*** MS Friends***

          The About MS Section



      Email: ab@netcomuk.co.uk

Multiple sclerosis is a disease caused by inflammation and scarring of tissue in the brain and spinal cord. More specifically, the inflammation breaks down myelin, the white, fatty material that provides a thick sheath or covering for nerve fibers in the central nervous system.
A healthy myelin sheath enables a nerve cell to send electrical impulses along its fiber at high velocity, a function critical for accomplishing such basic activities as walking, eating, or breathing.
As multiple sclerosis causes more and more of the sheath to be stripped away, a process called demyelination, electrical impulses proceed more and more slowly down the fiber. Depending on which nerves are affected, severe or mild disabilities can occur. If myelin in sensory nerves is lost, for example, a person may have an impaired sense of touch.
Multiple sclerosis gets its name because the demyelination is often followed by sclerosis, or hardening of nervous system tissue, usually at multiple sites. The sclerosis is the result of scar tissue forming in the central nervous system (a process called gliosis).
In part because we can not determine in advance which nerve fibers will be affected in a particular patient--the disease can impair any part of the central nervous system--the severity of multiple sclerosis is often unpredictable.
Some people may have mild problems, with no significant permanent disability. For others, multiple sclerosis means severe paralysis and confinement to a wheelchair. It is known that the disease often strikes people in the prime of life, most commonly between the ages of 20 and 40, although some people do not develop multiple sclerosis until their forties or fifties. The disease strikes about twice as many women as men.
What Are The Symptoms Of Multiple Sclerosis?
Although severe forms of multiple sclerosis can be devastating, the illness shortens a person's average life expectancy by only about five years. Common symptoms of the disease include fatigue and loss of strength. Patients often have increased muscle stiffness (spasticity).
There may be loss of sensation in the arms and legs, or an ever-present tingling sensation, like feeling pins and needles. People also may have facial pain.
If multiple sclerosis has affected the cerebellum, a portion of the nervous system near the back of the brain, the patient may have poor coordination, loss of balance, or tremors.
If the optic nerve is involved, the patient may have blurred or reduced vision. Patients with demyelination of the brain stem, a region that controls eye movement, commonly have double vision, since each eye may no longer focus on the same object.
If the illness has impaired the spinal cord, in addition to losing leg strength, the patient may lose bladder control, become constipated, or become impotent.
One common feature of multiple sclerosis is that many symptoms worsen when patients are exposed to heat. This is because elevated temperatures -- whether from a hot bath, exercise, or exposure to the sun -- further slow the conduction of electrical impulses in nerve fibers.
Conversely, a cold bath can sometimes temporarily relieve symptoms or reduce some of the fatigue multiple sclerosis patients often feel.
Neurologists divide multiple sclerosis into two types. The first, known as exacerbating-remitting disease, is characterized by fluctuations in nerve function. Periods of deteriorating ability are followed by periods of recovery, although, as time passes, recovery often becomes less and less complete.
The second form of the illness, chronic progressive disease, has more of a steady downhill course, typically without periods of temporary recovery. Frequently, people who initially have the fluctuating form of multiple sclerosis go on to develop the chronic form.
What Are The Treatment Options For Multiple Sclerosis?
There are two basic strategies for treating multiple sclerosis. One regimen attempts to reduce the underlying inflammation and the presumed impaired immune attack against the nervous system. The other strategy emphasizes relief of symptoms.
Treating the Causes of Inflammation and
Immune System Dysfunction
The choice of drugs to reduce inflammation depends on the type of multiple sclerosis. For people with exacerbating-remitting multiple sclerosis, the more mild form of the illness, physicians often recommend a pituitary hormone known as adrenocorticotrophic hormone, or ACTH.
This hormone stimulates the adrenal glands to produce cortisol and certain other steroids that reduce inflammation. Alternatively, synthetic steroids, such as prednisone or methylprednisolone, may be given to lower inflammation in the nervous system.
Other agents that might more effectively reduce inflammation are under study. Preliminary research indicates that alpha and beta interferon may be of benefit, and ongoing studies seek to determine the optimum dose of these naturally occurring substances.
Another promising drug for people with relatively mild multiple sclerosis is copolymer-I. A small study suggests that the drug can help people who take it for an extended period. Unlike many other drugs used to treat multiple sclerosis, copolymer-I appears to have few side effects. A larger, multicentre, controlled study of the drug is underway.
People who have chronic progressive multiple sclerosis, the more severe form of the illness, are much more difficult to treat. Drugs for this illness tend to be stronger immunosuppressive agents and carry more serious side effects.
Neurologists debate whether these drugs should be used at all. Some believe that the risks of using these drugs far outweigh their benefits. Others believe that they should treat multiple sclerosis aggressively, even if it means using a drug that can only temporarily stop the disease from getting worse until a better, safer treatment comes along.
One of the better known drugs that falls into this category is cyclophosphamide, or Cytoxan. Data indicate that only about a third of people who receive the drug show improvement; another one-third remain stable, neither improving nor deteriorating; and one-third deteriorate at about the same rate that would be expected if they did not take the drug.
Another experimental treatment for severe and milder forms of multiple sclerosis is plasma exchange, or plasmapheresis. In this procedure, blood is removed from the body and the plasma portion is discarded before the red and white blood cells are returned.
The strategy behind this treatment is that plasmapheresis may remove harmful antibodies or other harmful substances circulating in the blood that may damage the nervous system. A large, multicenter study underway in Canada may determine the effectiveness of the treatment.
Another procedure recently tested in multiple sclerosis patients is total lymphoid radiation. This treatment, which involves radiation of the immune system, has been used successfully for 20 years in treating early stages of a cancer called Hodgkin's disease.
Preliminary studies suggest that the treatment may help stabilize people with chronic progressive multiple sclerosis for as long as three to four years. A larger clinical trial is planned.
Monoclonal antibodies are one of the more promising experimental therapies for multiple sclerosis, and one which you will be hearing more about in the next few years. Monoclonal antibodies are pure antibodies that can be generated in huge quantities in animals, usually mice.
And unlike drugs that suppress the entire immune system, causing unwanted side effects, these antibodies can be directed against specific cells believed to damage the nervous system in multiple sclerosis patients. Various clinical trials are underway or being planned to evaluate monoclonal antibodies directed against all T-cells, against helper T-cells, or against the subset of activated T-cells.
Activated T-cells, as opposed to resting cells, are believed to mediate damage to the nervous system in people with multiple sclerosis. Researchers at Stanford University plan to test monoclonal antibodies against HLA-DR2, the genetic marker discussed above. Future studies also are likely to examine the ability to block certain T-cell receptor molecules that may be common in tissue damaged by multiple sclerosis.
Treating Symptoms
Medical experts have generally been more successful at treating symptoms than the root causes of multiple sclerosis. The drug baclofen (Lioresal) treats such symptoms as painful spasms and stiffness. Another anti-spastic drug, dantrolen (Dantrium), is effective but can cause serious liver damage. Two drugs can reduce fatigue in multiple sclerosis patients: amantadine (Symmetrel) and semoline Cylert).
None of these medications, however, are without their own set of risks and side effects. A common side effect of baclofen, for example, is weakness. In order to make an informed decision about their health care needs, individuals should ask their physicians to fully explain the benefits, risks and costs of all treatment options, including alternatives.
The inability to control bladder function is a distressing problem that leaves many people with multiple sclerosis ashamed to leave home. The drug Ditropan helps control bladder function. Constipation, another symptom frequently seen in patients, can be treated with several compounds.
A first treatment might be bulk laxatives such as Metamucil alone or in combination with a stool softener such as Colace or Surfak. If these do not work, Milk of Magnesia, Dulcolax or several other agents may be prescribed. An enema may be needed to keep the constipation from causing serious damage.
Facial pain and other painful syndromes can be treated with anticonvulsive medications such as carbamazepine (Tegretol), phenytoin sodium (Dilantin) or Valproic Acid (Depakote). Elavil, originally manufactured as an antidepressant, also helps treat pain originating in the nervous system, as in multiple sclerosis.
As a last resort, if severe pain persists and interferes with such basic functions as speaking or chewing, some people may have a section of the nerve surgically removed or blocked. People who undergo this procedure will have numbness over part or much of the face.
A surgeon can first reversibly block the nerve to give the patient an idea of the numbness that will be produced. For some, the loss of feeling may be as disturbing as the pain they had before surgery.
