Multiple sclerosis (MS) is an inflammatory, chronic, degenerative disorder that affects nerves in the brain and spinal cord. Myelin, the fatty substance that surrounds and insulates nerves and facilitates the conduction of nerve impulses is the initial target of inflammatory destruction in multiple sclerosis.
MS is characterized by intermittent damage to myelin, called demyelination. Demyelination causes scarring and hardening (sclerosis) of nerve tissue in the spinal cord, brain, and optic nerves. Demyelination slows conduction of nerve impulses, which results in weakness, numbness, pain, and vision loss.
Because different nerves are affected at different times, MS symptoms often worsen (exacerbate), improve, and develop in different areas of the body. Early symptoms of the disorder may include vision changes (e.g., blurred vision, blind spots), numbness, dizziness, and muscle weakness.
MS can progress steadily or cause acute attacks (exacerbations) followed by partial or complete reduction in symptoms (remission). Most patients with the disease have a normal lifespan.
MS is the most common neurological cause of debilitation in young people. According to the National Institute of Neurological Disorders and Stroke, about 250,000–350,000 people in the United States have been diagnosed with multiple sclerosis. Worldwide, the incidence of MS is approximately 0.1%. Northern Europe, the northern United States, southern Australia, and New Zealand have the highest prevalence, with more than 30 cases per 100,000 people.
MS is more common in women and in Caucasians. The average age of onset is between 20 and 40, but the disorder may develop at any age. Children of parents with MS have a higher rate of incidence (30–50%).
Multiple sclerosis is classified according to frequency and severity of neurologicalsymptoms, the ability of the central nervous system (CNS) to recover, and the accumulation of damage.
* Primary progressive MS causes steady progression of symptoms with few periods of remission.
* Relapsing-Remitting MS causes worsening of symptoms (exacerbations) that occur with increasing frequency, along with periods of reduced symptoms (remission).
* Secondary progressive MS is initially similar to relapsing-remitting MS but eventually follows a progressive course without remissions.
* Relapsing-Progressive MS causes cumulative damage during exacerbations and remissions.
Multiple sclerosis symptoms include weakness, numbness, and tingling in one or more of the limbs;vision loss; uncontrollable movements; dizziness; and fatigue.
During early stages of the disease, symptoms of MS often occur, disappear completely for a time, and then return again. There is no cure for MS and the condition can become increasingly debilitating over time. MS treatment varies depending on the type and severity of symptoms and usually includes medications.
Ok, we got the technical stuff out of the way. Now this is the nitty gritty.
Here are some questions to ask your doctor (e.g., neurologist) about multiple sclerosis. Print this out, check off the questions you would like answered, and take it with you to your doctor appointment. The more knowledge you have about multiple sclerosis, the easier it will be to make important decisions about your treatment and medical care. If he/she does not have answers to your questions, then you need to shop for a Neurologist who is a MS Specialist and who can provide you with knowledge, appropriate treatment "choices" (treatments are always YOUR choice), and is accessible to you when you need him/her.
Questions to Ask Your Doctor about Multiple Sclerosis (MS) - Do your homework first. Know the answers to these questions before you ask your doctor. If he/she gives you an answer that is different from your research, ask for references, written material, even a "go to" person/place for you to verify. No doctor will know the answers to all of these questions. Some of these questions, quite frankly, cannot be answered because we just do not know. An honest doctor will tell you "I don't know" to at least 3 of these questions. If he gives that answer to more than 10, you might want to start interviewing neurologists who specialize in the treatment of Multiple Sclerosis so that you have a doctor who is current with the information that is available. It also helps to have a doctor who is willing to answer your questions, and to spend more than 5 minutes with you.
* What other conditions can cause multiple sclerosis symptoms?
* Why do you suspect that I have multiple sclerosis?
* How will my condition be diagnosed? What types of examinations and tests will be performed?
* What do tests to diagnose MS involve?
* How should I prepare for these exams and tests?
* Are there any risks associated with these tests?
* Once multiple sclerosis has been diagnosed, what types of tests might I need to have on a regular basis?
* What type of MS do I have? Ask how your type was determined.
* How severe is my current condition?
* What is the usual prognosis for people who have this type of MS?
* How do you expect my condition to progress?
* How might MS affect my daily life?
* What type of treatment do you recommend?
* Why do you recommend this particular course of treatment? (Remember it is a RECOMMENDATION, your choice.)
* Should I seek a second opinion? Why or why not? (NOTE: ALWAYS GET 2nd OPINION)
* Might lifestyle changes, such as diet and exercise, help slow or stop the progression of my multiple sclerosis? If so, what changes do you recommend?
* What support resources are available to help me change my lifestyle?
