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Multiple sclerosis
Classification and external resources
.
Demyelinization by MS. The CD68 colored tissue shows several macrophages in the area of the lesion.^ Destruction of myelin , a fatty insulation covering the nerve fibers, is the main characteristic of MS. The end results of this process, called demyelination, are multiple patches of hard, scarred tissue called plaques or lesions .
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
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^ Magnetic resonance imaging (MRI) of the brain and spine is often used to evaluate individuals with suspected MS. MRI shows areas of demyelination as bright lesions on T2-weighted images or FLAIR (fluid attenuated inversion recovery) sequences.
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^ In antineoplastic studies, the drug showed several immunomodulatory effects, inducing macrophage-mediated suppression of B-cell, T-helper and T-cytotoxic lymphocyte function.

Original scale 1:100
ICD-10 G35.
ICD-9 340
OMIM 126200
DiseasesDB 8412
MedlinePlus 000737
eMedicine neuro/228 oph/179 emerg/321 pmr/82 radio/461
MeSH D009103
.Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminata) is a disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms.^ Multiple sclerosis is a disease in which the myelin (a fatty substance which covers the axons of nerve cells) degenerates.

^ Multiple sclerosis (MS) in children and adolescents is a rare disease.

^ Demyelination is a characteristic hallmark of the neuro-inflammatory disease multiple sclerosis.
  • Multiple Sclerosis : by Ray Sahelian, M.D., Natural treatment - herbs, ginkgo, fish oils 2 February 2010 10:010 UTC www.raysahelian.com [Source type: Academic]

[1] .Disease onset usually occurs in young adults, and it is more common in females.^ Fatigue is the most common and debilitating symptom of MS and often occurs early in the disease.
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^ As observed in many autoimmune disorders, MS is more common in females than males; the mean sex ratio is about two females for every male.
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^ BACKGROUND: Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system and is the most common cause of neurologic disability in young adults.

[1] .It has a prevalence that ranges between 2 and 150 per 100,000.[2] MS was first described in 1868 by Jean-Martin Charcot.^ Prevalence rates range from less than 5 per 100,000 (e.g.

^ A French neurologist at the Salpetrière in Paris, Jean Martin Charcot, first described multiple sclerosis (MS) in 1868, noting the accumulation of inflammatory cells in a perivascular distribution within the brain and spinal cord white matter of patients with intermittent episodes of neurologic dysfunction ( 1 – 3 ).
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
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^ Charcot also observed cognition changes in MS since he described his patients as having a "marked enfeeblement of the memory" and "with conceptions that formed slowly".
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[3]
.MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other.^ The symptoms of MS occur when the brain and spinal cord nerves no longer communicate properly with other parts of the body.
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^ A layer of insulation that surrounds the nerve fibers in the brain and spinal cord.
  • Multiple sclerosis 2 February 2010 10:010 UTC www.uams.edu [Source type: Academic]

^ Other herpesviruses can also infect brain cells.

.Nerve cells communicate by sending electrical signals called action potentials down long fibers called axons, which are wrapped in an insulating substance called myelin.^ Your nerve cells have a protective covering called myelin.
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^ (Axons are the long filaments that carry electric impulses away from a nerve cell.

^ Axon: The part of the nerve cell that carries an electrical signal over a long distance.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

.In MS, the body's own immune system attacks and damages the myelin.^ In autoimmune diseases, immune factors attack the body’s own cells.
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

^ Some substance specifies the target of the immune attack, which in MS is myelin.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ In the case of MS, the immune system attacks the tissues that make up myelin.
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.When myelin is lost, the axons can no longer effectively conduct signals.^ When the myelin is destroyed, the neurons can no longer effectively conduct their electrical signals.

^ The myelin sheath is a jacket of insulation around axons to help them conduct their electrical discharges quickly down the axon.
  • Diagnose-Me: Condition: Multiple Sclerosis 2 February 2010 10:010 UTC www.diagnose-me.com [Source type: Academic]

^ Finally, with mitoxantrone we have a drug at hand which can be used in progressive forms of multiple sclerosis, especially when other disease modifying drugs are not or no longer effective.

[4] .The name multiple sclerosis refers to scars (scleroses—better known as plaques or lesions) in the white matter of the brain and spinal cord, which is mainly composed of myelin.^ "Impact of disease-modifying therapies on brain and spinal cord atrophy in multiple sclerosis."

^ Fampridine—SR for multiple sclerosis and spinal cord injury.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ MRI can reveal lesions, indicative of the myelin loss caused by multiple sclerosis, on your brain and spinal cord.
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[3] .Although much is known about the mechanisms involved in the disease process, the cause remains unknown.^ Although much is known about how MS causes damage, its exact cause remains unknown.

^ More than one antigen may be involved, some may trigger the disease, and others may keep the process going.

^ The exact cause is unknown, but most experts believe MS is an autoimmune disease.
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Theories include genetics or infections. .Different environmental risk factors have also been found.^ Although many risk factors for multiple sclerosis have been identified, no definitive cause has been found.

^ Inheriting genetic risk factors for multiple sclerosis is not sufficient to cause this demyelinating disease of the central nervous system; exposure to environmental risk factors is also required.
  • Multiple Sclerosis : by Ray Sahelian, M.D., Natural treatment - herbs, ginkgo, fish oils 2 February 2010 10:010 UTC www.raysahelian.com [Source type: Academic]

^ One interpretation of these studies is that an environmental factor, either protective or harmful, is acquired in early life; the risk of disease later in life reflects the effects of the early environment.
  • Multiple sclerosis 2 February 2010 10:010 UTC www.uams.edu [Source type: Academic]

[4][5]
.Almost any neurological symptom can appear with the disease, and often progresses to physical and cognitive disability.^ No disability and minimal neurologic symptoms.

^ Axonal destruction is another central pathological feature and a contributor to the accumulating disability of disease progression.

^ Progressive-Relapsing MS. The disease is progressive from the start with acute symptom flare-ups and continued deterioration between relapses.

[4] .MS takes several forms, with new symptoms occurring either in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms).^ Progressive-relapsing MS (PRMS) is a rare form of MS, occurring in less than 5% of patients.
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^ This form is referred to as the relapsing-progressive form.
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^ With time, the symptoms get more severe.
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[6] .Between attacks, symptoms may go away completely, but permanent neurological problems often occur, especially as the disease advances.^ Sexual dysfunction may also occur, especially in patients with urinary problems.
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^ Between attacks, the patient may improve and even get completely better.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Between attacks, symptoms may resolve completely, but permanent neurologic problems often persist, especially as the disease advances.
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[6]
.There is no known cure for MS. Treatments attempt to return function after an attack, prevent new attacks, and prevent disability.^ Is there any treatment for MS? .
  • Multiple Sclerosis | HealthyWomen 2 February 2010 10:010 UTC www.healthywomen.org [Source type: Academic]

^ There is no known way to prevent multiple sclerosis .
  • Multiple sclerosis 2 February 2010 10:010 UTC www.uams.edu [Source type: Academic]

^ There is no cure for MS, but it is not fatal except in rare cases.
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[4] .MS medications can have adverse effects or be poorly tolerated, and many patients pursue alternative treatments, despite the lack of supporting scientific study.^ Many medications under investigation for the treatment of MS are immunosuppressants.
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^ Thalamotomy is a more efficacious surgical treatment for intractable MS tremor, however the higher incidence of persistent neurological deficits in patients receiving lesional surgery supports the use of deep brain stimulation as the preferred surgical strategy.
  • Multiple sclerosis signs and symptoms - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]

^ Support groups (listed on a card in the pocket at the back of this pamphlet) and counseling may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause.
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.The prognosis is difficult to predict; it depends on the subtype of the disease, the individual patient's disease characteristics, the initial symptoms and the degree of disability the person experiences as time advances.^ The prognosis (the expected future course of the disease) for a person with multiple sclerosis depends on the subtype of the disease; the individual's sex, race, age, and initial symptoms; and the degree of disability the person experiences.

^ The prognosis (the expected future course of the disease) for a person with multiple sclerosis depends on the individual's age, initial symptoms, the degree of disability the person experiences but also sex and race.
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^ Individuals who are older than fifty when diagnosed are more likely to experience a chronic progressive course, with more rapid progression of disability.
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[7] .Life expectancy of patients is nearly the same as that of the unaffected population.^ The life expectancy of people with MS is now nearly the same as that of unaffected people.
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^ Exerted a low level of control on their anger, with just 11 per cent of patients reporting the same high levels of control compared to the top 25 per cent of the general population.

^ Were about the same as non MS patients when it came to expressed anger, with 30 per cent of patients reporting the same high levels as the top 25 per cent of the general population .

[7]

Contents

Classification

Progression of MS subtypes
.Several subtypes, or patterns of progression, have been described.^ Several subtypes, or patterns of progression, have been described.

^ Nevertheless, several subtypes, or patterns of progression, have been described.
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^ Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes .
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.Subtypes use the past course of the disease in an attempt to predict the future course.^ Subtypes use the course of the disease so far in order to extrapolate the future development of it.
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^ Subtypes use the past course of the disease in an attempt to predict the future course.

^ Prognosis Prediction of the future course of the disease.
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.They are important not only for prognosis but also for therapeutic decisions.^ Subtypes are important not only for prognosis but also for therapeutic decisions.

^ The probable prognosis gives a better groundwork for therapeutic decisions.
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In 1996 the United States National Multiple Sclerosis Society standardized four subtype definitions:[6]
  1. relapsing remitting,
  2. secondary progressive,
  3. primary progressive, and
  4. progressive relapsing.
The relapsing-remitting subtype is characterized by unpredictable relapses followed by periods of months to years of relative quiet .(remission) with no new signs of disease activity.^ In 1996 the United States National Multiple Sclerosis Society standardized the following four subtype definitions: Relapsing-remitting Relapsing-remitting describes the initial course of 85% to 90% of individuals with MS. This subtype is characterized by unpredictable attacks (relapses) followed by periods of months to years of relative quiet (remission) with no new signs of disease activity.

