MEDICAL SURFARI: MULTIPLE SCLEROSIS: AN IMMUNE SYSTEM DISEASE

Muscle weakness, becoming easily fatigued, impairment of sensation, tremor, visual disturbances, bowel, bladder and sexual dysfunction -- as well as depression -- are some of the common signs and symptoms of multiple sclerosis (MS).

MS is a chronic, often disabling disease of the central nervous system and its symptoms may be as mild as numbness in the limbs or as severe as paralysis and loss of vision. Generally, people with MS are diagnosed between ages 20 and 40 and this disease is about twice as common in women as men. The exact cause of the disease is not clear since it can be triggered possibly by viruses, environmental factors, genetic and immune system factors.

MS seems to be more common among Caucasians, particularly those of Northern European ancestry. Worldwide it tends to occur with a much greater frequency in latitudes farther away from the equator (above 40 degrees latitude). However, it is almost unheard of in some populations such as Eskimos.

It is now generally accepted that MS involves an auto-immune process, wherein one's body develops an abnormal immune response against proteins in one's own central nervous system. This results in the destruction of myelin, the insulating sheath that surrounds nerve fibers. Just as the insulation surrounding an electrical wire may cause it to short out or impair its electrical conduction, the destruction of myelin impairs the transmission of nerve impulses sometimes causing them to be slowed or halted. This in turn produces the symptoms of MS.

There is no single diagnostic laboratory test, symptoms, or physical finding which, when present or positive, cinches the diagnosis is MS. A careful and thorough history and examination, as well as other tests, often including a MRI scan of the brain, spinal fluid tests and electrical diagnostic tests are taken together to make the diagnosis.

It is generally quite difficult to predict the course of MS for any particular individual. MS may follow any one of four clinic courses:

1. A benign sensory form which is characterized by sensory and/or visual symptoms. These patients have no severe long-term disability.

2. Some patients experience a relapsing-remitting course characterized by partial or total recovery after attacks, relapses or flares.

3. Others may experience a relapsing-remitting course that later becomes steadily progressive.

4. A minority of MS patients have progressive disease from the onset and do not experience much in the way of remissions.

MS is a chronic disease and as anyone with a chronic disease will confirm for you; it may take its toll on one's life in a variety of ways. Attitude, self-esteem, friendships and family relationships, and even sexuality may be affected. People who live well with a chronic disease have a survival attitude that is not always easy to maintain. A disease process may take away one's ability to do some things but it does not take away one's ability to think creatively or adapt to new circumstances.

People experiencing health problems are challenged each day to commit brave acts that require courage, and courage builds self-esteem. When managing MS, a survival attitude and good support can make all the difference in achieving a fulfilling and productive life.

Worldwide Web Resources

The National Multiple Sclerosis Society

www.nmss.org

The National Multiple Sclerosis Society is the oldest and largest non-profit MS organization and provides education and support to both health care and professionals, and people with MS.

The International Federation of Multiple Sclerosis Societies

www.ifmss.org.uk

The IFMSS, through its World of Multiple Sclerosis Web site, provides current and useful information around the world to all members of the MS community (health professionals, researchers, persons with MS, families and caregivers.)

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.