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PATIENT TEACHING AID
TEAR ALONG PERFORATION
Multiple
Sclerosis
Normal
neuron
and signal
conduction
Damaged
neuron and
disrupted signal
conduction
MEDICAL ILLUSTRATION: KRISTEN WIENANDT, CMI 2004
Destruction of Tissue That Covers the Nerves
Multiple sclerosis (MS) is a disease of the nervous system that specifically affects the nerves in the brain
and spinal cord, as well as the optic nerve. The nerves become damaged when the fatty covering (called
the myelin sheath) that protects the nerve cells is destroyed, making it difficult for the nerves to send and
receive messages. Scientists do not completely understand the cause of myelin destruction, but it is thought
to be an autoimmune process. In an autoimmune disease, the protective mechanisms of the body’s
immune system attack its own healthy tissues, mistaking them for harmful invaders. In this case, the body
begins destroying the myelin covering around the nerve cells. As in other autoimmune diseases, patients
with MS probably have a genetic predisposition to develop this condition, but it does not become symptomatic until an outside event, such as a viral infection, begins the autoimmune process. The most common symptoms are visual problems, muscle weakness, poor coordination, fatigue, muscle spasms, numbness, tremors, or dizziness. Some patients have mild symptoms, with little progression of their disability
and even partial or complete disappearance of symptoms for long periods of time. Other patients suffer
severe attacks from which they do not recover function, leaving them permanently disabled.
continued
Copyright Jobson Publishing L.L.C., 2004
U.S. Pharmacist
PATIENT TEACHING AID
Treatment Goal Is to
Decrease Acute Attacks
MS is a chronic disease, without a cure. It does not
usually shorten life span, although it can have a
dramatic effect on a person’s quality of life.
In the United States, there are up to 350,000 diagnosed cases of
MS, with many more undiagnosed due to its unusual presentation, highly variable symptoms, and lack of a definitive test. MS
is more common in people who lived in temperate climates during their first 15 years and is more common in women than
men. The first symptoms usually appear between ages 20 and
40, once the myelin protective covering on the nerve fibers is
destroyed. Symptoms are a result of damage to the nerve fibers,
leaving them unable to properly conduct electrical impulses to and from the brain. If the damaged nerves are not covered again with a new protective myelin sheath, permanent scar tissue leaves
these nerves unable to function. The symptoms of MS are dependent on the amount of damage
to the nerve fibers and whether new myelin tissue can be made to repair the damage. There is no
cure for MS. The goals of treatment are to decrease the number of acute attacks and to limit
those attacks so they do not cause severe, permanent disability. Anti-inflammatory drugs such as
steroids have been used successfully in acute attacks but do not improve the long-term prognosis. Exciting new research is looking into drugs that not only shorten acute attacks but also lessen
the number of attacks and stop the progression of the disease.
Symptoms: Symptoms of MS are highly variable in individuals, and may appear suddenly and
disappear unpredictably. This is, in part, due to the fact that the body attempts to repair areas of
damaged myelin sheath before permanent damage to nerve fibers occurs. The most common
early symptoms are sensations of numbness and tingling in the arms, legs, trunk, and face or weakness and stiffness in an extremity. Early visual disturbances include pain or partial blindness in
one eye, poor vision, double vision, or eye pain. Other symptoms include dizziness, difficulty in
concentration, depression, and unusual emotional reactions. Eventually, problems with bladder
or bowel control, spastic muscles, and sexual dysfunction can result. Since there is no specific test
for MS and its early symptoms resemble many other conditions, diagnosis is often difficult and
is made over a period of time. The history of symptoms along with a careful physical exam can
reveal important clues, and laboratory tests can also be helpful in confirming the condition.
Disease Patterns: The natural course of MS is not predictable. After the initial symptoms occur,
the disease may not reappear for years. In the more progressive form, an MS “attack” may result
in a permanent, disabling condition in which the patient is confined to a wheelchair. Since MS
does not run a predictable course, it is can be hard to determine whether medical treatment has
led to improvement or if the disease has gone into remission. Symptoms can be controlled with
drugs, physical therapy, exercise, and a healthy lifestyle. Scientists do know that anti-inflammatory drugs can lessen the severity of an acute attack, although these drugs are not helpful in preventing future attacks. Drugs known as interferons can shorten acute attacks and also lessen the
number of attacks and the progression of the disease. Some patients with severe, progressive disease control their symptoms with potent immunosuppressive drugs, but these carry significant
side effects. Many other treatments, including monoclonal antibodies, plasma exchange, and bone
marrow transplantation, are being studied for their long-term effects in preventing attacks. These
therapies have serious risks. A new treatment using a synthetic myelin protein known as copolymer I is being studied with promising results in patients with severe progressive MS. Scientists
are exploring vaccine development and ways to stimulate the body to make new myelin after an
attack to avoid permanent damage to the nerve fibers. Your pharmacist can answer questions about
current medications that treat MS.
U.S. Pharmacist