Multiple sclerosis (MS) can be thought of as an inflammatory process involving different areas of the central nervous system (CNS) at various points in time. as the name suggests, multiple sclerosis affects many areas of the CNS.

Multiple sclerosis is more common in individuals of northern European descent. Women are more than twice as likely to develop multiple sclerosis as men. Multiple sclerosis usually affects people between the ages of 20 and 50 years, and the average age of onset is approximately 34 years.

The central nervous system is made up of the brain and spinal cord. They process information from our environment and control voluntary muscle movements to allow the body to do certain things.

When you touch something hot, for example, signals are sent from sensory nerve endings in your hand up long nerves in your arm, eventually reaching the spinal cord. From there, the signal is transferred up your spinal cord to your brain, where the information is processed. your brain then sends a signal back down the spinal cord to the nerves in your arm. These nerves cause the muscles in your arm to contract, pulling your hand away from the heat.

This neural system works efficiently, unless there is a disease process affecting the pathways in the spinal cord and brain. Multiple sclerosis is one of the diseases that can affect these pathways. Signals are transmitted within the central nervous system along pathways.

These pathways are made up of long fibers called nerves. Nerves are capable of transmitting information from the environment to the brain. Everything you see, touch, taste, smell, or feel is transmitted along nerves to your brain.

Nerves also carry information responsible for our alertness, behavior, ability to understand and think rationally, capacity to communicate with others, and feeling and interpreting emotions.

To help transmit all this information in a timely manner, the nerves are covered by a fatty substance called myelin. Myelin insulates the nerves and allows them to transmit information to and from the brain in a fraction of a second.

If the myelin is disrupted in any way, the transmitted information is not only delayed, but it may also be misinterpreted by the brain.

Multiple sclerosis results in destruction of the myelin surrounding the nerves of the CNS. the destruction is thought to be caused by the body’s immune system attacking the myelin sheath.

This autoimmune destruction of the myelin sheath leads to areas of demyelination (also known as plaques) in the brain and spinal cord.

These plaques disrupt the transmission of information in the CNS and lead to the symptoms seen in multiple sclerosis.

The symptoms of multiple sclerosis can be different from person to person. Visual, sensory, and motor signs and symptoms are all part of multiple sclerosis. the clinical manifestations are varied, and therefore there is a wide range of symptoms that can appear. some people have mild cases of multiple sclerosis with little or no disability over the years. others have more severe types of multiple sclerosis, requiring confinement to a wheelchair or bed.

Still others may live their entire lives symptom-free (some individuals without multiple sclerosis symptoms are found incidentally to have multiple sclerosis lesions by MRI, or individuals in whom an examination of their brain after death unexpectedly reveals that they were affected by the disease). this variability makes it difficult in some cases to diagnose multiple sclerosis. often the signs and symptoms are mistaken as being psychiatric in origin.

The first symptoms of multiple sclerosis are often visual changes. Large number of people with multiple sclerosis develop optic neuritis (inflammation of the optic nerve, which is an extension of the central nervous system), described as a painful vision loss. If a patient is diagnosed with optic neuritis early, treatment could change the course of the disease.

Before the actual loss of vision, the patient may have visual changes described by many people as blurred or hazy vision, flashing lights, or alterations in color. the tissues around the eye and moving the eye may be painful. most people recover over several months. others are left with permanent visual defects. Double vision occurs when the eyes move in different directions and is another common symptom of multiple sclerosis.

Multiple sclerosis commonly affects the cerebellum, the portion of the brain responsible for balance and fine motor coordination. consequently, people with multiple sclerosis often have difficulty maintaining their balance when walking and performing delicate tasks with their hands. Unexplained dropping of a cup or other object or unusual weakness can occur.

Patients may experience facial pain, a sensation of spinning referred to as vertigo, and sometimes hearing loss. Virtually any area of the body can be involved, making this disease the great imitator of other disorders of the nervous system. the patient may experience painful muscle spasms or loss of strength in one or more of the arms or legs.

The nerve fibers that conduct touch, pain, and temperature sensations are often affected, causing tingling, numbness or electrical-type pain sensations in the chest, abdomen, arms or legs. Multiple sclerosis can involve the nerves responsible for involuntary actions of the bladder and intestines. the pateint may often have constipation and urinary retention. These symptoms lead to other complications, such as infections of the bladder, kidney, or blood.

Most people with multiple sclerosis complain of a constant state of tiredness. something as simple as carrying groceries up a flight of stairs may become an impossible task for someone with multiple sclerosis.

A peculiar trait of multiple sclerosis is the relationship between higher temperatures and the worsening of symptoms. People often complain of worsening of any of their symptoms after taking a hot shower, or participating in strenuous exercise.

