Steve Schultz


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Steve Schultz

  1. 1. Steve Schultz Biology and Human Focus Lab Report Multiple Sclerosis ABSTRACT This report includes the basic facts about Multiple Sclerosis. Treatments, effects of treatments, symptoms, who MS affects, different types of MS, process of diagnosing MS, Future treatments, and Pathophysiology are explained through the course of this report. The course, at which this disease takes, once symptoms become obvious, is also explained. INTRODUCTION An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted (NINDS). In 1868, Dr. Jean Martin Charcot made the first diagnosis of MS. Many investigators believe MS to be an autoimmune disease -- one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus (MSIF). Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing (NINDS).In the worst cases, MS can produce partial or complete paralysis. Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations. Some may also experience pain. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss (Better Health). Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. Depression is another common feature of MS (NINDS). An estimated 2,500,000 people around the world have multiple sclerosis. These people are generally: • Young adults - symptoms first appear between the ages of 20 and 50 years. • Female - 70 per cent of people with MS are female. • Caucasian - 98 per cent of people with MS are Caucasian. • Living in temperate zones - MS is generally more common between latitudes 40° and 60° north and south of the equator. • Have a relative with MS - between 10 and 20 per cent of people with MS have a relative with the disease, suggesting a genetic link (Better Health).
  2. 2. The cause of multiple sclerosis is not yet known, but thousands of researchers all over the world are meticulously putting the pieces of this complicated puzzle together. The damage to myelin in MS may be due to an abnormal response of the body's immune system, which normally defends the body against invading organisms (bacteria and viruses) (Multiple Sclerosis). Many of the characteristics of MS suggest an 'auto-immune' disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors (MSIF). One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the auto-immune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making vulnerable the brain's defense mechanisms (i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin (MSIF). Relapsing-Remitting MS In this form of MS there are unpredictable relapses (exacerbations, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be inactive for months or years. • Frequency - approx 25% (MSIF) Benign MS After one or two attacks with complete recovery, this form of MS does not worsen with time and there is no permanent disability. Benign MS can only be identified when there is minimal disability 10-15 years after onset and initially would have been categorized as relapsing-remitting MS. Benign MS tends to be associated with less severe symptoms at onset (e.g. sensory). • Frequency - approx 20% (MSIF) Secondary Progressive MS For some individuals who initially have relapsing-remitting MS, there is the development of progressive disability later in the course of the disease often with superimposed relapses. • Frequency - approx 40% (MSIF)
  3. 3. Primary Progressive MS This form of MS is characterized by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an accumulation of deficits and disability which may level off at some point or continue over months and years. • Frequency - approx 15% (MSIF) Unlike many other diseases, there is no straightforward ‘positive or negative’ test for MS and none of the range of tests available to help doctors with their diagnosis is 100% conclusive on its own. This means that ultimately a doctor will diagnose MS by a combination of observing a person’s symptoms, and ruling out other possibilities. This is called a ‘clinical diagnosis’ (Better Health). Problems with diagnosis Unfortunately for a significant minority of people (10 – 15 %) a definite diagnosis is still not possible even after all the available tests have been carried out. However, it is possible to rule out other very serious causes of MS type symptoms, and over time with periodic examinations and the monitoring of changes in a person’s condition, diagnosis is possible in the vast majority of cases (Multiple Sclerosis). New MS Diagnostic Criteria International Medical and Scientific Boards have drawn up new MS diagnostic criteria to help medical professionals distinguish between MS and other conditions that may present similar symptoms. The new criteria allow the results of MRI scanning to include so that it may be possible to diagnose MS when someone has had only one episode of symptoms. When the new criteria are used, a person may be classified as having MS, possible MS or not MS (Multiple Sclerosis). Clinical diagnosis Early MS may present itself as a history of vague symptoms, which may occur sporadically over a prolonged period of time and could often also be attributed to a number of other medical conditions. Invisible or subjective symptoms are often difficult to communicate to doctors and health professionals and sadly it has not been uncommon for people with MS to be treated unsympathetically in the very early stages of diagnosis. Even when a person shows a ‘classic’ pattern of MS type symptoms, the symptoms must conform to agreed criteria before a doctor or neurologist can diagnose clinically ‘definite’ MS (Better Health). These criteria are that: ‘Two different areas of the central nervous system are affected, and that these effects have been experienced on at least two separate occasions of at least one month apart and that the person is within the normal age range for the onset of MS’ So although it is possible to be diagnosed as having ‘definite’ MS on your first visit to a neurologist, it is also quite likely that the diagnosis will be uncertain, and that the person will be referred for further tests (Multiple Sclerosis).
