiple sclerosis. The National Multiple Sclerosis Society estimates that nearly 400,000 individuals are affected by the disease.
Women are more likely than men to be affected by the disease. It can occur at any age, but the diagnosis is usually made in patients between ages 15 to 45 years.
The cause is unknown, but studies suggest that multiple sclerosis is likely to involve multiple factors that trigger the disease. These include genetic, environmental, and lifestyle factors, such as cigarette smoking. It is most common in Caucasians of northern European origin, but some ethnic groups that have a high risk of developing the disease include African-Americans, Asians, as well as Hispanics or Latinos.
Signs and Symptoms
The clinical picture of multiple sclerosis varies among patients. Cognitive (mental) changes may predominate in some patients, while depression, visual symptoms or motor impairment, such as walking difficulties or weakness, may occur in others.
The classic symptoms of multiple sclerosis include:
- Bilateral facial weakness
- Bladder and bowel dysfunction
- Chronic pain – affects 30-50% of patients
- Eye symptoms like double vision, blurred vision
- Heat intolerance
- Irregular twitching of facial muscles
- Muscle cramps/Spastic muscles
- Overwhelming fatigue – occurs in 70% of patients
- Poor memory and concentration
- Sensory loss (numbness and tingling) – usually an early complaint
- Sexual dysfunction
- Walking difficulties
It is often difficult to diagnose multiple sclerosis because signs and symptoms may come and go. The diagnosis is based on a thorough evaluation of clinical findings and ancillary tests, which include the following:
- Magnetic resonance imaging of the brain
- Evoked potentials (nonspecific)
- Spinal fluid analysis, which reveals the presence of oligoclonal bands and immunoglobulin G (IgG)
There is no cure for multiple sclerosis. The management of this disease consists of immunomodulatory therapy to target the immune disorder, as well as symptomatic treatment to improve quality of life.
Immunomodulatory therapy aims to reduce the frequency of relapses and to slow disease progression. Studies suggest that early intervention is recommended. Methylprednisolone can be used to hasten recovery from acute exacerbations, but there is no evidence that it can alter the course of the disease.
Plasma exchange or plasmapheresis is sometimes used as an option to treat severe attacks if steroids are ineffective or contraindicated.
At American Infusion Centers we use the following drugs for multiple sclerosis: