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Multiple Sclerosis in General

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Multiple Sclerosis in General

Multiple Sclerosis is a disease of random acts of damage and senseless disability.  Basically MS , meaning "multiple scars" is the result of many dozens or hundreds of attacks on the white matter of the brain and spinal cord.  These attacks do seem to be autoimmune in nature, but the triggers of these attacks are varied and it appears that each person has more than one or two.  It is likely that they are set off in susceptible people, who are made susceptible by the accidents of their racial, genetic and ethnic background, combined possibly with the location on the globe of where they grew up.  Finally scientists in the field also believe that a major trigger is an infection, possibly many years before the disease gets started.  It is also believed that a combination of different causes can develop into MS in different people.  Contrary to popular belief, stress and trauma do not "cause MS."  but they may bring on attacks or relapses after the disease is established.

The white matter of the CNS - Central Nervous System is mainly where the long nerves run as they communicate between the brain and the body.  These long nerve fibers, called "AXONS" are sheathed in a fatty, white insulating layer called "MYELIN.

The damage in MS is caused by two things.  The first is an autoimmune attack on the myelin, which causes a large amount of inflammation around the nerves being attacked.  This is what causes the sudden onset of symptoms.  When the insulating myelin is damaged the nerve signal slows down and the nerve doesn't function right.  This dysfunction might be related to anything in the body that is controlled by brain or spine nerves.  This means the symptoms can be almost anything.  Common symptoms are weakness of muscles, stiffness of muscle groups, odd sensations like tingling or numbness, problems with the balance, or with any of the special senses.   Attacks on the myelin of the nerves of the eye is very common.  But, dozens of other symptoms are possible.

In the great majority of people with MS, the attacks on the myelin come on suddenly, over hours or days, in different groups of nerves.  This is what causes the typical MS Relapse or Flair up.  A relapse is accompanied by a large amount of inflammation around the nerve cells.  In most cases the myelin is able to repair itself - at least to some extent.  As the nerve sheath heals, the symptoms subside, either completely or partially.  The period after repair is known as a remission.  During a remission the symptoms lessen or disapperar.  This gives rise to the name of the most common form of MS - Relapsing Remitting.  It is this pattern of an attack which may linger for days to months - and then subsides, that doctors looks for when they are first considering MS.

The second problem is the direct degeneration of the axons themselves.  We know that axon death (nerve fiber death) happens early in the disease.  It also may be independent of the inflammation caused by attack on the myelin sheath. Axonal death is the cause of the progressive disability that most people eventually develop.  Nerve death in the brain and spine is permanent.  This axon loss occurs throughout the disease.  As more and more nerves are lost, the person begins to suffer more and more permanent disability.  The rate at which this disability occurs is extremely varied.  Some people have hardly any sustained damage over their lifetime, while others suffer progressively with more and more disability.  The direct axonal degeneration and death accelerates in the progressive forms of MS.  Why peoples' experience varies so much with MS is not known, but is the question behind a huge amount of research.

However, we all need to understand that  Multiple Sclerosis is NOT A DEATH SENTENCE!  Few people actually die directly from the disease.  Statistics show that less than 25% of people with MS will be confined to a wheel chair after 20 years of illness.  They may from time to time need one, or a cane or some assistance in walking, but the majority will not be so disabled.

Currently there are medications that have been shown statistically to slow the progress of the disease, especially the formation of new attacks in the brain and spine, and in the progression of disability.  These medications, the firstline of treatment DO NOT suprress the immune system.  They do work to modulate a specific part of the immune system to slow the attack on the nerves.  These medications appear to be most successful in slowing the disease if taken very early (the first several years)  in the course of the disease.  There is no currently known cure.

As of right now, 2008, MS still shortens life span by 7 years or less, but this is because the majority of people with MS who are at the end of their lives now, did not have access to the Disease Modifying Drugs that are now available, during the time when their MS would have been responsive.  Scientists believe that within a decade people with MS will have the same life span as the general population.  This includes people who are being diagnosed now.


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