MS cause a mystery

The world is a dangerous place. It’s over-run with all manner of lurking hazards, from bacteria living on your skin to fungal organisms hiding out in the crevices and hidden places of your world. How do we survive this daily onslaught? Through the action of our immune system, which functions to protect us, from skin to bone, on a minute-to-minute basis. Although affected by various diseases and many medications, it works constantly to keep us free from hostile invasion.

The immune system of an organism protects against disease by identifying and killing pathogens and tumor cells. Unfortunately, this complex system of protection can turn against us. it may over-react and attack the body. This results in the class of immune-mediated diseases, of which there are many examples, like some allergies, sinusitis, asthma, rheumatoid arthritis, and more.

Some of these conditions, like rheumatoid arthritis, are inherited. We have no choice in these, since (again) you can’t choose your family. Other auto-immune diseases resulting from excessive action of the immune system are of unknown origin. One in particular leads to an attack on important components of the nervous system, resulting in a degeneration of the nerve cell. I refer now to multiple sclerosis. This is a degenerative and debilitating disease and is the most widespread disabling neurological condition of young adults around the world. About 200 new cases are diagnosed per year in the U.S., with approximately a million people living with the disease in this country alone.

Multiple sclerosis is an unpredictable disease of the central nervous system, specifically the brain and spinal cord. In MS, the immune system attacks the protective sheath that covers nerve fibers via an inflammatory process. This covering is composed of myelin and has a critical function. Myelin can be compared to the insulation coating on electrical wires. It allows a nerve to send a signal at a significantly faster rate. When the protective myelin is damaged, and the nerve fiber is exposed, the messages that travel along that nerve may be slowed or blocked.

Without myelin, nerve impulses take too long to allow our (relatively) large, complex bodies to function appropriately. This attack on myelin causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. The damaged areas of the affected nerves develop scar tissue which gives the disease its name – many areas of scarring, ie multiple sclerosis.

The signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. This is another example of a disease which can differ greatly from person to person. Over the course of the disease, depending on the location of affected nerve fibers, the afflicted individual may experience numbness or weakness in one or more limbs. This typically occurs on one side of the body at a time.

Some people with severe MS may lose the ability to walk independently or at all. Others may suffer a partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement. Prolonged double vision is another impairment experienced. Other symptoms include tingling pain in certain parts of your body, electric-shock sensations (especially with certain neck movements). Many will have tremors, a lack of coordination or unsteady gait. Speech problems can also be experienced. This will often manifest as slurring of the speech. Or MS may cause fatigue. For most, normal gait will become impossible and mobility, one of the keys to quality of life measures, will become markedly impaired.

Not only are the symptoms variable, so is the course of the disease. Most experience what is termed a relapsing-remitting course, in which periods of new symptoms or relapses develop over days or weeks, followed by partial or complete resolution. These quiet periods can sometimes last for months, occasionally even years. Approximately 65 percent of those who have these relapses and remittances will eventually develop steady progression of the disease. This is termed secondary-progressive MS. In contrast, primary-progressive MS causes a gradual onset of symptoms. Those with this form of the disease will have a steady progression, without any relapses.

Who gets multiple sclerosis and why? This is probably the greatest mystery associated with the disease. We are certain it is auto-immune in nature as previously stated, but, other than that, we don’t know. Scientists believe the disease may be triggered by an as-yet-unidentified environmental factor in a person who is genetically predisposed to respond. We know women are about twice as likely as men are to develop MS. There is also a familial association: if one of your parents or siblings has had MS, you are at higher risk of developing the disease. Some believe a viral infection can lead to the development of MS, including the Epstein-Barr virus, which causes mononucleosis.

Unfortunately, there are no specific diagnostic tests conclusive for MS. Typically it is a diagnosis of exclusion. Rule out other possible conditions that can produce similar signs and symptoms and if you are left with no other possibilities……it’s probably MS. There is no blood test that can definitively diagnose it. A spinal tap, in which fluid is removed from around a person’s spinal cord, may be performed to rule out infection. But this specimen can show some of the cell types produced by the immune system when MS is responsible. An MRI can reveal some of the lesions associated with multiple sclerosis on the brain and spinal cord. But in those with relapsing-remitting MS, the diagnosis is fairly straightforward and based on a pattern of symptoms consistent with the disease and confirmed by brain imaging scans.

There’s no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms. Prednisone, or some other oral steroid, is a mainstay of treatment for MS since the damage to myelin is the result of inflammation, and reducing inflammation is the primary action of steroids. Some newer medications have been developed, although, unfortunately, these tend to be associated with some severe side effects. As with any condition causing weakness and impaired stability, lower extremity bracing can aid in gait, and seems to help many with maintaining their independence, as well as reducing the risk of dangerous falls.

If you are suffering from some as-yet-unnamed condition and are not receiving a satisfactory explanation, it may be time to see a specialist. Multiple sclerosis is one of many conditions for which there is no definitive diagnostic test, and not every physician is schooled in the many nuances of this disease. Although not the only type of doctor skilled in its diagnosis and treatment, certainly a neurologist is one. This concept applies to many medical problems: there is a time and place to seek out the skills of a specialist. As the saying goes “a general practice physician is a jack of all trades (maladies), master of none”. If you are not getting answers from your doctor about your condition, maybe a doctor who has special expertise in that area will. Be your own advocate; play a part in your medical care.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments