Health Questions and Answers

MULTIPLE SCLEROSIS

What is multiple sclerosis (MS)?
MS is the most common disabling neurologic disease of young people under age 40, affecting approximately 250,000 Americans. It is probably an autoimmune disease, characterized by relapsing and remitting episodes of inflammation in the brain and spinal cord. This inflammation destroys the myelin, which is the insulating sheath around nerve cells, and hence destroys the ability of the nerves to conduct electrical impulses (action potentials).

Describe the clinical symptoms of MS.
Clinically, MS may affect almost any part of the brain or spinal cord. Generally, symptoms come on fairly abruptly, over a period of hours to days, persist for several weeks, and then resolve over a period of several more weeks, often returning completely to normal. On average, patients have one attack per year, although about 20% of patients have a chronic progressive course with steady worsening deficits, without abrupt attacks. The highly variable presentation of MS reflects the fact that it may involve the optic nerves, spinal cord, pyramidal tracts, spinothalamic tracts, brain stem, or cerebellum.

Can any treatments alter the natural course of MS?
While a cure for MS remains elusive, some therapies may actually alter the natural course of MS. Beta interferon-1a (Rebif or Avonex), beta interferon-1b (Betaseron), and glatiramer acetate (Copaxone) decrease the number of yearly relapses in patients with MS, as demonstrated in large clinical trials. The drugs seem equally effective, cutting attacks by approximately one third. Major side effects of beta interferon include flulike symptoms and leukopenia. Copaxone has relatively few side effects; mild injection site inflammation is the only one of note. Despite their apparent benefit in decreasing relapses of MS, none of the drugs has shown much benefit in patients with chronic progressive MC, nor is it clear how well they prevent ultimate disability.

How long do patients survive the onset of MS?
MS may be disabling but is seldom fatal. Most patients experience intermittent relapses for 5-15 years, followed by a more chronic progressive phase of variable duration. The life expectancy is almost normal and about one third of patients never experience significant disability.

References
WEB SITES
www.neuroguide.com
www.aan.com (American Academy of Neurology)
www.medmatrix.org
www.internets.com/mednets/sneurolo.htm
www.medwebplus.com/subject/Neurology.html

BIBLIOGRAPHY

  • Rolak LA: Multiple sclerosis. Clin Med Res 1:57-60, 2003.
  • Noseworthy JH (ed): Neurologic Therapeutics. London, Martin Dunitz, 2003.
  • Bradley WG, Daroff RB, Fenichel GM, Jankovic J: Neurology in Clinical Practice, 4th ed. Philadelphia, Butterworth-Heinemann, 2004.

 

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