The exact reason this occurs is unknown. Perhaps it is because at higher temperatures nerve conduction decreases, which could lead to further slowing in the transmission of messages in nerves that have already lost myelin.

A physician should be notified if you or someone you know have any of the signs and symptoms associated with multiple sclerosis. Also check with a doctor if you or someone you know have any signs or symptoms that may not be associated but that are of concern. the person may not have multiple sclerosis, but because of the nonspecific nature of this disease, it is best to let a qualified professional make that determination.

Several of the symptoms of multiple sclerosis may send the patient to a hospital’s emergency department. If visual changes and painful eye movements are experienced, visit the nearest emergency department. the patient could have optic neuritis, one of the most common early signs of multiple sclerosis.

If the patient experiences personality changes or sudden loss of strength in the arms and legs they should go to the emergency department for evaluation. These symptoms are common with multiple sclerosis, but they can also be signs of other serious diseases, such as stroke, infection, or chemical imbalances.

Diagnosing multiple sclerosis is difficult. the vague and nonspecific nature or this disease mimics many other diseases. Doctors combine history, physical exam, laboratory work, and sophisticated medical imaging techniques to arrive at a diagnosis.

A complete blood count, blood chemistry, urine analysis, and often spinal fluid evaluation are all routine laboratory tests used to rule out other diagnoses and help confirm the diagnosis of multiple sclerosis. An MRI, which creates an image of the brain or the spinal cord, is used to search for changes within the brain or spinal cord that are particular to multiple sclerosis. more often than not, a neurology specialist is required to make a diagnosis.

There are several treatment options for multiple sclerosis. the following is a brief summary of the drugs approved by the FDA to treat multiple sclerosis. For more information, consult your physician.

Substances called interferons are immunomodulatory (meaning they affect the action of the immune system) drugs that have been approved to treat multiple sclerosis. Interferons are also made by the body, mainly to combat viral infections.

Interferons have been shown to decrease relapses by about one-third (if compared to patients receiving placebo) and delay progression of the disease. Common side effects include flu-like symptoms (which tend to disappear with time) and injection site reactions (which can be minimized with analgesics, rotation of injection sites, and local measures to prepare the skin prior to injection).

Interferons include interferon beta-1a (Avonex) which is given once a week as an injection into the muscle interferon beta-1a [(Rebif), which is given three times per week as an injection below the skin)], and interferon beta-1b [(Betaseron), which is given every other day as an injection below the skin].

Glatiramer acetate (Copaxone) is a mixture of amino acids used to treat multiple sclerosis. Glatiramer acetate has been shown to decrease the relapse rates of multiple sclerosis by about one-third (if compared to patients receiving placebo) and appears to also have an effect on the overall progression of multiple sclerosis.

Common side effects with Glatiramer acetate include a sensation of chest tightening following the injection, and injection site reactions which may include rare skin lesions referred to as lipoatrophy. Copaxone is given every day as an injection below the skin.

Natalizumab (Tysabri) is a monoclonal antibody that binds to white blood cells and interferes with their movement from the bloodstream into the brain and spinal cord. White blood cells are thought to play a role in causing the nervous system damage in multiple sclerosis.

Tysabri decreases relapses by about two- thirds (if compared to patients receiving placebo) and reduces the accumulation of disability, but carries a warning for increasing the risk of progressive multifocal encephalopathy (PML), a potentially fatal brain infection. because of this risk, Tysabri can only be given to patients that have registered for treatment under a controlled drug distribution program.

Several drugs that suppress the immune system and are used to treat cancer have also been used to treat multiple sclerosis, but they may make people with multiple sclerosis very ill, especially if not used with caution. Mitoxantrone (Novantrone) is a chemotherapy agent that has been approved by the FDA to treat multiple sclerosis.

Treatment with mitoxantrone requires monitoring of cardiac function, and there is a fixed limit to the dose that can be administered to patients. It also carries the long-term risk of leukemia. For these reasons, Novantrone is typically reserved for patients with more aggressive forms of multiple sclerosis.

New research and treatment methods are currently being investigated and are expected to offer some hope to people with multiple sclerosis.

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Smoking may increase the risk of multiple sclerosis in people who have other risk factors for the neurological disorder, researchers said on Wednesday.

The findings suggest that smokers who have high levels of a protein that protects against the Epstein-Barr virus, a common herpes virus, were twice as likely as nonsmokers to get multiple sclerosis (MS), the researchers wrote in the online edition of the journal Neurology.

