Multiple Sclerosis (MS)

Original Editors -Sarah Demarest & Beth Niehbur from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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 Definition/Description

Multiple Sclerosis (MS) is an autoimmune disorder in which the body's immune cells attack the central nervous system (CNS), affecting the brain, spinal cord and optic nerve. MS is characterized by inflammation, demyelination and gliosis. An inflammatory response occurs when the body's immune cells attack the CNS, which leads to an increase in pressure and therefore disrupting the nerve conductivity. Demyelination is a process where a nerves protective covering, known as myelin, is damaged due to the autoimmune response leading to decreased nerve conduction velocity and early fatigue of the nerve. Gliosis occurs when demyelinated areas become fibrotic, which causes proliferation of neuroglial tissue in the CNS and leads to scarring of the tissue.

The course that MS can take will be different from one person to another as well as unpredictable. The disease can be divided into four clinical subytpes, which describe how the disease will progress as well as the corresponding characteristics that become evident for each subtype. Relapsing-remitting MS (RRMS) is the most commone subtype, affecting 85% of people with MS and is characterized by short attacks to the CNS followed by complete or partial return to normal functioning. Secondary-progressive MS (SPMS) is a subgroup that begins as a relapsing-remitting course accompanied by a steady decline in function and is often developed by patient. Primary-Progressive MS (PPMS) is a progression of the disease where a steady decline in function experienced from the onset of the disease. Progressive-Relapsing MS (PRMS) is similar to PPMS but has the additional characteristic of acute attacks.

Prevalence

It is estimated that in the United States there are 400,000 people being affected by MS and 2.1 million people globally. Females are 2 to 3 times more likely to have MS than males, which may indicate hormones play a role in acquiring the disease. The prevalence of MS has increased within the last 5 decades with the increase primarily being due to females. MS rarely occurs in children as well as adults over the age of 50 and will most commonly present between the ages of 20-40 years. The risk of being diagnosed with MS is increased in a person who has a sibling with MS by 3%, a fraternal twin by 5% and an identical twin by 25%.

MS can occur in many ethnics groups, with the most common populations being Caucasians with an ancestry from nothorn Europe, followed by African-Americans, latinos/hispanics and asians. It is rarely seen in ethnic populations such as, Australian Aborigines, New-Zealanders, Yakutes, Inuit, Hungarian Romani and Norwegian Lapps. There have been studies that show the prevalence of MS is higher in some geographical locations than in others, such as northern United States, norther Europe, southern Canada, New Zealand, Southern Australia and Scandinavian countries. Regions with a lower prevalence of MS tend to be closer to the equator, such as Asia, Africa, and South America.

Characteristics/Clinical Presentation

Multiple Sclerosis will present with varying symptoms because it depends on the location of the nerves being affected. Symptoms usually appear suddenly and rapidly over a period of minutes or hours but in more rare cases the symptoms may be insidious and take several weeks to months to develope. Numbness and weakness in one or several limbs progressing from parathesias, visual disturbances such as double vision and fatigue are typically the early symptoms that will present with MS. Other common symptoms presented with MS are:

• Pain: Headache, chronic neuropathic pain, paroxysmal limb pain
  
• Cognitive symptoms: Short-term memory dificits, diminished executive function, diminished attention/concentration
  
• Affective Symptoms: Depression, anxiety
  
• Motor symptoms: spasticity, spasms, ataxia, impaired balance and gait
  
• Speech and swallowing: dysarthria, dysphonia, dysphagia
  
• Bladder/Bowel symptoms: spastic or flaccid bladder, constipation, diarrhea and incontinence
  
• Sexual Symptoms: impotence, decreased libido, decreased ability to achieve orgasm

The pattern of symptoms will be different from person to person. The initial symptoms are typically acute and followed by a period of remission with complete or partial recovery. An increase in symptoms can occur with an increase in body temperature because many MS patients have a sensitivity to heat.

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