* Is it possible to reverse the effects of MS?
* Will medication(s) be used to treat my condition? (Get complete info on each)
* What are the benefits, risks, and possible side effects from these medications?
* What should I do if I experience serious side effects?
* Emergency Telephone number to call:
* About how long might it take for my MS treatments to begin working?
* How will my condition be monitored? Are there any warning signs I should look for?
* What should I do if my symptoms worsen or these warning signs develop? Telephone number to call:
* Might physical and/or occupational therapy help me to manage my MS symptoms? Why or why not? Physical/Occupational Therapist: Telephone number to call:
* What should I do if I have trouble performing daily tasks and normal activities?
* What other therapies might help me manage my MS symptoms?
* Are there any local support groups for people with MS?
* Are there any support groups for family members and caregivers?
* Can you recommend resources for more information about MS?
SYMPTOMS OF MULTIPLE SCLEROSIS
Initial symptoms of MS may be brief and mild. The first serious attack usually lasts weeks or months.
The most common early symptoms include sensory abnormalities (e.g., tingling, numbness, itching, tightness, burning, shooting pain in the back and limbs [Lhermitte's sign]) difficulty walking, eye pain, and vision loss.
Symptoms of the disease vary, depending on where the damage occurs, and range from minor physical annoyances to major disabilities.
Common symptoms include the following:
* Balance and equilibrium abnormalities (e.g., dizziness, vertigo, uncoordinated movements, tremor)
* Bladder and bowel dysfunction (e.g., urgency, incontinence, nocturia, constipation)
* Behavioral changes (e.g., mood swings, depression)
* Cognitive dysfunction (e.g., impaired memory, reasoning, concentration)
* Facial numbness
* Motor abnormalities (e.g., muscle weakness, spasticity, spasm)
* Sexual dysfunction (e.g., erectile dysfunction, sexual inactivity)
* Vision abnormalities (e.g., eye pain, vision loss in one eye, double vision [diplopia], involuntary eye movement [nystagmus])
* Muscle weakness can involve the extremities (arms and legs) on one side of the body (hemiparesis), both legs (paraparesis), or all four extremities (quadraparesis). Muscles in the affected area may tighten (spasticity) and contract spontaneously (spasm or clonus).
Many people with MS experience fatigue and need to rest and/or sleep during the day in order to continue their activities. The degree of fatigue may not be related to the severity of other symptoms.
An increase in body temperature (e.g., caused by hot weather, hot bath and showers, or fever) can worsen symptoms or produce new ones. This occurs because elevated body temperature slows nerve impulse conduction, especially in demyelinated nerves.
Symptoms depend on which parts of the brain and spinal cord are damaged and how bad the damage is.
Early symptoms may include:
* Muscle problems. You may feel weak and stiff, and your limbs may feel heavy. You may drag your leg when you walk or have trouble lifting your foot (foot drop). You may drop things more than usual and be less coordinated.
* Visual problems. Your vision may be blurred or hazy. You may have eyeball pain (especially when you move your eyes), blindness, or double vision. Optic neuritis-sudden loss of vision that is often painful-is a fairly common first symptom.
* Sensory problems. You may feel tingling, a pins-and-needles sensation, or numbness. You may feel a band of tightness around your trunk or limbs or a feeling of electricity moving down your back and limbs.
* Balance problems. You may feel lightheaded or dizzy or feel like you're spinning.
As MS gets worse, you may have tremors and pain and feel stiff when you move. You may have problems with controlling urination, swallowing, and thinking clearly. MS can lead to depression. Many people with MS are sensitive to heat. Hot weather, a fever, a hot shower, or too much exercise can make their symptoms worse until they cool down.
MS is very unpredictable. Your symptoms may suddenly get worse with no warning, or you may go for years without any problems.
Diagnosing MS is not always easy. The first symptoms may be vague, and many of the symptoms can be caused by problems other than MS. Try not to be frustrated if months or even years go by before your illness is definitely identified as MS. MS is not diagnosed unless a doctor can be sure that you have had at least two attacks. The doctor will examine you, ask you questions about your symptoms, and do some tests. An MRI is often used to confirm the diagnosis, because the patches of damage (lesions) caused by MS attacks can be seen with this test.
ALWAYS get copies of your tests and MRI's with written reports for your records. This will save you a lot of time and frustration in the future if and when you choose to change doctors, facilities, or treatment plans and provides you with a timeline of date of onset through to present day treatment.
More posts to come on diet, medications, exercise, workplace challenges, your rights in the workplace, pregnancy, careers, incontinence, vitamins and supplements, lab work, and alternative medicine.
Sources: WebMD, Multiple Sclerosis Society, Various Bloggers, Life Experience
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