^ In some persons, the disease progresses by gradual clinical decline with no distinct periods of remission.
  • http://www.mdguidelines.com/multiple-sclerosis 2 February 2010 10:010 UTC www.mdguidelines.com [Source type: Academic]

^ Many patients do well with no therapy if the disease remains in remission after the initial attack.
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.Deficits suffered during attacks may either resolve or leave sequelae, the latter being more common as a function of time.^ Deficits suffered during the attacks may either resolve or may be permanent.
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^ Patients are typically given high doses of intravenous corticosteroids , such as methylprednisolone , to end the attack sooner and leave fewer lasting deficits.
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^ Patients are typically given high doses of intravenous corticosteroids, such as methylprednisolone, or plasma exchange to end the attack sooner and leave fewer lasting deficits.

[1] .This describes the initial course of 85–90% of individuals with MS.[6] When deficits always resolve between attacks, this is sometimes referred to as benign MS.^ When deficits always resolve between attacks, this is referred to as "benign" MS. .

^ When deficits always resolve between attacks, this is referred to as " benign " MS. .
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^ In 1996 the United States National Multiple Sclerosis Society standardized the following four subtype definitions: Relapsing-remitting Relapsing-remitting describes the initial course of 85% to 90% of individuals with MS. This subtype is characterized by unpredictable attacks (relapses) followed by periods of months to years of relative quiet (remission) with no new signs of disease activity.

[8] .The relapsing-remitting subtype usually begins with a clinically isolated syndrome (CIS).^ Clinically isolated syndrome (CIS) suggestive of multiple sclerosis.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Nevertheless the earliest clinical presentation of relapsing-remitting MS (RRMS) is the clinically isolated syndrome (CIS).

^ Three-year data from the BENEFIT study suggest that, in patients with clinically isolated syndrome (CIS), immediate treatment with interferon (IFN) ß-1b significantly delays progression to clinically definite multiple sclerosis (CDMS).

.In CIS, a patient has an attack suggestive of demyelination, but does not fulfill the criteria for multiple sclerosis.^ "The challenge of managing patients with multiple sclerosis."

^ The management of multiple sclerosis patients.
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^ It is the principle target of attack in multiple sclerosis.
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[1][9] However only 30 to 70% of persons experiencing CIS later develop MS.[9]
.Secondary progressive MS (sometimes called "galloping MS") describes around 65 % of those with an initial relapsing-remitting MS, who then begin to have progressive neurologic decline between acute attacks without any definite periods of remission.^ Relapsing-remitting MS .
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^ In the "secondary progressive" pattern, the person with MS begins with relapses and remissions, followed by more steady progression of symptoms.
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^ Primary progressive Primary progressive describes the approximately 10% of individuals who never have remission after their initial MS symptoms.

[1][6] .Occasional relapses and minor remissions may appear.^ Glatiramer acetate appears to work as well as interferon beta drugs in decreasing the number and severity of relapses, but it may have less effect on lesions.
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^ There may, or may not be intermittent relapses, remissions, or periods of temporary minor improvements.

^ This is called relapsing-remitting (RR) MS. Primary-progressive (PP) MS is characterized by a gradual clinical decline with no distinct remissions, although there may be temporary plateaus or minor relief from symptoms.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

[6] .The median time between disease onset and conversion from relapsing-remitting to secondary progressive MS is 19 years.^ About 4 out of every 10 people with relapsing-remitting MS will progress to secondary progressive MS within 10 years.
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^ Secondary progressive , which initially follows a relapsing-remitting course.
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^ At onset, about 65% of patients have a relapsing-remitting form of the disease.
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[10]
.The primary progressive subtype describes the approximately 10–15% of individuals who never have remission after their initial MS symptoms.^ Primary progressive Primary progressive describes the approximately 10% of individuals who never have remission after their initial MS symptoms.
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]

^ Several subtypes, or patterns of progression, have been described.
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]

^ Primary-progressive MS .
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[11] .It is characterized by progression of disability from onset, with no, or only occasional and minor, remissions and improvements.^ The drug has no effect on progression of disability.

^ Some of those with an exacerbating-remitting course will eventually develop a slow progression involving fewer and less complete remissions with cumulative disabilities.
  • Diagnose-Me: Condition: Multiple Sclerosis 2 February 2010 10:010 UTC www.diagnose-me.com [Source type: Academic]

^ In many instances RRMS evolves into secondary progressive (or chronic progressive) MS where there are no clear relapses and remissions, only gradual deterioration.
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[6] .The age of onset for the primary progressive subtype is later than for the relapsing-remitting, but similar to mean age of progression between the relapsing-remitting and the secondary progressive.^ Secondary-progressive (SP) MS begins with a relapsing-remitting course followed by a later primary-progressive course.
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^ Secondary progressive , which initially follows a relapsing-remitting course.
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^ Secondary progressive , which at first follows a relapsing-remitting course and then becomes progressive.
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.In both cases it is around 40 years of age.^ MS primarily affects adults, with an age of onset typically between 20 and 40 years, and is more common in women than in men.
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^ Onset typically occurs between the ages of 15 and 40 years, with a peak incidence between 20 and 30 years old.

^ Progression of the handicap was most rapid in case of a secondary progressive course, female sex, high relapse rate in the preceding remitting phase and "year of progression" at a higher age.

[1]
.Progressive relapsing MS describes those individuals who, from onset, have a steady neurologic decline but also suffer clear superimposed attacks.^ Progressive relapsing MS (PR-MS).
  • Multiple Sclerosis Overview -- GeneReviews -- NCBI Bookshelf 2 February 2010 10:010 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes .
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^ Progressive relapsing Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes.

.This is the least common of all subtypes.^ Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes .
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^ Progressive relapsing Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes.

[6]
.Atypical variants of MS with non-standard behavior have been described.^ Several studies have shown that starting treatment with interferons during the initial attack can decrease the chance that a patient will develop MS. Special cases of the disease with non-standard behavior have also been described although many researchers believe they are different diseases.

^ Individual patients' T cells vary so much that it may not be possible to develop a standard vaccine or peptide therapy beneficial to all, or even most, MS patients.
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^ Progressive relapsing Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes Special cases of the disease with non-standard behavior have also been described although many researchers believe they are different diseases.
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.These include Devic's disease, Balo concentric sclerosis, Schilder's diffuse sclerosis and Marburg multiple sclerosis; and there is debate on whether they are MS variants or different diseases.^ Multiple sclerosis (MS) in children and adolescents is a rare disease.

^ MS = multiple sclerosis .
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^ These cases are sometimes referred to as borderline forms of multiple sclerosis and are Neuromyelitis optica (NMO), Balo concentric sclerosis, Schilder's diffuse sclerosis and Marburg multiple sclerosis.

[12] .Multiple sclerosis also behaves differently in children, taking them more time to reach the progressive stage.^ Chronic progressive multiple sclerosis .
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Multiple sclerosis , commonly referred to as MS, takes time to diagnose.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ "The diagnosis of primary progressive multiple sclerosis."

[1] .Nevertheless they still reach it at a lower mean age than adults.^ RESULTS: The mean T2-hyperintense and T1-hypointense lesion volumes were lower in patients with PPMS than in patients with SPMS, while the mean absolute brain volumes were similar in the 2 groups.

^ Researchers report that they found lower levels of uric acid in the blood of MS patients than of people without the disease.
  • Diagnose-Me: Condition: Multiple Sclerosis 2 February 2010 10:010 UTC www.diagnose-me.com [Source type: Academic]

^ MS primarily affects adults, with an age of onset typically between 20 and 40 years, and is more common in women than in men.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple Sclerosis Clinical Trials 2 February 2010 10:010 UTC www.clinicalconnection.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

[1]

Signs and symptoms

Main symptoms of multiple sclerosis
.The person with MS can suffer almost any neurological symptom or sign, including changes in sensation (hypoesthesia and paraesthesia), muscle weakness, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia), fatigue, acute or chronic pain, and bladder and bowel difficulties.^ Acute demyelinating optic neuritis.

^ Common presenting symptoms include monocular visual impairment with pain (optic neuritis), paresthesias, weakness, and impaired coordination ( Table 1 ) .
  • Diagnosis and Management of Multiple Sclerosis - November 15, 2004 - American Family Physician 2 February 2010 10:010 UTC www.aafp.org [Source type: Academic]

^ Multiple sclerosis can cause a variety of symptoms, including paranoid delusions, changes in sensation ( hypoesthesia ), muscle weakness, abnormal muscle spasms, or difficulty to move; difficulties with coordination and balance; problems in speech ( Dysarthria ) or swallowing ( Dysphagia ), visual problems ( Nystagmus , optic neuritis , or diplopia ), fatigue and acute or chronic pain syndromes, bladder and bowel difficulties, cognitive impairment, or emotional symptomatology (mainly major depression ).
  • Multiple sclerosis signs and symptoms - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]

[1] .Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common.^ Cognitive impairments are common.
  • Multiple sclerosis signs and symptoms - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]

^ Common presenting symptoms include numbness, weakness, visual impairment, loss of balance, dizziness, urinary bladder urgency, fatigue, and depression.
  • Diagnosis and Management of Multiple Sclerosis - November 15, 2004 - American Family Physician 2 February 2010 10:010 UTC www.aafp.org [Source type: Academic]

^ Some symptoms common in pregnancy and after the baby's birth can be made worse by MS. These include depression and fatigue.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[1] .Uhthoff's phenomenon, an exacerbation of extant symptoms due to an exposure to higher than usual ambient temperatures, and Lhermitte's sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS although not specific.^ This is an electrical sensation that runs down the back and into the legs, which is produced by bending the neck forward.

