Multiple Sclerosis (Ms)

span class="pagesection">Basic Information

Multiple sclerosis (MS) is usually characterized as a slowly progressive, chronic disease of the central nervous system in which multiple nervous-system functions are affected. Patients are affected differently as far as duration and severity of the disorder (the inability to predict its course understandably causes stress in most patients), but most cases involve a cycle of what are called remissions and exacerbations. In other words, a patient may go for lengthy periods of time without symptoms -- the disease is then in a period of remission, but then seemingly "out of the blue" an exacerbation or a recurrence will occur. These periods of remissions and exacerbations usually become more frequent as the disease progresses, though there has been some success in staving off periods of exacerbations with recently approved FDA medication.

How does MS occur?

Our nerve fibers have a protective covering called myelin coating or plaques. When numerous areas of these plaques suffer damage or are destroyed, the nerve impulses are interrupted, causing the insidious symptoms associated with MS. This damage is called demyelination -- resulting from inflammatory lesions of the white matter in the central nervous system. These lesions or patches in the brain or spinal cord are unable to direct normal nerve impulses. The door is then opened for various and multiple neurological disturbances to occur.

Living with MS is a challenge because the average patient must deal with symptoms -- mild to debilitating -- over long periods of time, learning how to make the best use of the good periods when the disease is in remission, while learning to effectively treat physical symptoms during periods of exacerbation. If you have been diagnosed with MS you may find yourself adapting to new physical challenges around both work and leisure time, while learning how to maintain optimum mental health.

As with other lengthy, chronic diseases in which debilitation occurs, the role of family, friends, and a trusting relationship with your health care provider and counselor and/or therapist is tantamount, not to mention involvement in local MS support groups where others will understand and share practical information as well as give you needed emotional comfort which is especially important when you are newly diagnosed. And over time you will be able to do the same for other new MS patients, giving them support and demonstrating acceptance of their disease -- an empowering step for both of you to take. As with any other chronic illness, your own attitude plays an integral part in your overall physical and mental well-being.

The cause of MS remains a mystery. But there are some clues:

• There is an increased incidence among families -- genetic predisposition is probable
• There is suspicion that a slow, or latent virus causes infection. There are elevated titers in the patient's cerebral spinal fluid (CSF) which occurs during infection with a number of viruses, including measles.
• There appears to be an association with the human leukocyte antigen (HLA) and altered number of T-cells.
• The cause most suspected then is immunologic abnormality (possibly in tandem with additional factors).

Still and all, this officially remains a disease of unknown cause.

There are 50 to 100 cases per 100,000 persons in the U.S. Who then is most at risk?

• 20% of patients have a relative with MS
• Women have a slightly higher incidence than men.
• MS can occur in any age group but most often one or more symptoms are first diagnosed in patients between the ages of 20 and 35. In only 13% of cases is MS diagnosed in patients under 10 or over 40.
• There is an increased risk to adolescents who have spent the first 15 years of their lives in cool or temperate climates. Risk for MS is unchanged if the adolescent moves to a warmer climate during adulthood, suggesting that environmental factors play a part. MS is seen 5 times more often in temperate or cool climates than in the tropics.
• There are no measures to take to prevent MS.

Symptoms and course of the disease vary greatly among patients. In some cases spontaneous recovery occurs with no remission during the patient's lifetime. In other cases patients worsen rapidly, with a severe form of MS, and the disease is progressive without remission, sometimes ending in death within a few months, usually due to secondary infection. But these two scenarios are the extremes on either end of the spectrum

In the great majority of cases patients follow a course of remissions and exacerbations (or a slow, chronic progressive course without remissions or exacerbations) over the course of 30 or 35 years or even 50 years, sometimes with little disability. In fact, 1/3 of patients present little disability after 15% years. However, in a number of patients the quality of life lessens over the course of many years, causing progressive disablement, sometimes permanently.

While MS is not curable, the many aggravating and sometimes debilitating symptoms are treatable and can usually be controlled. Meanwhile, scientific research into both cause and cure is aggressive, meaning that treatments are becoming more and more effective and hope for or expectations of a cure remain within the realm of reason.

Symptoms

Symptoms vary among patients but early symptoms include:

• paresthesia or compression of the peripheral nerve (sometimes referred to as "pins and needles") on one or more of the extremities, on the trunk, or on one side of the face (loss of sensation or numbness and tingling)
• weakness of a leg or hand
• visual disturbances including dimness of vision, blurred or double vision or eye pain
• gait disturbances and clumsiness, or difficulty keeping balanced
• vertigo

Symptoms that can present (usually in later stages) include:

• loss of bladder/bowel control
• impotence
• pain
• marked and extreme mood swings
• tremors and weakness
• difficulty speaking

Complications that occur in late stages include:

• urinary-tract infections
• cognitive impairment
• bed sores and constipation from inactivity
• loss or partial loss of vision

Diagnosis/Treatment

MS, best interpreted in a clinical setting, can be difficult to diagnose. Symptoms vary dramatically among individuals -- some have one mild symptom, others have several severe symptoms, etc. And many patients may have had one or two mild symptoms for many years before seeking treatment.