  4. 4. RESULTS Pathophysiology: MS is regarded as an autoimmune disease. Most of what is known about MS is derived from its model in animal research, which is experimental allergic encephalomyelitis. The auto antigen in MS most likely is one of several myelin proteins (e.g., proteolipid protein [PLP], myelin oligodendrocyte glycoprotein [MOG], MBP). Microglial cells and macrophages perform jointly as antigen-presenting cells, resulting in activation of cytokines, complement, and other modulators of the inflammatory process, targeting specific oligodendroglia cells and their membrane myelin. The pathologic hallmark of MS is multicentric, multiphasic CNS inflammation and demyelization. Originally, each MS lesion was thought to evolve through episodes of demyelization and remyelination into a chronic burned-out plaque with relative preservation of axons and gliosis. Thus, the neuropsychological dysfunction occurred, despite an essentially intact neural network, until late in the disease course. However, recent studies have demonstrated that axonal transactions do occur during acute exacerbations; furthermore, axonal damage, as measured by magnetic resonance spectroscopy, was found to correlate with clinical disability. Clearly, more work is needed to understand the associations among inflammation-mediated demyelization, axonal injury, and clinical disability. For unclear reasons, lesions characteristically involve the optic nerve and periventricular white matter of the cerebellum, brain stem, basal ganglia, and spinal cord. Identifying MS lesions in gross specimens is difficult, as is identifying MS lesions in gray matter on radiographic images; hence, the predilection for white matter may not be disease related. The peripheral nervous system rarely is involved (Multiple Sclerosis). Treatment There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. However, three forms of beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting MS. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe (NINDS). The FDA also has approved a synthetic form of myelin basic protein, called copolymer I (Copaxone), for the treatment of relapsing-remitting MS. Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third. An immunosuppressant treatment, Novantrone (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic MS. While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients (Explaining). Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers such as baclofen, tizanidine,
  5. 5. diazepam, clonazepam, and dantrolene. Physical therapy and exercise can help preserve remaining function, and patients may find that various aids -- such as foot braces, canes, and walkers -- can help them remain independent and mobile. Avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue. If psychological symptoms of fatigue such as depression or apathy are evident, antidepressant medications may help (Multiple Sclerosis). Other drugs that may reduce fatigue in some, but not all, patients include amantadine (Symmetrel), pemoline (Cylert), and the still-experimental drug aminopyridine. Although improvement of optic symptoms usually occurs even without treatment, a short course of treatment with intravenous methylprednisolone (Solu-Medrol) followed by treatment with oral steroids is sometimes used (Explaining). Drug treatment The two principle aims of drug therapy for MS are to ease specific symptoms and hamper the progression of disease by shortening the attacks. The types of drugs used in treatment depend on a number of factors, including the person's form of MS. Some of the drug treatments available include: • Immunotherapy - these drugs are taken in the form of subcutaneous (under the skin) or intramuscular injection. These medications slow the frequency and severity of attacks, which means the myelin sheaths are subjected to less damage. Immunotherapy works by modifying the activity of the immune system. This treatment is most often prescribed for people with relapsing–remitting MS. • Methotrexate - usually taken orally. This drug is traditionally used to treat rheumatoid arthritis, but recent research has discovered its effectiveness for treating progressive MS. It is not in common use. • Methylprednisolone - taken either as pills or injections. This cortisone-like drug is used to control the severity of an MS attack, by easing inflammation at the affected site (Multiple Sclerosis). Side effects of drug treatment The possible side effects of drug treatment depend on the medications used and you should discuss any concerns with your doctor. Depending on the drug, side effects may include: • Drowsiness • Gastrointestinal upsets • Fluid retention • Swelling • Flu-like symptoms • Skin irritation at the site of injection • Mood altering effects (Multiple Sclerosis)