^ Lhermitte's sign is an electrical sensation that runs down the back and into the limbs, and is produced by bending the neck forward.
  • Multiple sclerosis signs and symptoms - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]

^ L’Hermmitte’s sign, which is caused by lesions in the cervical spine in the neck, is an electrical buzzing sensation that runs down the back and into the legs.
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

[1] The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale or EDSS.[13]
.Symptoms of MS usually appear in episodic acute periods of worsening (called relapses, exacerbations, bouts, attacks, or "flare-ups"), in a gradually progressive deterioration of neurologic function, or in a combination of both.^ Progressive-Relapsing MS. The disease is progressive from the start with acute symptom flare-ups and continued deterioration between relapses.

^ A relapse (also called exacerbation or flare-up) is an attack that brings about new symptoms or worsening of old symptoms.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

^ Most patients have the relapse-remitting form of MS in which flare-ups (also called relapses or exacerbations) of symptoms are followed by periods of remission.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

[6] .Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors with a rate rarely above 1 and a half per year.^ Interferon in relapsing-remitting multiple sclerosis.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Multiple sclerosis relapses are often unpredictable and can occur without warning with no obvious inciting factors.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ "Vaccinations and the risk of relapse in multiple sclerosis.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

[1] .Some attacks, however, are preceded by common triggers.^ Some attacks, however, are preceded by common triggers.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple Sclerosis Clinical Trials 2 February 2010 10:010 UTC www.clinicalconnection.com [Source type: Academic]
  • Health Information About Multiple Sclerosis 11 September 2009 9:47 UTC www.powerofoxygen.com [Source type: FILTERED WITH BAYES]
  • Multiple sclerosis 11 September 2009 9:47 UTC lifesettlementretirement.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ In some cases, the trigger for an MS attack seems to be a viral infection, but at other times, other physical or emotional stress is blamed.

^ For some people the initial MS attack is preceded by infection , trauma , or strenuous physical effort.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple sclerosis signs and symptoms - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

.Relapses occur more frequently during spring and summer.^ Frequent relapses during the first few years of the disease.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[14] .Viral infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse.^ Infections, such as the common cold , influenza , and gastroenteritis , increase the risk for a relapse.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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^ "Infections and the risk of relapse in multiple sclerosis".
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ Correale J, Fiol M, Gilmore W. The risk of relapses in multiple sclerosis during systemic infections.
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

[1] .Stress may also trigger an attack.^ Emotional and physical stress may also trigger an attack, [19] [20] [21] as can severe illness of any kind.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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[15] .Pregnancy affects the susceptibility to relapse, with a lower relapse rate at each trimester of gestation.^ Pregnancy can directly affect the susceptibility for relapse.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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^ The annual relapse rate decreased during pregnancy and significantly increased during the first 3 months after delivery.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Our results confirm the known reduced relapse rate during pregnancy, which is followed by an increased relapse rate after delivery.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

.During the first few months after delivery, however, the risk of relapse is increased.^ In the first few months after delivery, however, they may temporarily have more relapses.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ The risk for a first clinical attack increases, however, in the 6 months after a woman gives birth.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

^ The annual relapse rate decreased during pregnancy and significantly increased during the first 3 months after delivery.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

[1] .Overall, pregnancy does not seem to influence long-term disability.^ Pregnancy does not seem to influence long-term disability.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ It primarily affects young adults and may result in significant long-term disability.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Long-term toxicities (amenorrhoea and therapy-related leukemia) seem acceptable but a valid evaluation will need a longer follow-up in more patients.

.Many potential triggers have been examined and found not to influence MS relapse rates.^ Many potential triggers have been examined and found not to influence relapse rates in MS. Influenza vaccination is safe, does not trigger relapses, and can therefore be recommended for people with MS. There is also no evidence that hepatitis B , varicella , tetanus , or Bacille Calmette-Guerin (BCG - immunization for tuberculosis ) increases the risk for relapse.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ BACKGROUND: Methotrexate is a potent immunosuppressant which in theory could reduce relapse rates and delay disease progression in multiple sclerosis (MS).

^ Significant effect found on time to first relapse, proportion of patients relapse free, relapse rate, , number of moderate or severe relapses, and need for hospitalization over two years.

.There is no evidence that vaccination and breast feeding,[1] physical trauma,[16] or Uhthoff's phenomenon[14] are relapse triggers.^ There is no evidence that any type of vaccination cause multiple sclerosis.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]

^ Statistically, there is no good evidence that either trauma or surgery trigger relapses.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ Many potential triggers have been examined and found not to influence relapse rates in MS. Influenza vaccination is safe, does not trigger relapses, and can therefore be recommended for people with MS. There is also no evidence that hepatitis B , varicella , tetanus , or Bacille Calmette-Guerin (BCG - immunization for tuberculosis ) increases the risk for relapse.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

Causes

.Most likely MS occurs as a result of some combination of genetic, environmental and infectious factors.^ The disease results from both genetic and environmental factors.
  • Multiple Sclerosis and Food Hypersensitivities 2 February 2010 10:010 UTC www.chetday.com [Source type: Academic]

^ A combination of environmental and genetic factors likely plays a role.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

^ MS likely occurs as a result of some combination of both environmental and genetic factors.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

[1] .Epidemiological studies of MS have provided hints on possible causes for the disease.^ One interesting study used MS patients to provide support to other MS patients as part of a telephone intervention program.

^ Visual evoked potential (VEP) studies are widely used for the diagnosis of multiple sclerosis (MS) and are also useful in monitoring the effects of various therapeutic modalities in the disease.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ DESIGN, SETTING, AND PARTICIPANTS: Men are less susceptible to many autoimmune diseases, including MS. Possible causes for this include sex hormones and/or sex chromosome effects.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

.Theories try to combine the known data into plausible explanations, but none has proved definitive.^ Various theories try to combine the known data into plausible explanations.
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Genetics

HLA region of Chromosome 6. Changes in this area increase the probability of suffering MS.
.MS is not considered a hereditary disease.^ Genetic MS is not considered a hereditary disease.

^ MS is not considered a hereditary disease.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple Sclerosis Clinical Trials 2 February 2010 10:010 UTC www.clinicalconnection.com [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ MS is not strictly an hereditary disease.
  • Multiple Sclerosis | Health | Patient UK 2 February 2010 10:010 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

.However, a number of genetic variations have been shown to increase the risk of developing the disease.^ Its clinical course is variable and unpredictable and exact etiology is unknown, although data suggests that it is an autoimmune disease triggered by a viral infection in genetically susceptible individuals.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Other tools have been developed that make the painstaking work of teasing out the disease's genetic secrets possible.
  • Multiple Sclerosis: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS) 2 February 2010 10:010 UTC www.ninds.nih.gov [Source type: Academic]

^ However, in the course of the disease, treatment failure may be influenced by interrater variability and frequent remissions.

[17]
.The risk of acquiring MS is higher in relatives of a person with the disease than in the general population, especially in the case of siblings, parents, and children.^ Because a person's risk of MS is slightly higher when a relative (especially a parent, sister, or brother) has MS, there may be a genetic link .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ The risk of developing this disease is estimated to be less than one tenth of one percent (1 in 1000) in the general population.

^ The recurrence rate in siblings of affected children is approximately 2% to 8%, much higher than the prevalence rate in the general population but much lower than in single-gene diseases.

[4] .The disease has an overall familial recurrence rate of 20%.^ The recurrence rate in siblings of affected children is approximately 2% to 8%, much higher than the prevalence rate in the general population but much lower than in single-gene diseases.

[1] .In the case of monozygotic twins, concordance occurs only in about 35% of cases, while it goes down to around 5% in the case of siblings and even lower in half-siblings.^ Twin concordance and sibling recurrence rates in multiple sclerosis.
  • Multiple Sclerosis - References: Online References For Health Concerns 2 February 2010 10:010 UTC www.lef.org [Source type: Academic]

^ The unexpectedly low rate of concordance in monozygotic (MZ) twins with multiple sclerosis (MS) suggests that they share a systemic condition called the multiple sclerosis trait.

^ Pituitary (Pituitary Gland) The pituitary gland is a small (half-inch), bean-shaped organ that hangs down from the lower center of the brain on a stalk attached to another gland, the hypothalamus.
  • Diagnose-Me: Condition: Multiple Sclerosis 2 February 2010 10:010 UTC www.diagnose-me.com [Source type: Academic]

This indicates susceptibility is partly polygenically driven.[1][4]
.It seems to be more common in some ethnic groups than others.^ It affects women more frequently than men, is more common in Northern European Caucasians than other ethnic groups, and is seen in greater numbers in temperate climates than warm ones.

^ MS, like other presumed autoimmune diseases, is more common in females and often first manifests clinical symptoms during young adulthood.
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
  • Journal of Clinical Investigation -- Multiple sclerosis 28 January 2010 1:31 UTC www.jci.org [Source type: Academic]

^ For example in Norway MS is up to five times more common in the inland farming areas than in the relatively nearby coastal fishing areas (Alter, 1977).
  • Multiple Sclerosis and Food Hypersensitivities 2 February 2010 10:010 UTC www.chetday.com [Source type: Academic]

Apart from familial studies, specific genes have been linked with MS. Differences in the human leukocyte antigen (HLA) system—a group of genes in chromosome 6 that serves as the major histocompatibility complex (MHC) in humans—increase the probability of suffering MS.[1] The most consistent finding is the association between multiple sclerosis and alleles of the MHC defined as DR15 and DQ6.[1] Other loci have shown a protective effect, such as HLA-C554 and HLA-DRB1*11.[1]

Environmental factors

Different environmental factors, both of infectious and non infectious origin have been proposed to as risk factors for MS. Although some are partly modifiable, only further research—especially clinical trials—will reveal whether their elimination can help prevent MS.[18]
.MS is more common in people who live farther from the equator, although many exceptions exist.^ MS is more common in those who grew up in colder regions that are farther away from the equator.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Many people with MS are sensitive to heat.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ This pattern is more common in older people.
  • Multiple sclerosis 2 February 2010 10:010 UTC www.uams.edu [Source type: Academic]

[1] .Decreased sunlight exposure has been linked with a higher risk of MS.[18] Decreased vitamin D production and intake has been the main biological mechanism used to explain the higher risk among those less exposed to sun.^ Several biological mechanisms have been proposed to explain how vaccines might cause allergic or autoimmune diseases.

