Aging Begins at 30

M.S., A Disease in Search of a Cure

Day to day I see staff who work hard in the hospital despite the need to use a cane or a wheelchair. They are often victims of multiple sclerosis (M.S.), a disease that damages the central nervous system (brain, eyes and spinal cord) with scattered areas of inflammation as if they had been peppered by grapeshot.

Early symptoms occur in young people aged 20 to 40, more often women than men. They are blurring of vision (optic neuritis), a tremor, staggering gait, spasm, stiffness or paralysis of muscle, slurred speech, bladder difficulty, or variable limb paralysis. Because the disease lasts 30 or more years, the elderly are frequently affected. Often there is great fatigability.

The disease is most common in temperate climates, suggesting an environmental factor. Blood relatives of M.S. patients develop the disease eight times more often than the general population. The M.S. patients tend to come from the higher socioeconomic group.

M.S. is usually most active in the first four years after its onset, but the second attack may occur ten years later or never. If recovery is complete with each episode, 80% have unrestricted function in 10 years. If recurrences are on a background of stepwise deterioration then in ten years 50% are disabled.

The reason for symptoms in M.S. is a series of defects, called plaques, in the covering (called myelin) of nerve fibers in the brain, spinal cord and eye. Integrity of the myelin is important for rapid transmission of signals. With loss or damage to myelin, signal transport slows and may stop even though the nerve fiber may be normal otherwise. Myelin is produced by cells called oligodendrocytes, which are probably the target of the disease, causing loss of myelin. Symptoms may occur when the damaging process is active and may clear as the activity subsides. Multiple areas of scarring (sclerosis) as attacks heal, give the name multiple sclerosis.

Diagnosis is made by clinically demonstrating involvement of multiple sites in the central nervous system, magnetic resonance imaging (MRI), and measurement of conduction of signals in the brain. Examination of spinal fluid may help in diagnosis.

Exercising muscles and putting them through their full range of movement is important. Muscle spasm can be relieved with diazepam (Valium®), baclofen (Lioresal®), or dilantin. Anti-inflammatory steroids by mouth have been helpful. Intravenous methylprednisolone hastens recovery, but none of these medicines reduce long-term disease activity. Cyclosporine (Sandimmune®) or cyclophosphamide (Cytoxan®) may slow the progression of symptoms.

Education and group therapy for the patient and their family are very important. Treatments improve the quality of life.

Assessment of new treatment is very difficult because of patient and doctor bias and variability of the disease. Trials have to be large, randomized, compared with an inactive substance (placebo), and done so that neither the patient nor the doctor know who is getting active medicine. This tedious, expensive method, strengthened by evidence from quantitative MRI is yielding some answers.

Beta interferon (anti-viral protein) significantly reduces the accumulation of MRI detected lesions. We are at last moving in the right direction. Research continues.

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See related Patient Topics Bones, Joints and Muscles, Brain and Nervous System or Multiple Sclerosis.

See related Provider Topics Bones, Joints and Muscles, Brain and Nervous System or Multiple Sclerosis.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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