The Everything Health Guide to Multiple Sclerosis

An authoritative guide to help you understand symptoms, decide on treatment, and enhance your well-being

Margot Russell, Allen C Bowling

• Publisher: Everything
• Year: 2008
• Print ISBN: 9781598698053
• eBook ISBN: 9781605507620
• Topic: Medicine
• Subtopic: Diseases & Allergies

The National Multiple Sclerosis Society estimates that 400,000 people in the United States have been diagnosed with MS. Because MS is a chronic disease, people with this diagnosis will live with the disease for years. MS sufferer Margot Russell and Dr. Allen C. Bowling, a nationally known MS expert, team up to help you:

• Recognize signs and symptoms
• Understand the types of MS
• Decide on treatment and find the right doctor
• Explore alternative therapies
• Take charge by creating a management plan
• Develop strength and avoid relapse
• And more!

Filled with tips for daily living (like staying cool) and the latest information on new treatments, this reassuring book offers more than medical advice. It gives readers with MS the strength, knowledge, and resources they need so they can live a full, active life!

CHAPTER 1


MS: The Nuts and Bolts

IF YOU’VE PICKED up this book, it is most likely because you—or someone you love—has been diagnosed with multiple sclerosis (MS), or perhaps your doctor has mentioned MS as a possibility. Whatever the case, you may have already discovered that putting MS into perspective can be a challenging process. MS is a complex disease, and one that is especially hard to diagnose. Its symptoms vary widely from person to person, and although researchers have made great strides in understanding the condition, the cause remains a mystery.

What Is MS?

While most everyone has heard of MS, you certainly wouldn’t be the first person to lack a full understanding of its nuts and bolts. When MS is suspected or diagnosed, it is not uncommon for someone to ask “What exactly is MS?”

MS is defined as a chronic, inflammatory, demyelinating disease that affects the central nervous system (CNS). What that means in a nutshell is this: MS is thought to be an autoimmune disease that affects the command center of your body’s functions—your CNS— resulting in a myriad of neurological symptoms. To get a better handle on the mechanics of MS, you must first understand the roles the CNS and the immune system play.

The Nervous System

The nervous system is composed of two parts:

• The central nervous system is made up of the brain, spinal cord, and optic nerves. It interprets sensory information and sends commands to the muscles.

• The peripheral nervous system (PNS) connects the CNS to the glands, sensory organs, and muscles through a branching network of nerves.

Both the CNS and the PNS are made up of nerves that act as the body’s messenger system. Each nerve is covered by a fatty substance called myelin, which provides insulation and helps in the transmission of nerve impulses, or messages between the brain and other parts of the body. MS is exclusive—its sole target is the CNS.

The Role of the Immune System

The immune system is a complex system of cells, tissues, and organs that work together to protect your body from foreign invaders— mostly germs that can cause infection. Although people barely take notice of their immune system, it is incredibly competent, able to recognize millions of enemies, target them, and wipe them out. This is known as an immune response.

Because a healthy immune system has the remarkable ability to distinguish between your own cells and foreign cells, your defense system and your own cells coexist quite peacefully. In abnormal situations, however, the immune system mistakes your own cells for foreign invaders and then launches an attack on the healthy cells and tissues. This is called an autoimmune response. A disease that results from this type of faulty immune response is called an autoimmune disease. A great number of diseases are believed to be autoimmune in nature, including type-1 diabetes and rheumatoid arthritis. MS is also thought to be an autoimmune disease.

Fact

There are more than eighty known autoimmune diseases affecting approximately fifty million Americans, or one in five people. Of that group, 78 percent are women. Autoimmune diseases are the third most common category of disease in the United States after cancer and heart disease.

Although science is not sure why, it appears that in MS, the immune system has lost the ability to distinguish the good cells from the bad cells and, through the process of inflammation, begins to attack the myelin sheath that coats and protects the nerves. The myelin coating is distributed along the axons of the nerves, the long extensions that carry electric impulses. As the myelin is stripped and destroyed, bare spots or scars (also called sclerosis) appear along the nerve in multiple areas—thus the name MS. As a result, signals transmitted from nerve cell to nerve cell throughout the CNS are disrupted or slowed down. Experts once believed that axons themselves were spared during the disease process, but research has shown that the axons can be damaged or broken. Your symptoms depend on the extent of myelin or axon damage and where the damage is located in your CNS. For example, if the myelin sheath along your optic nerve (which connects the eye to the brain) has been damaged, you may have a problem with your eyesight.

Understanding Plaques

Plaques (or areas of scarring) are the hallmark signs of MS, and they can occur at any site where there are myelinated axons within the CNS. These axons conduct impulses at a very high rate and allow the transfer of information between neurons to facilitate motor function and sensory perception. The location and number of lesions vary greatly from person to person.

Scientists have discovered that the nerves actually try to remyelinate— to restore the insulating myelin along the damaged nerve— but the results are less than perfect. In time, scar tissue builds up and, along with the damaged axons, the ability of the nerve to transmit nerve impulses is compromised or destroyed. Keep in mind that damage to the CNS doesn’t happen all at once, but usually occurs in distinct but unpredictable episodes, also known as an MS relapses, attacks, flares, or exacerbations. Relapses are chracterized by the sudden appearance or worsening of a symptom (or symptoms) that lasts at least twenty-four hours. These episodes are usually followed by periods of recovery or remission.