^ In patients with active MS disease, serum concentrations of IL-12 were significantly higher in those patients with active HHV-6 infection than in patients with latent infection.

^ Scientists have found evidence that a direct interaction between vitamin D and a common genetic variant alters the risk of developing multiple sclerosis (MS).

[18][19]
.Severe stress may also be a risk factor although evidence is weak.^ "A systematic review of several potential non-genetic risk factors for multiple sclerosis."

^ Although many risk factors for multiple sclerosis have been identified, no definitive cause has been found.
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^ Emotional and physical stress may also trigger an attack, [19] [20] [21] as can severe illness of any kind.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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[18] .Smoking has also been shown to be an independent risk factor for developing MS.[19] Association with occupational exposures and toxins—mainly solvents—has been evaluated, but no clear conclusions have been reached.^ There are several studies that associate smoking with an increased risk of the progression of MS…” .

^ Initially, a survey of occupational therapy practice for MS patients including the characteristics and needs of these patients is necessary to develop a research agenda for efficacy studies.

^ Thus dietary and digestive system changes (and MS risk divergence) would occur in twins mainly after age 18.
  • Multiple Sclerosis and Food Hypersensitivities 2 February 2010 10:010 UTC www.chetday.com [Source type: Academic]

[18] .Vaccinations were also considered as causal factors for the disease; however, most studies show no association between MS and vaccines.^ "Vaccination may be associated with autoimmune diseases."

^ MS is not considered a hereditary disease.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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^ Study shows Lisinopril good for MS .

[18] .Several other possible risk factors, such as diet and hormone intake, have been investigated; however, more evidence is needed to confirm or refute their relation with the disease.^ More investigations are needed.

^ Climate , diet , geomagnetism , toxins , sunlight exposure, genetic factors, and infectious diseases have all been discussed as possible reasons for these regional differences.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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^ The investigators noted that events related to cladribine's mechanism of action, such as lymphopenia, were reported more frequently with cladribine treatment.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

[19]
.Gout occurs less than would statistically be expected in people with MS, and low levels of uric acid have been found in MS patients as compared to normal individuals.^ Progressive-relapsing MS (PRMS) is a rare form of MS, occurring in less than 5% of patients.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

^ Researchers report that they found lower levels of uric acid in the blood of MS patients than of people without the disease.
  • Diagnose-Me: Condition: Multiple Sclerosis 2 February 2010 10:010 UTC www.diagnose-me.com [Source type: Academic]

^ MS patients had normal sleep.

.This led to the theory that uric acid protects against MS, although its exact importance remains unknown.^ What remains unknown: the genetic basis of MS .
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
  • Journal of Clinical Investigation -- Multiple sclerosis 28 January 2010 1:31 UTC www.jci.org [Source type: Academic]

^ The pathophysiology of the fatigue of MS remains unknown.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ N EW YORK (Reuters Health) – High levels of HDL (“good”) cholesterol may help protect against disabilities related to multiple sclerosis or MS. .

[20]

Infections

.Many microbes have been proposed as potential infectious triggers of MS, but none has been substantiated.^ Many claims have been made for the role of viruses, slow or otherwise, as the trigger for MS, but as of 2001 no strong candidate has emerged.
  • Multiple sclerosis 2 February 2010 10:010 UTC www.uams.edu [Source type: Academic]

^ Such studies have strengthened scientists' conviction that MS is a disease with many genetic components, none of which is dominant.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

^ Microbes Infect 2002 Nov;4(13):1327-33 Abstract quote Multiple sclerosis (MS) is thought by many investigators to have an infectious component, and several microorganisms have been associated with the disease during the last three decades.

[4]
.Genetic susceptibility can explain some of the geographic and epidemiological variations in MS incidence, like the high appearance of the disease among some families or the risk decline with genetic distance, but does not account for other phenomena, such as the changes in risk that occur with migration at an early age.^ Some worsen with age and disease progression.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
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^ Such changes appear to occur early on in the disease process and to be ongoing.

^ MS likely occurs as a result of some combination of both environmental and genetic factors.
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[5] .An explanation for this epidemiology finding could be that some kind of infection, produced by a widespread microbe rather than a rare pathogen, is the origin of the disease.^ Ryleigh was just diagnosed with a rare genetic disease called tuberous sclerosis, but her general practitioner disagrees with the findings of her ophthalmologist.
  • Multiple Sclerosis - Associated Content - Topic - associatedcontent.com 11 September 2009 9:47 UTC www.associatedcontent.com [Source type: General]

^ It is thus likely that the contribution of HLA in MS is primarily towards onset and initial triggering mechanisms rather than influencing disease progression, chronicity and severity.

^ To learn more about this disease and its powerful effects you may find help in some of these sites.
  • Multiple Sclerosis - Associated Content - Topic - associatedcontent.com 11 September 2009 9:47 UTC www.associatedcontent.com [Source type: General]

[5] .Different hypotheses have elaborated on the mechanism by which this may occur.^ In addition, we hypothesize that reduced trophic support from damaged targets or degeneration of efferent fibers may trigger preprogrammed neurodegenerative mechanisms.

.The hygiene hypothesis proposes that exposure to several infectious agents early in life is protective against MS, being the disease a response to a later encounter with such agents.^ Later in the course of the disease, about half of them develop secondary-progressive MS. Their symptoms and disabilities worsen as they continue to have relapses but do not fully recover.

^ Climate , diet , geomagnetism , toxins , sunlight exposure, genetic factors, and infectious diseases have all been discussed as possible reasons for these regional differences.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ Intravenous immunoglobulin (IVIG) has several effects on the immune system that could have a beneficial influence on disease processes in multiple sclerosis (MS).

[1] .The prevalence hypothesis proposes that the disease is due to a pathogen more common in regions of high MS prevalence.^ The prevalence of HHV-6 infection was significantly higher in patients with MS (16/26) than in patients with other neurological diseases (6/21) and in blood donors (43/150).

^ MS, like other presumed autoimmune diseases, is more common in females and often first manifests clinical symptoms during young adulthood.
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
  • Journal of Clinical Investigation -- Multiple sclerosis 28 January 2010 1:31 UTC www.jci.org [Source type: Academic]

^ In these areas there is a noticeable north/south gradient with MS being more prevalent in higher latitude, temperate regions.
  • Multiple Sclerosis and Food Hypersensitivities 2 February 2010 10:010 UTC www.chetday.com [Source type: Academic]

.This pathogen is very common, causing in most individuals an asymptomatic persistent infection.^ Multiple sclerosis (MS) is one of the most common causes of neurological disability in young and middle-aged adults.

^ Multiple sclerosis is the third most common cause of severe disability in patients between the ages of 15 and 50 years.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Catheter-associated UTI is the most common nosocomial infection, accounting for > 1 million cases in hospitals and nursing homes.

.Only in a few cases, and after many years since the original infection, does it bring demyelination.^ Since I was diagnosed with a severe case of Multiple Sclerosis, I have been through many things that you also may be struggling with ...
  • multiplesclerosis, ms symptoms, symptoms ms, multiple and sclerosis, symptomsmultiple sclerosis, multiple sclerosis symptoms, ms news, news ms,symptoms of ms, ms help, ms multiple sclerosis 28 January 2010 1:31 UTC www.tamingmultiplesclerosis.com [Source type: General]

^ This syndrome is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and emotions, and is usually seen only in severe cases.
  • Multiple Sclerosis: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS) 2 February 2010 10:010 UTC www.ninds.nih.gov [Source type: Academic]
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

^ And some of the references are outdated, ie it has been a few more years since being diagnosed and my husband is now my ex.I didn't go to the MS walk this year.

[5][21] .The hygiene hypothesis has received more support than the prevalence hypothesis.^ In placebo-controlled studies, common side effects other than local reactions were reported no more frequently among vaccine recipients than among individuals receiving a placebo.

^ Investigations in northern Europe and America have detected three HLAs that are more prevalent in people with MS than in the general population.
  • Multiple Sclerosis: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS) 2 February 2010 10:010 UTC www.ninds.nih.gov [Source type: Academic]
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

^ MS is five times more prevalent in temperate climates-such as those found in the northern United States, Canada, and Europe-than in tropical regions.
  • Multiple Sclerosis: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS) 2 February 2010 10:010 UTC www.ninds.nih.gov [Source type: Academic]
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

[5]
.Evidence for viruses as a cause includes the presence of oligoclonal bands in the brain and cerebrospinal fluid of most patients, the association of several viruses with human demyelinating encephalomyelitis, and induction of demyelination in animals through viral infection.^ Levels of IgG are increased in the cerebrospinal fluid of most MS patients.
  • Multiple Sclerosis: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS) 2 February 2010 10:010 UTC www.ninds.nih.gov [Source type: Academic]

^ The occurrence of carbohydrate craving in early life may have increased the patient's vulnerability to viral infection given the importance of 5-HT and melatonin in immunomodulation and the regulation of the integrity of the blood brain barrier.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ The physician may also study the patient's cerebrospinal fluid (the colorless liquid that circulates through the brain and spinal cord) for cellular and chemical abnormalities often associated with MS. These abnormalities include increased numbers of white blood cells and higher-than-average amounts of protein, especially myelin basic protein and an antibody called immunoglobulin G .
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

[22] .Human herpes viruses are a candidate group of viruses linked to MS. Individuals who have never been infected by the Epstein-Barr virus have a reduced risk of having the disease and among the infected ones those infected as young adults have a greater risk than those who had it at a younger age.^ MS is very much an individual disease.