Exercise can cause problems for people with multiple sclerosis because the resulting overheating can make neurological symptoms worse. But because cold temperatures increase the velocity of electrical impulses in nerves, which are slowed in multiple sclerosis, exercising in cold water may temporarily help relieve symptoms of multiple sclerosis.
The ability to dissipate heat in cold water, combined with the buoyancy that people have in water, allows patients to maintain fitness through swimming without suffering the side effects of overheating that they would experience if they exercised in more conventional ways.
In addition, an experimental drug, 4-aminopyridine, appears to increase the velocity of impulses in demyelinated nerves. This and/or related drugs are expected to become generally available to treat multiple sclerosis during the next few years.
Physical medicine and rehabilitation are important complements to drug therapy for multiple sclerosis. Physical therapists work with the patient on developing strength, coordination, balance, and stamina to perform activities without tiring.
Occupational therapists concentrate more on coping with daily living and have introduced several devices that help people function more easily, for example, with dressing and eating. One of the most useful innovations is the motor scooter, a vehicle that has allowed people to maintain their jobs long after they would have had to retire on disability.
The device is useful not only for people who can no longer walk, but also for ambulatory people who tire easily due to the disease.
In addition, vocational rehabilitation has taken on greater emphasis. People who can no longer physically perform their jobs can learn new skills in an increasing number of vocational programs, including many sponsored by local chapters of the Multiple Sclerosis Society.
Also, progressive companies are supporting individuals' abilities to work from their homes. As this trend continues, more people will be able to remain productive employees through computers in their homes.
Conclusion
All of these various forms of therapy -- established and experimental drug treatments, physical therapy, occupational therapy, and new mechanical devices -- have helped to promote a much greater degree of independence among people with multiple sclerosis.
Increasingly, people with this disease are leading happier, fuller, and more productive lives. The large number of clinical trials and research studies underway promises to offer even more effective treatments for multiple sclerosis in the future.
Source: National Institutes of Health, Warren Grant Magnuson Clinical Center, Adapted from Multiple Sclerosis: Medicine for the Public, John Richert, M.D. Associate Professor of Neurology, Georgetown University Medical Center.
CLICK HERE FOR MORE

This page accessed times. Page created by: ab@netcomuk.co.uk




			The About MS Section
		Email: ab@netcomuk.co.uk	Multiple sclerosis is a disease caused by inflammation and scarring of tissue in the brain and spinal cord. More specifically, the inflammation breaks down myelin, the white, fatty material that provides a thick sheath or covering for nerve fibers in the central nervous system. A healthy myelin sheath enables a nerve cell to send electrical impulses along its fiber at high velocity, a function critical for accomplishing such basic activities as walking, eating, or breathing. As multiple sclerosis causes more and more of the sheath to be stripped away, a process called demyelination, electrical impulses proceed more and more slowly down the fiber. Depending on which nerves are affected, severe or mild disabilities can occur. If myelin in sensory nerves is lost, for example, a person may have an impaired sense of touch. Multiple sclerosis gets its name because the demyelination is often followed by sclerosis, or hardening of nervous system tissue, usually at multiple sites. The sclerosis is the result of scar tissue forming in the central nervous system (a process called gliosis). In part because we can not determine in advance which nerve fibers will be affected in a particular patient--the disease can impair any part of the central nervous system--the severity of multiple sclerosis is often unpredictable. Some people may have mild problems, with no significant permanent disability. For others, multiple sclerosis means severe paralysis and confinement to a wheelchair. It is known that the disease often strikes people in the prime of life, most commonly between the ages of 20 and 40, although some people do not develop multiple sclerosis until their forties or fifties. The disease strikes about twice as many women as men. What Are The Symptoms Of Multiple Sclerosis? Although severe forms of multiple sclerosis can be devastating, the illness shortens a person's average life expectancy by only about five years. Common symptoms of the disease include fatigue and loss of strength. Patients often have increased muscle stiffness (spasticity). There may be loss of sensation in the arms and legs, or an ever-present tingling sensation, like feeling pins and needles. People also may have facial pain. If multiple sclerosis has affected the cerebellum, a portion of the nervous system near the back of the brain, the patient may have poor coordination, loss of balance, or tremors. If the optic nerve is involved, the patient may have blurred or reduced