  6. 6. Treatment for specific symptoms Treatments for specific symptoms may include a range of treatments, including: • Muscle problems - a combination of drugs may ease muscle problems, including stiffness and tremors. Physiotherapy is also recommended. • Fatigue - some studies have found that drugs used to treat the sleep disorder narcolepsy are helpful in controlling MS-related fatigue. • Neurological symptoms - visual disturbances can be helped with drugs, including steroids. • Continence - treatment for continence problems may include special exercises, medications, continence aids (such as disposable pads) and certain dietary changes. • Neuropsychological problems - treatment for depression or anxiety may include counseling or medication. Memory problems and other cognitive difficulties can be better managed with professional help from a neurophysiologist (Multiple Sclerosis). Health care providers A person with MS can better manage their symptoms by drawing on the resources of a health care team, including: • Physiotherapy - including tailored exercise programs to improve strength, coordination and flexibility. • Occupational therapy - to learn coping strategies and new energy saving skills to ensure a more independent life. These may include the use of aids. • Neuropsychological therapy - including techniques to improve memory and cognitive skills. • Other therapies - as needed, such as speech therapists, eye specialists. • Nursing. • Social workers (Multiple Sclerosis) Alternative therapies Medications and physical therapies can be complemented by alternative therapies. See your health care provider for information, advice and possible referral. The ranges of alternative therapies that may be helpful include: • Acupuncture • Biofeedback therapy • Chiropractic • Hypnosis • Massage • Meditation • Relaxation techniques
  7. 7. • Tai chi • Yoga (NINDS) CONCLUSIONS The Course of MS The course of MS is unpredictable. Some people are minimally affected by the disease while others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms there are a number of distinct patterns relating to the course of the disease (MSIF). It is impossible to predict accurately the course of MS for any individual, but the first five years give some indication of how the disease will continue for that person. This is based upon the course of the disease over that period and the disease type. The level of disability reached at end points such as five and ten years is thought to be a reliable predictor of the future course of the disease (Multiple Sclerosis). The prospect of therapy for MS should be encouraging to those newly diagnosed with MS. Drugs such as interferon beta are possible treatments for those who are relapsing-remitting and ambulatory. The interferon betas may slow the progression of disability as well as reduce the severity and frequency of exacerbations. At this stage it is not known whether interferon beta has any impact on primary progressive MS. The research currently targeting MS gives hope that therapy which will interfere with the process of MS (even if not curing the disease) is not an unreasonable expectation in the near future (Multiple Sclerosis). Other future or experimental treatments include: Cannabis. Cannabis, the source of marijuana, has been found to improve tremor and spasticity in animal studies. In one study of MS patients, a third reported improvements in pain, spasms, tremor, mood, appetite, fatigue, vision, sexual and urinary function, and memory. Cannabis may, however, worsen balance and posture in patients with spasticity due to MS. Four studies of cannabis used in capsules or in an oral spray are currently underway in England (MSIF), and Stem Cell Transplantation. Some investigators are studying the benefits of stem-cell transplantation procedures. Stem cells are produced in the bone marrow and are the early forms for all blood cells in the body (including red, white, and immune cells). Early studies indicate that it may slow progression, although at this point it is not a cure (Explaining). Since the cause of MS is still unknown how to prevent this disease is also unknown. Bibliography
  8. 8. Better Health Channel. “Explaining Multiple Sclerosis.” May 25, 1999. 2005. < is_explained?OpenDocument.>. Explaining Multiple Sclerosis. December 12, 2002, 2005. < http://www.mult->. Multiple Sclerosis International Federation (MSIF). “Welcome to the World of Multiple Sclerosis.” November 1, 2005. 2005. <>. National Institute of Neurological Disorders and Stroke (NINDS). October 13, 2005. 2005.<>.