^ Human herpes virus 6 and multiple sclerosis.

^ They include Epstein-Barr virus (the cause of mononucleosis), herpesvirus 6, herpes simplex virus, influenza, measles, mumps, varicella zoster virus, cytomegaolovirus, respiratory syncytial virus, and Chlamydia pneumonia .
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

[5][1] .Although some consider that this goes against the hygiene hypothesis, since the non-infected have probably experienced a more hygienic upbringing,[5] others believe that there is no contradiction since it is the encounter at a later moment with the virus the trigger for the disease.^ More than one antigen may be involved, some may trigger the disease, and others may keep the process going.

^ Whilst it is important to continue monitoring some of the safety issues, there is no evidence to suggest that the WHO should consider altering its recommendation that all countries should have universal infant and/or adolescent immunisation programmes.

^ Since antibodies and other proteins are part of the immune attack against the nervous system, it makes some sense to try to remove them.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[1] .Other diseases that have also been related with MS are measles, mumps and rubella.^ Any other relations to MS…?

^ The prevalence of HHV-6 infection was significantly higher in patients with MS (16/26) than in patients with other neurological diseases (6/21) and in blood donors (43/150).

^ MS, like other presumed autoimmune diseases, is more common in females and often first manifests clinical symptoms during young adulthood.
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
  • Journal of Clinical Investigation -- Multiple sclerosis 28 January 2010 1:31 UTC www.jci.org [Source type: Academic]

[1]

Pathophysiology

Blood-brain barrier breakdown

Demyelination in MS. On Klüver-Barrera myelin staining, decoloration in the area of the lesion can be appreciated (Original scale 1:100).
.The blood–brain barrier is a capillary system that should prevent entrance of T cells into the nervous system.^ "Endothelial cells of the blood-brain barrier: a target for glucocorticoids and estrogens?"

^ The central nervous system should be able to recruit oligodendrocyte stem cells capable to turn into mature myelinating oligodendrocytes, but it is suspected that something inhibits stem cells in affected areas.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ According to a strictly immunological explanation of MS, the inflammatory processes triggered by the T cells create leaks in the blood-brain barrier (a capilar system that should prevent entrance of T-cells in the nervous system).
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

[4] .The blood–brain barrier is normally not permeable to these types of cells, unless triggered by infection or a virus, which decreases the integrity of the tight junctions forming the barrier.^ "Endothelial cells of the blood-brain barrier: a target for glucocorticoids and estrogens?"

^ The occurrence of carbohydrate craving in early life may have increased the patient's vulnerability to viral infection given the importance of 5-HT and melatonin in immunomodulation and the regulation of the integrity of the blood brain barrier.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Tight junctions (TJs), present between the cerebral endothelial cells, form a diffusion barrier, which selectively excludes most blood-borne substances from entering the brain.

[4] .When the blood–brain barrier regains its integrity, usually after infection or virus has cleared, the T cells are trapped inside the brain.^ "Endothelial cells of the blood-brain barrier: a target for glucocorticoids and estrogens?"

^ The occurrence of carbohydrate craving in early life may have increased the patient's vulnerability to viral infection given the importance of 5-HT and melatonin in immunomodulation and the regulation of the integrity of the blood brain barrier.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Failure of immunoregulatory function in the brain Natalizumab-- may cause release of B cells and ciruculate, premature and mature B cells and increased transcription factors resulting in a productive infection.

[4]

Autoimmunology

.MS is currently believed to be an immune-mediated disorder mediated by a complex interaction of the individual's genetics and as yet unidentified environmental insults.^ The most significant genetic link to MS has been identified in the major histocompatability complex (MHC), a cluster of genes on chromosome 6 that are essential for immune system function.
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

^ The causes of MS are unclear, but it has become evident that both environmental and genetic factors play a role.

^ According to the National multiple sclerosis Society, multiple sclerosis (MS) is a chronic autoimmune disease in which the immune system is believed to attack and degrade myelin, the protective cov...
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

[4] .Damage is believed to be caused by the patient's own immune system.^ Theoretically, this condition develops when the body's immune system is damaged by genetic or environmental factors or both, causing it to attack its own tissues.

^ Interferons (really a family of immune chemicals) are biologically engineered but are produced in small quantities by your own immune system.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ The first suggests the immune system is actually attacking a virus (one too well-hidden for detection in the laboratory), and the myelin damage is an unintentional consequence of fighting the infection.
  • Multiple sclerosis 2 February 2010 10:010 UTC www.uams.edu [Source type: Academic]

.The immune system attacks the nervous system, possibly as a result of exposure to a molecule with a similar structure to one of its own.^ Inflammation occurs when the body's own immune cells attack the nervous system.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ The inflammations in the nervous system correspond to attacks.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ These proteins are similar to antibodies, which help the body's immune system recognize and destroy foreign substances, such as bacteria and viruses.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[4]
Lesions
.The name multiple sclerosis refers to the scars (scleroses – better known as plaques or lesions) that form in the nervous system.^ Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system.

^ This is where the disease gets its name, multiple sclerosis or multiple scarring.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Calabresi P. Multiple sclerosis and demyelinating conditions of the central nervous system.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]
  • Multiple sclerosis 28 January 2010 1:31 UTC www.lifespan.org [Source type: Academic]

.MS lesions most commonly involve white matter areas close to the ventricles of the cerebellum, brain stem, basal ganglia and spinal cord; and the optic nerve.^ MS affects the spinal cord and the brain.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ MS symptoms develop as the cumulative result of multiple lesions in the brain and spinal cord .
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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^ A layer of insulation that surrounds the nerve fibers in the brain and spinal cord.
  • Multiple sclerosis 2 February 2010 10:010 UTC www.uams.edu [Source type: Academic]

.The function of white matter cells is to carry signals between grey matter areas, where the processing is done, and the rest of the body.^ One explanation for this would be an imbalance between the Th1 type of helper T-cells , which fight infection, and the Th2 type, which are more active in allergy and more likely to attack the body.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ In the brain and spinal cord, white matter is broken up into cables carrying messages that are called tracts .
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Axon: The part of the nerve cell that carries an electrical signal over a long distance.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

.The peripheral nervous system is rarely involved.^ In Multiple Sclerosis (MS) pathology, early inflammation involves leukocyte migration across the blood-brain barrier (BBB) within the central nervous system.

^ Fatigue is also seen in diseases that affect the central, peripheral, and autonomic nervous systems (central fatigue).

^ But the myelin of nerves, peripheral nervous system myelin, is chemically different than central nervous system myelin and is made by different cells.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[4]
.More specifically, MS destroys oligodendrocytes, the cells responsible for creating and maintaining a fatty layer—known as the myelin sheath—which helps the neurons carry electrical signals.^ As myelin, axons, oligodendrocytes, and neurons are destroyed, the brain begins to shrink.

^ The oligodendrocyte cell that makes myelin was discovered.

^ MS is a chronic autoimmune disorder, in which the body attacks and destroys the myelin sheath that insulates and protects nerve fibers of the central nervous system (the brain, spinal cord and optic nerves).

[4] .MS results in a thinning or complete loss of myelin and, as the disease advances, the cutting (transection) of the neuron's extensions or axons.^ Figure 7 Neuron with axon, myelin and dendrites.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Axons or cell extensions are cut or interrupted as well.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ The present communication concerns four selected MS patients who experienced alterations in dream content and loss of morning dream recall during the course of the disease.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]

.When the myelin is lost, a neuron can no longer effectively conduct electrical signals.^ Myelin also helps conduct electrical signals, also termed impulses - i.e.

^ Myelin is the fatty insulating layer that surrounds nerves that conduct electrical impulses to neurons and muscles.

^ Loosely speaking the axon is the wire carrying the electrical signal generated by the neuron cell body.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[4] .A repair process, called remyelination, takes place in early phases of the disease, but the oligodendrocytes cannot completely rebuild the cell's myelin sheath.^ The oligodendrocyte cell that makes myelin was discovered.

^ It is known that a repair process, called remyelination, takes place in early phases of the disease, but the oligodendrocytes that originally formed a myelin sheath cannot completely rebuild a destroyed myelin sheath.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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^ The central nervous system should be able to recruit oligodendrocyte stem cells capable to turn into mature myelinating oligodendrocytes, but it is suspected that something inhibits stem cells in affected areas.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

[23] .Repeated attacks lead to successively fewer effective remyelinations, until a scar-like plaque is built up around the damaged axons.^ Also the neuron axons are damaged by the attacks.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
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^ Repeated attacks lead to successively fewer effective remyelinations, until a scar-like plaque is built up around the damaged axons, according to four different damage patterns [25] .
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ It stops currents from flowing between the individual axons which are just like single wires, that make up the cable.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[23] Different lesion patterns have been described.[24]
Inflammation
.Apart from demyelination, the other pathologic hallmark of the disease is inflammation.^ Characteristic pathological features of multiple sclerosis (MS) include inflammation, demyelination and axonal and oligodendrocyte loss.

^ The pathological hallmark is multifocal demyelination and inflammation in the CNS. In addition, there is also a variable extent of axonal damage.

^ Inflammation is a hallmark of various CNS diseases such as bacterial and viral infections, multiple sclerosis, Alzheimer's disease, and cerebral ischemia.