The Role of the Blood-Brain Barrier

And just when you think you’ve finally grasped it all, the blood-brain barrier comes into play. In simple terms, the blood-brain barrier is like a shield that exists to prevent chemicals and cells in the bloodstream from entering the CNS, while allowing the good stuff to pass through. Magnetic resonance imaging (MRI) shows that when a person with MS is having a relapse, the blood-brain barrier has broken down in the brain or spinal cord. This allows immune cells to cross over and attack the myelin.

Alert

Most people experience their first symptoms of MS between the ages of twenty and forty. Although scientists have documented cases of MS in young children and elderly adults, symptoms rarely begin before age fifteen or after age sixty. The average age of diagnosis is between twenty-nine and thirty-three years of age.

A key player in MS is a white blood cell in the immune system called a T cell. Scientists have learned that when specific T cells become activated, they leave the bloodstream and cross the blood-brain barrier to damage myelin.

Putting It All Together

Although MS is referred to as a neurological disorder, the problem seems to originate with the immune system. Research has shown that some sort of malfunction in the immune system interferes with the functioning of the nervous system. The process seems to follow these steps:

1. A faulty immune system loses the ability to distinguish the good cells from the bad cells.

2. A breakdown in the blood-brain barrier allows immune cells to travel into the CNS to attack the myelin and axons.

3. Toxic substances are released into the CNS, causing inflammation and resulting in the breakdown of myelin (in a process called demyelination) and axons.

4. Scar tissue forms where nervous system damage has occurred.

5. The inflammation, demyelination, and broken axons cause the nerve impulses to be slowed down in the transmission process, resulting in neurological symptoms.

6. The body tries to heal some of the damage caused by this process by naturally reducing inflammation and doing its best to regenerate myelin.

A useful way to picture the process of MS is to imagine a lamp cord. The electrical wire within the lamp cord is protected by a plastic coating, just as myelin coats and protects the nerves. Now, imagine that some kind of incident occurs that damages the cord in several small places. When you turn on the lamp, the electrical current may be disrupted, resulting in a faulty lamp. This is similar to what happens during an attack (or an exacerbation). Perhaps you grab a roll of electrical tape and try to patch up areas of damage on the cord, which is similar to what happens in remyelination. Now imagine further that the cord is somehow severed. In MS, broken or severed axons are no longer able to transmit a signal.

Essential

Repairing damaged myelin is the focus of the Myelin Repair Foundation, an organization whose aim is to accelerate research for myelin repair. Repairing the myelin damaged by MS may improve signal transmission in the central nervous system and reduce the symptoms of the disease. For more information visit www.myelinrepair.org.

Suspected Causes of MS

Although thousands of researchers across the world are trying to solve the puzzle, the exact cause of MS remains a mystery. Current research suggests that several factors may play a role in its development, including genetics and something in a person’s environment, possibly a virus.

Genetic Factors

Genetic factors probably play a role in making someone susceptible to MS, but it is currently believed that no single gene is responsible for causing it. This is known as genetic predisposition and is different from a genetic or hereditary illness that is passed directly from parent to child. Evidence suggests that MS occurs often enough in the same families that it is unlikely to be a coincidence. Take a look at the some of the statistics:

• The risk of developing MS is higher if another family member is affected, so if your brother, sister, parent, or child has MS, you have a 1 to 3 percent chance of developing it yourself.

• An identical twin runs a 30 percent chance of acquiring MS if her twin has the disease, whereas a nonidentical twin has only a 4 percent chance if her twin has it.

• In the United States the prevalence of MS is higher in Caucasians than in other racial groups. Caucasians have twice the incidence rates of African Americans.

• The higher prevalence of MS among people of northern European background suggests some genetic susceptibility. Native Indians of North and South America, the Japanese, and other Asian peoples have very low incidence rates.

These statistics suggest that genetic factors play a role in MS, but other data point to triggers in the environment. Some researchers feel that MS develops be...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Introduction
• Chapter 1: MS: The Nuts and Bolts
• Chapter 2: Signs and Symptoms
• Chapter 3: The Diagnosis Process
• Chapter 4: Dealing with a Diagnosis
• Chapter 5: Creating an MS Management Team
• Chapter 6: The Treatment of MS
• Chapter 7: The Relapse
• Chapter 8: Taking Charge
• Chapter 9: Managing Symptoms
• Chapter 10: Cognitive Challenges and Mood Changes
• Chapter 11: Complementary and Alternative Therapy
• Chapter 12: Stress and MS
• Chapter 13: Practicing Wellness
• Chapter 14: Mind and Body
• Chapter 15: MS and Employment
• Chapter 16: Family Life
• Chapter 17: MS and Real Life
• Chapter 18: The Future with MS
• Chapter 19: Creating a Support Network
• Chapter 20: Advanced MS and the Caregiver’s Role
• Appendix A: Additional Resources
• Appendix B: Glossary