There is no specific diagnostic test that is in itself conclusive of MS. The accepted definition of MS -- most often used in definitive diagnosis -- is multiple lesions of the central nervous system separated in time and space. That means there must be two or more separate central nervous system lesions in a patient as well as two characteristic episodes (more than one lesion in one location and more than one time).

Usual diagnostic tests include:

• MRI of the head to identify lesions, assess disease load and progression
• CSF (cerebral spinal fluid) analysis which reveals certain abnormalities associated with MS
• visual evoked response (VER) to assess myelin damage or destruction

Treatment varies according to the frequency and severity of remissions. With any chronic illness, patient education is key. A positive outlook by the patient and family members or support groups is an important ingredient. During remissions depression may set in, not only in the MS patient but in those close to the patient. Counseling and therapy are usually indicated for the family unit so the stresses associated with MS can be dealt with as effectively as possible. Stress, in fact, is thought to aggravate symptoms. Your local MS organization can be instrumental in providing up to the minute information about new and effective treatments and support groups available to you. And your health care provider can provide appropriate referrals to specialists both for your physical symptoms and disabilities as well as for therapists and/or psychiatrists. Antidepressants may be indicated for you and your family members. Certainly neurology referral is essential for all patients diagnosed with MS.

Fortunately most complaints can be effectively treated with the appropriate medications. Physical ailments that can be relieved with medication include:

• urinary incontinence or urgency
• fatigue
• pain
• tremor
• spasticity

However, you must provide a complete medical history for your health care provider. An assessment must be made if you have any other medical problems that would contradict you taking certain medications because of adverse drug interactions. Also, there are side effects associated with most medications. Ask your health care provider about possible side effects.

With treatment, most patients experience an improvement within months or even weeks after diagnosis -- but remember this is a chronic illness, most usually identified by remissions and exacerbations. In cases where exacerbations are acute, IV methylprednisolone has proven effective. And interferon-beta-1b prevents relapses in most patients, at least during the early cycles of the disease (although it can increase spasticity). Progress is being made all the time. New treatments are currently being investigated.

What you can do:

• Lead as normal a life as possible.
• Avoid stress as much as possible.
• Avoid heat (even hot showers) -- it may aggravate symptoms.
• Get massages on a regular basis to prevent muscle shortening.
• Avoid getting fatigued.
• Stay as physically and mentally active as you can (be sure your health care provider approves of any exercise program you undertake).
• Take rest periods during work or leisure activities whenever possible and appropriate.
• Stay sexually active if possible.
• Go to physical therapy if indicated.
• Eat a diet high in fiber (to lessen constipation)
• Be sure you have emotional support.

If you feel you have a symptom or symptoms of MS, please see your health care provider promptly.

Multiple Sclerosis and Diet

Multiple sclerosis (MS) is an autoimmune disease, meaning the immune system in this case attacks the myelin sheath surrounding the nerve cells of the body. It is a progressive disease and the symptoms can be weakness, fatigue, loss of balance, blurred vision and other neurological problems. What triggers expression of this disease is unknown.

Many diets have been proposed to fight the effects of MS including; gluten free, raw foods and natural foods. However, because this disease tends and wax and wane for no apparent reason there is no good evidence that these diets work. Still people with MS say they feel better when they make dietary changes.

Some things that might work:

Although far from definite, low levels of essential fatty acids, vitamin D and B12 have been proposed as triggers for MS. A recent study suggests a link between animal fats and sugary foods with a protective effect of vegetable protein, fiber, vitamin C, thiamin, riboflavin, calcium and potassium.

A. Eat fresh fruits (not processed), vegetables and whole grains. Avoid excessive refined (white flour and rice) and sugary foods. B. Keep total fat low. Replace saturated fats (in animal foods) with polyunsaturated fats (in legumes, nuts, and seeds). C. Take a multivitamin with mineral supplement. A B complex might also be warranted.

The International Federation of Multiple Sclerosis Society says that polyunsaturated fats including omega 3 might be beneficial because they are ant-inflammatory and immunosuppressive. Gamma linolenic acid (GLA) might help for the same reason. Again limit saturated fat and avoid excess fat. Ray Swank the founder of the Swank diet has been promoting a very, very low fat (no more than 20 grams/day) for several decades. One study that involved 150 people with MS showed that those who followed this diet had little deterioration attributable to the disease and much lower death rates than the people who ate more fat.

Eat legumes, nuts and seeds, fresh fruits, vegetables and whole grains and add the following: C Fish or ground flaxseed for omega 3 fats. Try fish oil supplements D. Try black currant oil or evening primrose for GLA E. Avoid caffeine, alcohol and smoking which all affect the nervous system

For fine tuning on dietary management of MS see a registered dietitian (RD) Visit www.multiplescerlosis.com for general information on MS. Donna Tinnerello MS, RD, CDN

Donna Tinnerello MS, RD,, CD/N is registered dietician with more than 10 years experience in HIV and nutrition. She works at Cabrini Medical Center in lower Manhattan,in private practice and the community.Her subspecialties are cardiovascular, renal, and gastrointestinal disease, diabetes and weight loss. Donna is available for private consultation by referral only.