Kathleen Costello, RN, MS, CRNP, MSCN
Maryland Center for MS Treatment and Research, University of Maryland
What is MS?
Multiple sclerosis is a complex disease that affects the central nervous system (brain, spinal cord, and optic pathways). It is characterized by relapses (neurologic symptoms which appear rapidly over a few days and then improve to some extent over weeks or months), and remissions (periods of time that are without new symptoms). The disease is unpredictable and some people experience a variety of symptoms that might worsen (progress) over time.
Studies show that there are several factors associated with the onset of MS. These factors include the environment, genetics, and a combination of the two. Some reports indicate that an environmental exposure to an undefined viral infection that occurs before the age of 15 can contribute to MS. Further studies indicate that the risk of developing MS relates to some sort of environmental exposure and having a specific combination of genes. It appears that MS occurs in people who are genetically predisposed to developing it, and there are multiple genes that must come together to make someone genetically predisposed.
The effect of the disease damages the insulating material that surrounds the nerve fibers in the central nervous system. This material is called myelin. The results of this damaging process are similar to what happens to insulation around an electrical wire. When the electrical wire is exposed to the environment (the insulation has worn off), it interrupts the normal flow of electricity and can cause a sporadic connection. Sometimes it causes an electrical short and no electricity will flow through the wire. Other times, the exposed wire “works” but not correctly. When there is damage to the nerve fibers of the brain or spinal cord, like in exposed wiring, there can be a sporadic connection causing a variety of symptoms. These symptoms are associated with the disease MS. Some of the symptoms include extreme physical fatigue, numbness, loss of balance, blurred vision, poor coordination, feelings of muscle weakness and stiffness (spasticity), changes in thinking, and bowel and bladder problems. Although currently MS is not a curable disease, several treatments are effective in reducing the frequency of relapses, and have an effect on reducing the progression of symptoms over time.
MS affects 2 to 3 times more women than men. There is a lot of research showing that people who grow up in a colder climate and in northern latitudes are at a somewhat greater risk of developing MS. Other studies show that MS is more common in people from European backgrounds. However, people from warmer climates and from other racial backgrounds can also develop MS. Most individuals are diagnosed while in their 20’s or 30’s, although the age of onset ranges from 15 to 50. A very small number of individuals are diagnosed under the age of 15 and over the age of 50.
The course of MS varies widely among individuals with the disease. About 85% of people who are diagnosed have a pattern of disease that is known as relapsing-remitting. This means that symptoms develop over a few days, remain for several weeks or months and then resolve either completely or partially. Over years, people that have relapsing-remitting MS have less and less relapses, but have changes that occur over time that cause limitation in function. These changes tend to occur over months or years. This type or course of MS is known as secondary-progressive, meaning secondary to having relapsing-remitting MS, the individual now experiences progression of symptoms over time. Most people who start with relapsing-remitting MS will change to a secondary-progressive disease course over 10 to 20 years. A smaller percentage of patients, 15% or less, might not experience a relapse. Rather these individuals have slow changes in function over time. Usually this is noticed as a progressive difficulty in mobility such as walking.
MS is thought to be an “immune-mediated” disease, meaning that errors in the function of the immune system cause damage in the central nervous system. The normal immune system functions to protect the body from various environmental hazards or pathogens such as viruses, bacteria and fungi. The immune system is very sophisticated and has regulatory mechanisms in place that helps it recognize the good and bad cells. In an immune-mediated disease such as MS, the regulatory mechanisms that help the immune system to function properly are disrupted. In MS, certain cells of the immune system become activated and enter the central nervous system by mistake. Once inside the central nervous system, an inflammatory process begins as the improperly functioning immune system produces damaging substances. These substances damage the insulating material that surrounds the brain and spinal cord. Usually these immune system cells are prevented from entering the central nervous system by the specialized blood vessels of the central nervous system. However, when the immune system is not functioning properly, these immune cells damage myelin causing changes to nerve fibers which create relapses and disease progression as seen in MS.
Treatments for MS focus on controlling the immune system and managing the symptoms. The current goals for MS are to reduce the frequency of relapses and to slow the progression of the disease by using a drug therapy approach called disease modifying treatments (DMTs). It is also important for people to work with their healthcare providers to find the best approach to address MS symptoms like extreme fatigue, bladder problems, and spasticity. MS symptoms can be managed with medication, physical therapy, mobility devices, and other self-care approaches. At this time, there is no cure for MS but research continues to make great advancement in the understanding and treatment of the disease.
If you had symptoms of MS in the military or within seven years after honorable discharge, you may be eligible for service-connected disability. If this is the case, complete the Veterans Application for Compensation and/or Pension (VA form 21-526) available online (http://www.va.gov) or at your Regional Office and return it to the Regional Office for processing. Veterans Service Organizations (VSO), such as the Paralyzed Veterans of America, United Spinal Association, and Disabled American Veterans are good support resources.
Last Updated: October 2009