.According to a strictly immunological explanation of MS, the inflammatory process is caused by T cells, a kind of lymphocyte.^ According to a strictly immunological explanation of MS, the inflammatory processes triggered by the T cells create leaks in the blood-brain barrier (a capilar system that should prevent entrance of T-cells in the nervous system).
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ That triggers inflammatory processes, stimulating other immune cells and soluble factors like cytokines and antibodies .
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ MS is believed to be an autoimmune disorder mediated by activated immune cells such as T- and B-lymphocytes and macrophages/microglia.

.Lymphocytes are cells that play an important role in the body's defenses.^ Internet can play an important role.

^ These observations suggest that stress and the HPA axis may play important roles in the pathology of these diseases.

^ T cells play a crucial role in the pathogenesis of most autoimmune disorders.

[4] .In MS, T cells gain entry into the brain via the previously described blood–brain barrier.^ "Endothelial cells of the blood-brain barrier: a target for glucocorticoids and estrogens?"

^ According to a strictly immunological explanation of MS, the inflammatory processes triggered by the T cells create leaks in the blood-brain barrier (a capilar system that should prevent entrance of T-cells in the nervous system).
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ Trafficking of inflammatory T cells into the CNS is a crucial event in the pathogenesis of MS, a process in which chemokines and their receptors have been demonstrated to play an important role.

.Evidence from animal models also point to a role of B cells in addition to T cells in development of the disease.^ "Neuroimaging of animal models of brain disease."

^ Thirty-eight percent to 50% of patients with MS develop ON at some point during the course of their disease.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ The combination of such approaches will likely generate a new series of hypotheses that can be examined by both animal and in vitro models of human disease.
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
  • Journal of Clinical Investigation -- Multiple sclerosis 28 January 2010 1:31 UTC www.jci.org [Source type: Academic]

[25]
.The T cells recognize myelin as foreign and attack it as if it were an invading virus.^ Myelin is attacked and digested by inflammatory cells.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ It is being used as a decoy to trick white blood cells into attacking it instead of myelin.

^ This procedure results in destruction of the immune system cells that were attacking myelin basic protein.
  • Multiple Sclerosis: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS) 2 February 2010 10:010 UTC www.ninds.nih.gov [Source type: Academic]
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

.This triggers inflammatory processes, stimulating other immune cells and soluble factors like cytokines and antibodies.^ That triggers inflammatory processes, stimulating other immune cells and soluble factors like cytokines and antibodies .
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ According to a strictly immunological explanation of MS, the inflammatory processes triggered by the T cells create leaks in the blood-brain barrier (a capilar system that should prevent entrance of T-cells in the nervous system).
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ This drug stimulates T cells in the body's immune system to change from harmful, pro-inflammatory agents to beneficial, anti-inflammatory agents that work to reduce inflammation at lesion sites.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

.Leaks form in the blood–brain barrier, which in turn cause a number of other damaging effects such as swelling, activation of macrophages, and more activation of cytokines and other destructive proteins.^ These leaks, in turn, cause a number of other damaging effects such as swelling , activation of macrophages , and more activation of cytokines and other destructive proteins such as matrix metalloproteinases .
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ According to a strictly immunological explanation of MS, the inflammatory processes triggered by the T cells create leaks in the blood-brain barrier (a capilar system that should prevent entrance of T-cells in the nervous system).
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

^ MS exacerbations appear to be caused by abnormal immune activity that causes inflammation and the destruction of myelin (the protective covering of nerve fibers) in the brain or spinal cord.
  • ASA : Multiple Sclerosis and Medical Cannabis 2 February 2010 10:010 UTC www.safeaccessnow.org [Source type: Academic]

[4]

Diagnosis

.
T1-weighted MRI scans (post-contrast) of the same brain slice at monthly intervals.
^ After a baseline period of 3 monthly MRI scans (months -2 to 0), patients followed a 9-month treatment period on 80 mg atorvastatin daily.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Correlations between changes in disability and T2-weighted brain MRI activity in multiple sclerosis: a follow-up study.
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
  • Journal of Clinical Investigation -- Multiple sclerosis 28 January 2010 1:31 UTC www.jci.org [Source type: Academic]

^ These are lesions in the brain that emit very low signals on an MRI scan.

Bright spots indicate active lesions.
.Multiple sclerosis can be difficult to diagnose since its signs and symptoms may be similar to other medical problems.^ I dealt with after I was first diagnosed with Multiple Sclerosis !!
  • multiplesclerosis, ms symptoms, symptoms ms, multiple and sclerosis, symptomsmultiple sclerosis, multiple sclerosis symptoms, ms news, news ms,symptoms of ms, ms help, ms multiple sclerosis 28 January 2010 1:31 UTC www.tamingmultiplesclerosis.com [Source type: General]

^ Medications used to slow the progression of multiple sclerosis may include: .
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ Multiple sclerosis (MS) is a complex neurological condition that is difficult to diagnose.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

[1][26] .Medical organizations have created diagnostic criteria to ease and standardize the diagnostic process for practicing physicians, specially in the first stages of the disease.^ Despite an appreciation of the large number of pathways and pathological processes that are involved in these diseases, a few practical targets and several new strategies have emerged from these studies.

^ This article specifically focuses on the differential diagnosis, diagnostic evaluation, medical management, and rehabilitation issues in MS. Similarly, the differential diagnosis treatment and rehabilitation in Parkinson's disease is discussed.

^ New diagnostic criteria for multiple sclerosis: Application in first demyelinating episode.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[1] Historically, the Schumacher and Poser criteria were both popular.[27] .Currently, the McDonald criteria focus on a demonstration with clinical, laboratory and radiologic data of the dissemination of MS lesions in time and space.^ And so there are multiple lesions in space and time.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ The focus remains on the objective demonstration of dissemination of lesions in both time and space.

^ However, recent clinical, biologic, and immunologic data have demonstrated that they reduce or abolish the therapeutic efficacy of IFN-beta in 10-20% of patients.

[1][28][29]
.Clinical data alone may be sufficient for a diagnosis of MS if an individual has suffered separate episodes of neurologic symptoms characteristic of MS.[28] Since some people seek medical attention after only one attack, other testing may hasten and ease the diagnosis.^ Some people have had only one episode of a neurological symptom such as optic neuritis, but MRI tests suggest they may have MS. This is known as a clinically isolated syndrome.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Some people have only one episode of a neurological symptom such as optic neuritis, but MRI tests suggest they may have MS. This is known as a clinically isolated syndrome.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Some people have only minor side effects, but others may have side effects that concern them more than their MS symptoms.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

.The most commonly used diagnostic tools are neuroimaging, analysis of cerebrospinal fluid and evoked potentials.^ Some of those most commonly used are: .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Visual evoked potential (VEP) studies are widely used for the diagnosis of multiple sclerosis (MS) and are also useful in monitoring the effects of various therapeutic modalities in the disease.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ By distinguishing new lesions from old ones Revealing increasing or decreasing numbers of lesions within the central nervous system over time Cerebrospinal Fluid Analysis .
  • Multiple sclerosis 2 February 2010 10:010 UTC adam.about.com [Source type: Academic]

.Magnetic resonance imaging of the brain and spine shows areas of demyelination (lesions or plaques).^ MRI Scan: Magnetic resonance imaging.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ "The role of nonconventional magnetic resonance imaging techniques in demyelinating disorders."

^ New criteria have recently been proposed by a group of experts and they emphasize the fundamental role played by magnetic resonance imaging.

.Gadolinium can be administered intravenously as a contrast to highlight active plaques and, by elimination, demonstrate the existence of historical lesions not associated with symptoms at the moment of the evaluation.^ The evolution to this secondary progressive form of the disease is associated with significantly fewer gadolinium-enhanced lesions and a decrease in brain parenchymal volume ( 30 , 31 ).
  • Journal of Clinical Investigation -- Multiple sclerosis 2 February 2010 10:010 UTC www.jci.org [Source type: Academic]
  • Journal of Clinical Investigation -- Multiple sclerosis 28 January 2010 1:31 UTC www.jci.org [Source type: Academic]

^ It is often used in conjunction with the contrast agent gadolinium, which helps distinguish new plaques from old.
  • Multiple Sclerosis: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS) 2 February 2010 10:010 UTC www.ninds.nih.gov [Source type: Academic]

^ At 18 months, treatment with Avonex was associated with a significant reduction of new T2 lesions, gadolinium enhanced lesions and T2 lesion volume.

[28][30] .Testing of cerebrospinal fluid obtained from a lumbar puncture can provide evidence of chronic inflammation of the central nervous system.^ "[Episodic disseminated inflammation of the central nervous system.

^ "Inflammation in the central nervous system: the role for dendritic cells."

^ The fluid is obtained with a spinal tap also called a lumbar puncture.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

.The cerebrospinal fluid is tested for oligoclonal bands, which are an inflammation marker found in 75–85% of people with MS.[28][31] The nervous system of a person with MS responds less actively to stimulation of the optic nerve and sensory nerves due to demyelination of such pathways.^ Optic neuritis is inflammation of the optic nerve.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ Optic neuritis is inflammation of the nerves in the eye.

^ Optic Neuritis: An inflammation of the optic nerve.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

.These brain responses can be examined using visual and sensory evoked potentials.^ Visual evoked potential (VEP) studies are widely used for the diagnosis of multiple sclerosis (MS) and are also useful in monitoring the effects of various therapeutic modalities in the disease.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Treatment with AC pulsed electromagnetic fields normalizes the latency of the visual evoked response in a multiple sclerosis patient with optic atrophy.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ The current diagnostic criteria are based on this clinical phenotype, with supportive evidence from magnetic resonance imaging, and examination of cerebrospinal fluid and visual evoked potentials in some cases.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

[32]

Management

.Although there is no known cure for multiple sclerosis, several therapies have proven helpful.^ Combination therapies in multiple sclerosis.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ There is no known cure for multiple sclerosis at this time.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ Emerging therapies in multiple sclerosis.
  • Multiple Sclerosis - References: Online References For Health Concerns 2 February 2010 10:010 UTC www.lef.org [Source type: Academic]

.The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability.^ After 6 months, significantly more combination therapy recipients had no new gadolinium-enhanced lesions (90.5% vs 31.3% with monotherapy; p < 0.001) [primary endpoint].