vision. Patients with demyelination of the brain stem, a region that controls eye movement, commonly have double vision, since each eye may no longer focus on the same object. If the illness has impaired the spinal cord, in addition to losing leg strength, the patient may lose bladder control, become constipated, or become impotent. One common feature of multiple sclerosis is that many symptoms worsen when patients are exposed to heat. This is because elevated temperatures -- whether from a hot bath, exercise, or exposure to the sun -- further slow the conduction of electrical impulses in nerve fibers. Conversely, a cold bath can sometimes temporarily relieve symptoms or reduce some of the fatigue multiple sclerosis patients often feel. Neurologists divide multiple sclerosis into two types. The first, known as exacerbating-remitting disease, is characterized by fluctuations in nerve function. Periods of deteriorating ability are followed by periods of recovery, although, as time passes, recovery often becomes less and less complete. The second form of the illness, chronic progressive disease, has more of a steady downhill course, typically without periods of temporary recovery. Frequently, people who initially have the fluctuating form of multiple sclerosis go on to develop the chronic form. What Are The Treatment Options For Multiple Sclerosis? There are two basic strategies for treating multiple sclerosis. One regimen attempts to reduce the underlying inflammation and the presumed impaired immune attack against the nervous system. The other strategy emphasizes relief of symptoms. Treating the Causes of Inflammation and Immune System Dysfunction The choice of drugs to reduce inflammation depends on the type of multiple sclerosis. For people with exacerbating-remitting multiple sclerosis, the more mild form of the illness, physicians often recommend a pituitary hormone known as adrenocorticotrophic hormone, or ACTH. This hormone stimulates the adrenal glands to produce cortisol and certain other steroids that reduce inflammation. Alternatively, synthetic steroids, such as prednisone or methylprednisolone, may be given to lower inflammation in the nervous system. Other agents that might more effectively reduce inflammation are under study. Preliminary research indicates that alpha and beta interferon may be of benefit, and ongoing studies seek to determine the optimum dose of these naturally occurring substances. Another promising drug for people with relatively mild multiple sclerosis is copolymer-I. A small study suggests that the drug can help people who take it for an extended period. Unlike many other drugs used to treat multiple sclerosis, copolymer-I appears to have few side effects. A larger, multicentre, controlled study of the drug is underway. People who have chronic progressive multiple sclerosis, the more severe form of the illness, are much more difficult to treat. Drugs for this illness tend to be stronger immunosuppressive agents and carry more serious side effects. Neurologists debate whether these drugs should be used at all. Some believe that the risks of using these drugs far outweigh their benefits. Others believe that they should treat multiple sclerosis aggressively, even if it means using a drug that can only temporarily stop the disease from getting worse until a better, safer treatment comes along. One of the better known drugs that falls into this category is cyclophosphamide, or Cytoxan. Data indicate that only about a third of people who receive the drug show improvement; another one-third remain stable, neither improving nor deteriorating; and one-third deteriorate at about the same rate that would be expected if they did not take the drug. Another experimental treatment for severe and milder forms of multiple sclerosis is plasma exchange, or plasmapheresis. In this procedure, blood is removed from the body and the plasma portion is discarded before the red and white blood cells are returned. The strategy behind this treatment is that plasmapheresis may remove harmful antibodies or other harmful substances circulating in the blood that may damage the nervous system. A large, multicenter study underway in Canada may determine the effectiveness of the treatment. Another procedure recently tested in multiple sclerosis patients is total lymphoid radiation. This treatment, which involves radiation of the immune system, has been used successfully for 20 years in treating early stages of a cancer called Hodgkin's disease. Preliminary studies suggest that the treatment may help stabilize people with chronic progressive multiple sclerosis for as long as three to four years. A larger clinical trial is planned. Monoclonal antibodies are one of the more promising experimental therapies for multiple sclerosis, and one which you will be hearing more about in the next few years. Monoclonal antibodies are pure antibodies that can be generated in huge quantities in animals, usually mice. And unlike drugs that suppress the entire immune system, causing unwanted side effects, these antibodies can be directed against specific cells believed to damage the nervous system in multiple sclerosis patients. Various clinical trials are underway or being planned to evaluate monoclonal antibodies directed against all T-cells, against helper T-cells, or against the subset of activated T-cells. Activated T-cells, as opposed to