An overview of multiple sclerosis
By Chelsea Kovar
In 1868, a French neurologist first identified multiple sclerosis as a disease.
Multiple sclerosis (MS) is a chronic, complex, and complicated disease that affects the immune system and the nervous system.
The immune system consists of numerous molecules and cells. The central nervous system (CNS) consists of the brain, spinal cord, and optic nerves.
Along with the brain and spinal cord, another structure known as myelin is involved.
Myelin is produced by cells called oligrodendrocytes. Myelin insulates and protects the axons to help complete the circuit (cycle).
Myelin is comparable to an insulated electrical wire that helps accelerate the conduction along the axons and out to the body. When myelin becomes destroyed or inflamed it is known as demyelination. As a result of demyelination, the circuit (cycle) is broken and disrupts the flow of messages to and from the brain to the body.
The transmission cycle is slow, depending upon how severe the loss of myelin is. The causes of MS are unknown. However, there are some theories regarding potential causes.
The first theory is that geographic location may be a risk factor. The farther away from the equator, the higher the risk of developing MS. People who live closer to the equator have a decreased risk of developing MS.
Northern Europeans and their descendants appear to have higher incidence rates. MS is thought to be more prevalent farther away from the equator due to climate, environment, sanitary conditions, and ethnic groups.
Overall, MS is most often seen in Caucasians.
Others believe genetics may play a role in developing MS. Although MS is not a hereditary trait, it is thought of as having a genetic predisposition.
One author notes, “The cause of MS is probably multifactional; an individual may be predisposed to develop MS if the appropriate combination of factors exists. Women are more frequently affected, for some unknown reason. The stated ratio is three women: two men.”
Various sources differ regarding the age of initial onset of MS. According to one source, “The frequency of onset of MS begins to increase around the age of 17, and reaches a peak in the early 30s.”
The Alternative Medicine and Multiple Sclerosis book differs by stating, “Although MS may affect people in all age groups, it is typically diagnosed between the ages of 20 and 40.”
In agreement, another source notes that, “MS doesn’t occur in children, or after the age of 55.” MS is a troubling disease because it strikes the younger age group, and is life-altering. Most patients have little or no understanding of MS, which is why it can be so challenging.
Diagnosing MS can be rather difficult. It is common for patients to think that they have MS, but in actuality, they don’t. There are not clearly defined symptoms specifically of MS, and sometimes, those symptoms might overlap with those of another disease.
Having symptoms, alone, is not enough evidence to declare a case to be MS. It’s very important to not misdiagnose a patient as having MS. Consequently, doctors are slightly hesitant to declare a case as MS without further explanation, observation, and examination.
“Watchful waiting” is the term used to describe the period of time before a diagnosis is made.
The use of Magnetic Resonance Imaging (MRI) is the primary tool used to depict visible changes in several areas of the central nervous system. MS can be diagnosed when lesions (injured tissue) occur in more than one area of the central nervous system at different times.
The majority of patients (more than 90 percent) who underwent an MRI testing produced abnormal test results. An MS patient may have to continue MRI testing to track the progress of the disease.
In order to ensure accuracy, doctors require that an episode (attack) needs to have lasted at least one day, and also be confirmed by neurological examination. Lancet states the combination of attacks and other test results are essential criteria for diagnosing MS.
Another possible diagnostic tool is the lumbar puncture (also known as a spinal tap). Patients are strongly encouraged to have constant communication with their primary doctor, possibly see a neurologist, and use MS centers to help when their symptoms arise, and even more so when they worsen.
The typical criteria to define MS consists of examining the age of onset (ages 15-50), and the particular pattern the disease follows.
It’s not uncommon for symptoms to vary from person to person, day to day, or even hour to hour.
Episodes may be referred to as relapses, attacks, and exacerbations. Improvement, or plateau of symptoms is known as remission.
Each case is different, and it usually depends on the site of a lesion (injured tissue). The various lesion sites are capable of producing different symptoms.
Normal symptoms might include, but are not limited to, loss of sensation, numbness, decreased sensitivity to pain, paralysis, bowel or bladder dysfunctions, double vision, blurry vision, involuntary eyeball movements, difficulties in chewing, swallowing, and slurred speech.
There are numerous possible, early, and advanced symptoms of MS, but each case is different from the next.
According to Lancet, the role of physical therapy is “disease-modifying,” because there is no complete cure for MS.
Physical therapy can be thought of as a preventative measure for secondary medical expenses. The symptoms most often treated in physical therapy are due to a limitation of movement, balance problems, spasticity that affects gait pattern, and increase in weakness.
Physical therapy is very important, because the patient’s function is always changing. Depending on each individual case, a physical therapy treatment session may include Pilates, Yoga, or Tai chi.
The goal of these interventions are to improve the state of well-being. It is common for physical therapy to work with the lower extremities, improving gait and mobility.
Other therapy needs could be addressed in occupational therapy or speech therapy. Occupational therapy instructs patients to make adjustments within the home environment.
Speech therapy helps overcome speech barriers. A physical therapist (PT) should perform a gait analysis, strength, flexibility and balance tests, and use a tool called an oximeter (an oxygen level recorder that detects the patient’s oxygen in the blood) during the initial evaluation.
According to an “Inside MS” article, it is stated that every MS patient receives a home exercise program (HEP) no matter what level of function or disability he/she is at.
The HEP might include the use of an exercise bike, mat exercises, physioballs, free weights, and aqua therapy.
Treatment is dependent upon the patient’s needs, goals set together by him/her and a physical therapist, and availability of resources.
Oftentimes, clinicians may look at the available community resources a patient has access to in an effort to help make the rehabilitation process attainable.
A physical therapist might encourage a patient to make some small changes regarding lifestyle, home setup, use of a car, and use of an assistive device such as a cane or walker; and alter wheelchair adjustments if needed.
It’s important to remember that patients need to be convinced that their lives can be better if they work at it. Oftentimes, patients just want a pill or an easy solution; however, it’s not that simple.
With the proper explanation and rationale for each individual’s case, a patient should want to improve his/her functional status.
The importance of patient compliance is so critical and crucial, because most insurance companies limit the number of physical therapy and/or occupational therapy sessions. Each health care insurance plan differs, and it’s important for the patient to understand what will be covered and to what extent.
MS tends to occur in one of four patterns; relapsing-remittance, secondary progressive, primary progressive, or progressive relapsing.
Relapsing-remitting is the appearance and disappearance of symptoms at random over a period of time.
Secondary progressive is a continuation of the relapsing-remitting course, which progresses steadily.
The primary progressive course is continuous from onset of MS.
Progressive relapsing is associated with nerve damage due to deterioration.
In conclusion, MS is a troubling and complicated disease from onset to death, with varying degrees of symptoms and severity. MS is a life-altering disease that mostly affects young females as early as the age of 15.
However, it’s important to remember that no two cases are exactly the same.
MS can be frustrating and difficult for patients to understand the cause (which is unknown), and then comprehend that there is no proven effective cure.
Physical therapy is used to help “disease modify” the symptoms and make lifestyle adjustments. MS patients, with the proper rehabilitation and education, can still live fulfilling lives.
Published August 2006
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