^ How often you have attacks How severe they are The part of the central nervous system that is affected by each attack Most people return to normal or near-normal function between attacks.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ Scientists continue their extensive efforts to create new and better therapies for MS. Goals of therapy are threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease progression.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

.As with any medical treatment, medications used in the management of MS have several adverse effects.^ Medication may be used only some of the time or regularly, depending on how severe or constant a particular symptom is.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Visual evoked potential (VEP) studies are widely used for the diagnosis of multiple sclerosis (MS) and are also useful in monitoring the effects of various therapeutic modalities in the disease.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ This article specifically focuses on the differential diagnosis, diagnostic evaluation, medical management, and rehabilitation issues in MS. Similarly, the differential diagnosis treatment and rehabilitation in Parkinson's disease is discussed.

.Alternative treatments are pursued by some patients, despite the shortage of supporting, comparable, replicated scientific study.^ Our research projects include participation in multi-site studies for new ms treatments, and patient focused outcome studies on improving quality of life.
  • Multiple Sclerosis, (MS), Linda E. Cardinale Multiple Sclerosis Center | CentraState Healthcare System 2 February 2010 10:010 UTC www.centrastate.com [Source type: Academic]

^ One interesting study used MS patients to provide support to other MS patients as part of a telephone intervention program.

^ Patients often seek alternative medical treatments for this problem including diet therapy, acupuncture, and herbal therapy.

Acute attacks

.During symptomatic attacks, administration of high doses of intravenous corticosteroids, such as methylprednisolone, is the routine therapy for acute relapses.^ High dose methylprednisolone given intravenously is typically administered for major relapse, and oral prednisone is given for mild to moderate relapses.

^ For an acute relapse, a course of intravenous corticosteroids is typically given (500 mg to 1 gram of methylprednisolone (Solu-Medrol) over 30 to 60 minutes for 3 days).
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Relapse rate, time to first relapse, time to progression of disability all favored high dose rebif and initial treatment wih high dose rebif.

[1] .Although generally effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery.^ Corticosteroids for the long-term treatment in multiple sclerosis.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ In West syndrome there is emerging evidence that early effective treatment might improve outcome in terms of both cognition and behavior.

^ In some instances convulsions appear to be the only manifestations of an attack of MS, but there is no general acceptance of seizures as the first and only symptoms of the disease.

[33] .Oral and intravenous administration seem to have similar efficacy.^ Murray TJ. Oral and intravenous methylprednisolone were equally efficacious for relapses in multiple sclerosis: commentary.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

[34] Consequences of severe attacks which do not respond to corticosteroids might be treated by plasmapheresis.[1]

Disease-modifying treatments

.
Disease-modifying treatments are expensive and most of these require frequent (up-to-daily) injections.
^ It is also very useful in following-up many alterations, either in their natural history, as in Alzheimers disease, or in order to monitor treatments on cerebral tumors or infectious processes.

^ However, in the course of the disease, treatment failure may be influenced by interrater variability and frequent remissions.

^ At present, there is no effective disease modifying therapy, but a wide range of symptomatic treatments are available.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

Others require IV infusions at 1–3 month intervals.
.As of 2009, five disease-modifying treatments have been approved by regulatory agencies of different countries for MS. Interferon beta-1a (trade names Avonex, CinnoVex, ReciGen and Rebif ) and interferon beta-1b (U.S. trade name Betaseron, in Europe and Japan Betaferon).^ INTERFERON BETA 1A .

^ Interferon beta babies-- Pregnancy on MS treatment .

^ Beta Interferon 1a .
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

.A third medication is glatiramer acetate (Copaxone), a non-interferon, non-steroidal immunomodulator.^ Copaxone (glatiramer acetate injection).
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Immune modulators to help control the immune system, including interferons (Avonex, Betaseron, or Rebif), monoclonal antibodies (Tysabri), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), methotrexate, azathioprine (Imuran), cyclophosphamide (Cytoxan), and natalizumab (Tysabri) Steroids may be used to decrease the severity of attacks Medications to control symptoms may include: .
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ "Glatiramer acetate (Copaxone) therapy for multiple sclerosis."

.The fourth medication, mitoxantrone, is an immunosuppressant also used in cancer chemotherapy.^ Novantrone (mitoxantrone) constitutes a fairly low dose of cancer chemotherapy.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

The fifth is natalizumab (marketed as Tysabri).[1] .The interferons and glatiramer acetate are delivered by frequent injections, varying from once-per-day for glatiramer acetate to once-per-week (but intra-muscular) for Avonex.^ Avonex * is administered with a deeper intra-muscular injection once a week.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Copaxone (glatiramer acetate injection).
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Injection, glatiramer acetate, 20 mg [for relapsing remitting multiple sclerosis] .
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

Natalizumab and mitoxantrone are given by IV infusion at monthly intervals.
.All five kinds of medications are modestly effective at decreasing the number of attacks in relapsing-remitting MS (RRMS) while the capacity of interferons and glatiramer acetate is more controversial.^ Interferon in relapsing-remitting multiple sclerosis.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Relapsing-remitting MS .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Immune modulators to help control the immune system, including interferons (Avonex, Betaseron, or Rebif), monoclonal antibodies (Tysabri), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), methotrexate, azathioprine (Imuran), cyclophosphamide (Cytoxan), and natalizumab (Tysabri) Steroids may be used to decrease the severity of attacks Medications to control symptoms may include: .
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

.Studies of their long-term effects are still lacking.^ Definitive comparative studies are still lacking.

^ Because steroids can produce numerous adverse side effects (acne, weight gain, seizures, psychosis), they are not recommended for long-term use.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

^ Still, they write, long-term observational studies are needed to fully characterize the risk of PML with this drug.

[1][35] .Comparisons between immunomodulators (all but mitoxantrone) show that the most effective is natalizumab, both in terms of relapse rate reduction and halting disability progression.^ There was a 45 % reduction in relapse rate.

^ All have shown significant reductions in relapse rates and accumulation of new magnetic resonance imaging (MRI) lesions, but only one trial (of IFNb1b) showed significant slowing of disability progression.

^ Clinical trials have shown that mitoxantrone has a statistically significant impact on reduction of relapse rate and delays disability progression in patients with relapsing remitting (RR) multiple sclerosis (MS) or secondary progressive (SP) MS. Treatment is well tolerated, but the risk of cardiotoxicity at higher cumulative doses is likely to limit the duration of treatment.

[36] .Mitoxantrone may be the most effective of them all, however, it is generally not considered as a long-term therapy, as its use is limited by severe secondary effects.^ The therapy of MS in the future will most likely use a combination of agents that are directed at the underlying disease state and stage in the individual patient.

^ CONCLUSION: Intravenous immunoglobulin is effective in many autoimmune neurologic diseases, but its spectrum of efficacy, especially as first-line therapy, and the appropriate dose for long-term maintenance therapy are not fully established.

^ Although they are very useful for improving acute symptoms in the relapsing-remitting patient, steroids do not improve the long-term course of the disease and can lose effectiveness if over-used.

[1][35] .The earliest clinical presentation of RRMS is the clinically isolated syndrome (CIS).^ Clinically isolated syndrome (CIS) suggestive of multiple sclerosis.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Three-year data from the BENEFIT study suggest that, in patients with clinically isolated syndrome (CIS), immediate treatment with interferon (IFN) ß-1b significantly delays progression to clinically definite multiple sclerosis (CDMS).

^ It has been hypothesized that their efficacy could be higher if used at the first appearance of symptoms, that is in the clinically isolated syndromes (CIS) suggestive of demyelinating events, a pathology which carries a high risk to convert to clinically definite MS (CDMS).
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

Treatment with interferons during an initial attack can decrease the chance that a patient will develop clinical MS.[1]
.Treatment of progressive MS is more difficult than relapsing-remitting MS. Mitoxantrone has shown positive effects in patients with secondary progressive and progressive relapsing courses.^ Secondary-progressive (SP) MS begins with a relapsing-remitting course followed by a later primary-progressive course.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

^ Secondary progressive , which initially follows a relapsing-remitting course.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Secondary progressive , which at first follows a relapsing-remitting course and then becomes progressive.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

.It is moderately effective in reducing the progression of the disease and the frequency of relapses in patients in short-term follow-up.^ In conclusion, SC interferon-beta-1b 250 micro g every other day reduces the frequency and severity of relapses and MRI measures of disease activity and may delay the progression of disability in RRMS. The drug appeared to be more effective than, and as well tolerated as, IM interferon-beta-1a 30 micro g once weekly.

^ Although these medications do not cure MS, they may reduce the overall number, frequency, and severity of relapses in some people who have the relapsing-remitting MS .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Patients with progressive forms of MS did not appear to benefit, although relapsing-remitting patients showed some neurologic improvement and had fewer relapses and reduced numbers of lesions in one study.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

[37] No treatment has been proven to modify the course of primary progressive MS.[38]
.As with any medical treatment, these treatments have several adverse effects.^ Many questions remain unanswered regarding the scope, severity, and treatment of chronic pain in these groups.

^ Other types of treatment should not replace these medications if you are a candidate for treatment with them.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Each of these therapies carries the risk of potentially severe side effects.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

.One of the most common is irritation at the injection site for glatiramer acetate and the interferon treatments.^ Copaxone (glatiramer acetate injection).
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ "Glatiramer acetate for the treatment of multiple sclerosis."