resting cells, are believed to mediate damage to the nervous system in people with multiple sclerosis. Researchers at Stanford University plan to test monoclonal antibodies against HLA-DR2, the genetic marker discussed above. Future studies also are likely to examine the ability to block certain T-cell receptor molecules that may be common in tissue damaged by multiple sclerosis. Treating Symptoms Medical experts have generally been more successful at treating symptoms than the root causes of multiple sclerosis. The drug baclofen (Lioresal) treats such symptoms as painful spasms and stiffness. Another anti-spastic drug, dantrolen (Dantrium), is effective but can cause serious liver damage. Two drugs can reduce fatigue in multiple sclerosis patients: amantadine (Symmetrel) and semoline Cylert). None of these medications, however, are without their own set of risks and side effects. A common side effect of baclofen, for example, is weakness. In order to make an informed decision about their health care needs, individuals should ask their physicians to fully explain the benefits, risks and costs of all treatment options, including alternatives. The inability to control bladder function is a distressing problem that leaves many people with multiple sclerosis ashamed to leave home. The drug Ditropan helps control bladder function. Constipation, another symptom frequently seen in patients, can be treated with several compounds. A first treatment might be bulk laxatives such as Metamucil alone or in combination with a stool softener such as Colace or Surfak. If these do not work, Milk of Magnesia, Dulcolax or several other agents may be prescribed. An enema may be needed to keep the constipation from causing serious damage. Facial pain and other painful syndromes can be treated with anticonvulsive medications such as carbamazepine (Tegretol), phenytoin sodium (Dilantin) or Valproic Acid (Depakote). Elavil, originally manufactured as an antidepressant, also helps treat pain originating in the nervous system, as in multiple sclerosis. As a last resort, if severe pain persists and interferes with such basic functions as speaking or chewing, some people may have a section of the nerve surgically removed or blocked. People who undergo this procedure will have numbness over part or much of the face. A surgeon can first reversibly block the nerve to give the patient an idea of the numbness that will be produced. For some, the loss of feeling may be as disturbing as the pain they had before surgery. Exercise can cause problems for people with multiple sclerosis because the resulting overheating can make neurological symptoms worse. But because cold temperatures increase the velocity of electrical impulses in nerves, which are slowed in multiple sclerosis, exercising in cold water may temporarily help relieve symptoms of multiple sclerosis. The ability to dissipate heat in cold water, combined with the buoyancy that people have in water, allows patients to maintain fitness through swimming without suffering the side effects of overheating that they would experience if they exercised in more conventional ways. In addition, an experimental drug, 4-aminopyridine, appears to increase the velocity of impulses in demyelinated nerves. This and/or related drugs are expected to become generally available to treat multiple sclerosis during the next few years. Physical medicine and rehabilitation are important complements to drug therapy for multiple sclerosis. Physical therapists work with the patient on developing strength, coordination, balance, and stamina to perform activities without tiring. Occupational therapists concentrate more on coping with daily living and have introduced several devices that help people function more easily, for example, with dressing and eating. One of the most useful innovations is the motor scooter, a vehicle that has allowed people to maintain their jobs long after they would have had to retire on disability. The device is useful not only for people who can no longer walk, but also for ambulatory people who tire easily due to the disease. In addition, vocational rehabilitation has taken on greater emphasis. People who can no longer physically perform their jobs can learn new skills in an increasing number of vocational programs, including many sponsored by local chapters of the Multiple Sclerosis Society. Also, progressive companies are supporting individuals' abilities to work from their homes. As this trend continues, more people will be able to remain productive employees through computers in their homes. Conclusion All of these various forms of therapy -- established and experimental drug treatments, physical therapy, occupational therapy, and new mechanical devices -- have helped to promote a much greater degree of independence among people with multiple sclerosis. Increasingly, people with this disease are leading happier, fuller, and more productive lives. The large number of clinical trials and research studies underway promises to offer even more effective treatments for multiple sclerosis in the future. Source: National Institutes of Health, Warren Grant Magnuson Clinical Center, Adapted from Multiple Sclerosis: Medicine for the Public, John Richert, M.D. Associate Professor of Neurology, Georgetown University Medical Center. CLICK HERE FOR MORE
			This page accessed times. Page created by: ab@netcomuk.co.uk