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Multiple sclerosis (MS) is a disease of the central nervous system (CNS). The CNS consists of the brain, optic nerves and spinal cord. With MS, areas of the CNS become inflamed, damaging the protective covering (known as “myelin”) that surrounds and insulates the nerves (known as “axons”). In addition to the myelin, over time, the axons and nerve cells (neurons) within the CNS may also become damaged.
The damage to the protective covering and also to the nerves disrupts the smooth flow of nerve impulses. As a result, messages from the brain and spinal cord going to other parts of the body may be delayed and have trouble reaching their destination – causing the symptoms of MS.
Areas of inflammation and damage are known as “lesions.” The changes in size, number, and location of these lesions may determine the type and severity of symptoms. While individuals with relapsing forms of MS are believed to experience more inflammation than those with progressive forms of MS, lesions still occur for individuals with all forms of MS. However, the lesions in progressive forms of MS may be less active and expand more slowly.
Additionally, areas of thick scar tissue may eventually form along the areas of permanently damaged myelin. These areas of scar tissue are referred to as “plaques.” The term “multiple sclerosis” originates from the discovery of these hardened plaques. Multiple refers to “many;” sclerosis refers to “scars.”
There are four different disease courses in MS
- Relapsing Remitting (RR)—Acute attacks followed by complete or partial recovery
- Secondary Progressive (SP)—Usually develops after RR. More consistent progression of symptoms resulting in more disability as time goes by.
- Progressive Relapsing (PR)—Third form of MS. More progressive disability but may include some recovery time from the disease.
- Primary Progessive (PP)—Most rare form of MS. Progression of disability from the very beginning. Rarey are there any improvements. With each attack patient becomes progressively worse.
Diagnosis and Testing
There is no single test that can diagnose multiple sclerosis. This is referred to as a diagnosis by exclusion, meaning that the doctor will complete a thorough physical examination followed by a few tests that can rule out other diagnoses. By ruling out all other possible diagnoses, MS can then be determined. Specific laboratory tests include:
- Magnetic Resonance Imaging (MRI)
- Visual Evoked Potential (VEP)
- Cerebrospinal Fluid sample
There currently is no cure for MS. However there are medications that can slow disease progression, as well as medications that can help alleviate some of the symptoms. Goals of therapy include improving recovery from attacks, and preventing or decreasing the number of relapses.
Treatment with a long-term, disease-modifying therapy (DMT) is crucial for most patients with relapsing forms of MS, since disease activity and damage continues within the CNS even when no new symptoms are present. When a patient begins a treatment regimen early in his or her disease course, disease activity is slowed. This not only reduces the number and severity of symptom flare-ups, as well as delays the progression of the disease (and possibly delays any related disability), but also reduces the number of active lesions that appear on an MRI.
National Multiple Sclerosis Society—www.nationalmssociety.org
Multiple Sclerosis Foundation—www.msfocus.org
Multiple Sclerosis Association of America—www.mymsaa.org
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