Previous studies have suggested that smoking and the virus-fighting protein were independent risk factors and this research looked at how they may be associated with each other, Claire Simon of Harvard University said in a telephone interview.

"we found that that association was stronger in people who reported smoking compared with people who did not report smoking," Simon said.

The study found no association between smoking and a gene related to the immune system gene called HLA-DR15, which is thought to be another risk factor for MS, she said.

Studying the potential risk factors simultaneously might provide clues about why some people get MS and others do not, Simon said.

MS is an incurable condition that affects more than 1 million people worldwide. the disease can cause mild symptoms in some people and permanent disability in others. Symptoms may include numbness or weakness in one or more limbs, partial or complete loss of vision, tingling or pain, electric-shock sensation with certain head movements, tremors and an unsteady gait.

Simon and colleagues analyzed information from 442 people with MS and 865 without the disease. All were participants in either the U.S.-based Nurses’ Health Study, the Tasmanian MS Study and the Swedish MS Study.

The team determined whether participants had either of the potential factors and looked at the participants’ smoking history. the researchers said they found a consistent association between MS, smoking and the body’s immune response to the Epstein-Barr virus across the three distinct, geographic regions.

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By Jenifer GoodwinHealthDay Reporter Latest Neurology News

TUESDAY, Jan. 18 (HealthDay News) — Preliminary research and reports from patients suggest that a controversial treatment for multiple sclerosis can help relieve fatigue and other symptoms, but many physicians remain highly skeptical of the claims.

The debate started in 2009, when Dr. Paolo Zamboni, a vascular surgeon from Italy, published an intriguing study that suggested that a blockage in the veins that drain blood from the brain and spinal cord and return it to the heart might contribute to multiple sclerosis (MS).

Calling it chronic cerebrospinal venous insufficiency, or CCSVI, Zamboni’s theory was that the blockages disrupt the flow of blood from the brain and spinal cord, causing blood to back up and damage the brain and the spinal cord.

Zamboni began surgically treating people with MS with balloon angioplasty to open their veins. Other CCSVI researchers have tried stents, in which a wire mesh is placed in the vein to prop it open.

The methods of Zamboni and the others set off a heated debate among physicians and patients. many MS physicians consider the claims utter hooey. but many people with MS, desperate for relief, pressed for research, and some, unwilling to wait, sought out physicians abroad who’d do the surgery.

Despite the skepticism, U.S. researchers began investigating venous blockage. in June, the National Multiple Sclerosis Society announced $2.4 million in funding for CCSVI studies, most of which are trying to answer the basic question of whether there is actually a link between venous blockages and MS.

Among those conducting CCSVI research is Dr. Michael Dake, a professor of cardiothoracic surgery at Stanford University School of Medicine.

Dake followed 30 people with MS who had stents implanted to open their veins. Two months after surgery, they reported feeling 50% less fatigued than before surgery, Dake said. they continued to be less fatigued at the one-year mark, even improving slightly from where they were two months after surgery, he said.

People who saw the most benefit were those with the relapsing-remitting form of MS, in which periods of remission, when the person feels relatively good, are followed by MS flares, Dake said.

People with more aggressive or more advanced forms of MS, including primary and secondary progressive MS, reported about a 40% drop in fatigue two months after the surgery, but the effect did not last at the one-year mark, Dake said.

MS is believed to be an autoimmune disease in which the body’s immune system attacks myelin, or the substance that insulates nerve fibers of the central nervous system. The damage disrupts nerve signals traveling to and from the brain, which can lead to numbness, movement difficulties and blurred vision. Other symptoms can include fatigue and cognitive problems, sometimes described by those with MS as being in a fog.

Vein opening is unlikely to help regenerate damaged myelin, which causes the movement difficulties, Dake said, but opening blocked veins looks like it may help alleviate fatigue, at least in people with relapsing-remitting MS.

“It’s a stretch to think opening up veins is going to deal with or reverse an injury that is due to demyelinating plaque, whereas the symptoms that are more general, such as fatigue and brain fog that are much more related to an obstruction in venous outflow from the brain — those could potentially be reversed,” he said.

Dake was scheduled to present his findings this week at the International Symposium on Endovascular Therapy in Miami Beach.

He cautioned that his research was not a randomized, controlled, clinical trial but rather a review of his clinical experience with 30 patients.

Therein lies the problem with CCSVI and its treatments, said Dr. Lily Jung, medical director of the neurology clinic at the Swedish Neuroscience Institute in Seattle.

“There is no clear evidence that MS has anything to do with blocked veins, and to then jump to therapy for blocked veins is premature,” Jung said.

The research done on CCSVI has not consistently established that people with MS are more likely to have venous blockage than are healthy people or those with other neurological diseases, Jung said. nor is it known when venous blockage occurs during the course of the disease or why such a blockage, if it occurs, would cause symptoms of MS.

Until much more is learned, Jung warned people against seeking treatment for CCSVI because of the danger of complications. According to the National Multiple Sclerosis Society, a Canadian man with MS died after seeking angioplasty in Costa Rica, and another had to have emergency open heart surgery to retrieve a stent that dislodged.

“It is not ready for prime time,” Jung said. “We need to first establish how firm the basis for the theory is and, secondly, have a widely accepted agreement about how to diagnose CCSVI before you try treatment for it,” she said.

Dr. James Benenati, president of the Society of Interventional Radiologists, described MS as a heterogeneous disease — meaning that not every person with MS has venous blockages, and not every person with venous blockages has MS. And that, he said, makes the research more difficult.

Benenati said he plans to begin offering the treatment to MS patients at Baptist Cardiac & Vascular Institute in Miami as part of a research study.

“My feeling and the society’s feeling is we don’t have enough data yet to say 100% yes or no,” Benenati said. “But to basically condemn something because there isn’t good data at this time is premature — and not very scientifically sound, either. my own feeling is it is going to pan out to be something of great value.”

In the meantime, not everyone with MS seems willing to wait for the lengthy clinical trials to be completed. “We’re getting a huge number of calls on this,” Benenati said. “It can be overwhelming.”

Copyright © 2011 HealthDay. All rights reserved.

SOURCES: Michael Dake, M.D., professor, cardiothoracic surgery, Stanford University School of Medicine, Stanford, Calif.; James Benenati, M.D., medical director, peripheral vascular laboratory, Baptist Cardiac & Vascular Institute, Miami; Lily Jung, M.D., medical director, neurology clinic, Swedish Neuroscience Institute, Seattle; presentation, Jan. 17, 2011, International Symposium on Endovascular Therapy, Miami Beach

Chepstow woman tells story of her disability

9:20am Tuesday 4th January 2011

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AT 29 years old, Meg Kingston was struck by the first serious symptoms of what was eventually diagnosed as multiple sclerosis (MS) – 17 years on, she has written and published a book about her experiences.

The MonSter and the Rainbow: Memoir of a Disability, is Chepstow-based Mrs Kingston’s account of her struggles to get a diagnosis, and how the disease took hold of her life.

Self-published, part of the proceeds from sales will go to MS charities, but another key aim, she says, is to try to get people to think about disability, and how the wider world views disability and the disabled.

“I think it is a problem for many people, understanding what chronic illness really means,” said Mrs Kingston, a former IT engineer, who also runs disability awareness programmes.

“It is difficult for people to understand that you have whatever disability you have, and you have to cope with it.

“Among those I’d like to read it are anyone who works with a person with a chronic illness, anyone who works in a service industry, anyone basically, who in a role where they have to deal with people.”

at the heart too, of The MonSter and the Rainbow is MS, the most common disabling neurological condition.

The book chronicles unflinchingly but not without humour, Mrs Kingston’s struggles with the challenges and frustrations of life with MS, and its effects on a previously fit person who can now only walk short distances with the aid of sticks, and uses a battery-powered wheelchair.

“One of the big problems is that everybody has heard of MS, but very few know what it is,” said Mrs Kingston, who has also published three volumes of short stories and is currently working on a drama with a BBC Radio Four producer.

• The MonSter and the Rainbow is published by Mrs Kingston’s own Jay Walker Writing, priced £8.99. it is available from the Rainbow Bookshop and Cafe, Moor Street, Chepstow, or through monster-rainbow.co.uk

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EDINBURGH, Scotland, Dec. 7 (UPI) — Scottish researchers say a discovery involving stem cells may lead to reversing nerve damage and paralysis caused by multiple sclerosis.

MS is caused when the body’s immune system attacks a substance called myelin that covers and protects nerve fibers, disrupting messages as they are sent around the body.

Researchers from Edinburgh and Cambridge universities say they have identified a mechanism that helps regenerate the myelin sheaths that protect the body’s nerve fibers, particularly in the brain, the Daily Express reported Monday.

Identifying a way of regenerating the sheaths could lead to new drugs and treatments, the researchers say.

MS begins as a relapsing-remitting condition in which symptoms appear and then fade away, but every relapse causes more damage and even though symptoms retreat the sufferer never returns to normal.

“Therapies that repair damage are the missing link in treating multiple sclerosis,” Professor Robin Franklin at Cambridge University said. “In this study we have identified a means by which the brain’s own stem cells can be encouraged to undertake this repair, opening up the possibility of a new regenerative medicine.”