^ Alpha interferon is also being studied as a possible treatment for MS. Common side effects of interferons include fever, chills, sweating, muscle aches, fatigue, depression, and injection site reactions.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

.Over time, a visible dent at the injection site, due to the local destruction of fat tissue, known as lipoatrophy, may develop.^ Local injection-site reactions were observed in up to a half of patients treated with glatiramer acetate, thus making a blind assessment of outcomes questionable.

^ Lipoatrophy is a fancy name for destruction of fat cells.

^ Many patients taking Betaseron complain of severe pain at the injection site caused by damaged tissue.

.Interferons produce symptoms similar to influenza;[39] some patients taking glatiramer experience a post-injection reaction manifested by flushing, chest tightness, heart palpitations, breathlessness, and anxiety, which usually lasts less than thirty minutes.^ Many experts are urging that patients with active disease be treated with a disease-modifying agent (interferons beta and alpha or glatiramer) as soon as they are diagnosed with MS. There are some arguments against this approach however: Many patients have a mild course that can be managed with less toxic agents that treat symptoms only.

^ They include pain at the injection site, chest pain, rapid heart beat, flushing, anxiety, and shortness of breath.

^ You may drop things more than usual and be less coordinated.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[40] .More dangerous but much less common are liver damage from interferons,[41] severe cardiotoxicity, infertility, and acute myeloid leukaemia of mitoxantrone,[1][35] and the putative link between natalizumab and some cases of progressive multifocal leukoencephalopathy.^ Tagged natalizumab , PML , progressive multifocal leukoencephalopathy , tysabri .

^ Some have more, some less, validity.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Progressive multifocal leukoencephalopathy can mimic the acute stage of an MS attack.
  • Multiple Sclerosis Treatment, Causes and Symptoms 2 February 2010 10:010 UTC www.healthnewsflash.com [Source type: Academic]

[1]

Management of the effects of MS

.Disease-modifying treatments reduce the progression rate of the disease, but do not stop it.^ Goal of therapy is to stop disease progression.

^ BACKGROUND: Methotrexate is a potent immunosuppressant which in theory could reduce relapse rates and delay disease progression in multiple sclerosis (MS).

^ Should I have disease-modifying therapy for MS? Physical therapy , occupational therapy , and nonmedical treatment done at home can help you manage symptoms and adjust to living and working situations.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

.As multiple sclerosis progresses, the symptomatology tends to increase.^ "The diagnosis of primary progressive multiple sclerosis."

^ Primary-progressive multiple sclerosis.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ "Primary and secondary progressive multiple sclerosis."

.The disease is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and disability.^ It is suggested that some of the cognitive deficits associated with MS, which are caused by synaptic disruption of neurotransmitter functions, may be reversed through pulsed applications of picotesla range EMF s.
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Recent developments in pharmacological treatment for disease progression and management of cognitive symptoms hold promise for patients suffering from the degenerative aspects of MS. ----- Ann Neurol.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Indeed, it may increase the number of lesions and reduce brain volume in people with MS and it may also increase their disability and the progression of the disease.

.Management of these deficits is therefore very important.^ Imaging plays an important role in the diagnosis and management of these syndromes.

.Both drug therapy and neurorehabilitation have shown to ease the burden of some symptoms, though neither influences disease progression.^ Some worsen with age and disease progression.

^ Progressive-Relapsing MS. The disease is progressive from the start with acute symptom flare-ups and continued deterioration between relapses.

^ In some instances convulsions appear to be the only manifestations of an attack of MS, but there is no general acceptance of seizures as the first and only symptoms of the disease.

[42][1] .Some symptoms have a good response to medication, such as unstable bladder and spasticity, while management of many others is much more complicated.^ This is discussed and some examples of homeopathic treatments, which seem to be more generalisable for commonly encountered MS symptoms, are given.

^ The possible side effects of using steroids or other medications to treat symptoms or control a relapse.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Medication may be used only some of the time or regularly, depending on how severe or constant a particular symptom is.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[1] .As for any patient with neurologic deficits, a multidisciplinary approach is key to improving quality of life; however, there are particular difficulties in specifying a ‘core team’ because people with MS may need help from almost any health profession or service at some point.^ Sildenafil (Viagra) is proving to be helpful for improving sexual dysfunction in some MS patients.

^ Vocational programs for the patient may be helpful.

^ The occurrence of cognitive deficits in patients with multiple sclerosis (MS) has been recognized since 1877 when Charcot first observed "enfeeblement of memory" in his patients.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

[1] .Multidisciplinary rehabilitation programmes increase activity and participation of patients but do not influence impairment level.^ Remarkably, patients noted that several months after initiation of treatment with EMFs they were able to recover, after a short period of rest, from fatigue which followed increased physical activity.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ A decrease in serum sHLA-I concentrations was observed in MS patients with demyelinating attacks, while an increase in CSF levels of sHLA-I was found in MS patients with lesional activity on MRI scans.

^ It is likely that once the level of CNS atrophy reaches a critical threshold, patients begin to suffer clinical impairment and disease progression.

[43]

Alternative treatments

.As with most chronic diseases, alternative treatments are pursued by some patients, despite the shortage of supporting, comparable, replicated scientific study.^ Chronic fatigue is a typical symptom of neurological diseases, and is most disabling in multiple sclerosis, postpoliomyelitis, poststroke, and in chronic fatigue syndrome.

^ Thirty-eight percent to 50% of patients with MS develop ON at some point during the course of their disease.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ This report concerns two MS patients with chronic disabling ataxia who experienced rapid improvement in gait and balance after receiving a series of treatments with EMFs.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

[44] .Examples are dietary regimens,[45] herbal medicine, including the use of medical cannabis,[46] and hyperbaric oxygenation.^ Patients often seek alternative medical treatments for this problem including diet therapy, acupuncture, and herbal therapy.

^ As long as the plant Cannabis and its products continue to be classified as narcotic drugs, medical use of the new preparation will need close supervision.

^ In MS'ers we tend to use these medications as adjuncts in refractory situations, for example in patients progressing despite using Avonex or Betaseron.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[47]

Prognosis

Disability-adjusted life year for multiple sclerosis per 100,000 inhabitants in 2002
     no data      less than 13      13–16      16–19      19–22      22–25      25–28      28–31      31–34      34–37      37–40      40–43      more than 43
.The prognosis (the expected future course of the disease) for a person with multiple sclerosis depends on the subtype of the disease; the individual's sex, age, and initial symptoms; and the degree of disability the person experiences.^ "The initiation of the autoimmune response in multiple sclerosis."

^ "Reproductive issues in persons with multiple sclerosis."

^ Fatigue is a common disabling symptom of multiple sclerosis (MS).

[7] .The disease evolves and advances over decades, 30 being the mean years to death since onset.^ The study was carried out on 76 subjects with long-term history of clinically confirmed SM. The mean duration of the disease was 8.5 years, and the mean age of the patients 37.8 years.
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Onset typically occurs between the ages of 15 and 40 years, with a peak incidence between 20 and 30 years old.

^ RESULTS: The mean duration of observation was 19.76 +/- 0.90 years; the mean age at MS onset was 12.73 +/- 0.25 years.

[1]
.Female sex, relapsing-remitting subtype, optic neuritis or sensory symptoms at onset, few attacks in the initial years and especially early age at onset, are associated with a better course.^ Secondary progressive , which initially follows a relapsing-remitting course.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Relapsing-remitting , where symptoms fade and then return off and on for many years.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Relapsing-Remitting MS: Average time until onset of symptoms* .

[7][48]
.The life expectancy of people with MS is 5 to 10 years lower to that of unaffected people.^ MS prognosis over 10-20 years.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ This constitutes half of all patients and about half of them (a quarter of the total MS patients) are disabled after 10 years.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Comparing rates of progression, it is clear to me that my MS has progressed faster this past 10 months off medication than over the previous year on Copaxone.
  • Joel's MS paraplegic tai chi journal 28 January 2010 1:31 UTC mstaichi.blogspot.com [Source type: General]

[1] Almost 40% of patients reach the seventh decade of life.[48] .Nevertheless, two thirds of the deaths in people with MS are directly related to the consequences of the disease.^ Interferon beta-1b (Betaseron) or mitoxantrone (Novantrone) may delay the progression of the disease for some people with secondary progressive MS .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ A small percentage of people diagnosed with MS may never have more than a few mild episodes and may never develop any disability, but the disease is unpredictable.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ And in July Cladribine was being announced as being available soon in Europe as the (potentially) first oral disease modifying drug available to people with MS: .

[1] .Suicide is also a much more important risk of death than in the healthy population, while infections and complications are specially hazardous for the more disabled ones.^ MS is much more likely to cause disability than death but doesn't have to cause either.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Being followed by more than one neurologist isn't good either unless their efforts are coordinated.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ A variety of attempts to study more restricted populations are in progress, including rare individual pedigrees with high recurrence risk.

[1]
.Although most patients lose the ability to walk prior to death, 90% are still capable of independent walking at 10 years from onset, and 75% at 15 years.^ This constitutes half of all patients and about half of them (a quarter of the total MS patients) are disabled after 10 years.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Multiple sclerosis is the third most common cause of severe disability in patients between the ages of 15 and 50 years.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Randomized clinical trials completed to date indicate that this form of K(+) channel blockade may be useful for the improvement of walking ability in patients with multiple sclerosis.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

[48][49]

Epidemiology

.Two main measures are used in epidemiological studies: incidence and prevalence.^ No standardised outcome measures were used across the studies.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ The studies have shown that quality of life questionnaires more broadly measure the impact of MS than do the most frequently used measures of disease activity and effects.

^ Using quality of life measures provides additional information in evaluating the effects of treatment and in studying the development of the disease.

.Incidence is the number of new cases per unit of person–time at risk (usually number of new cases per thousand person–years); while prevalence is the total number of cases of the disease in the population at a given time.^ In the group with seizures at any time in their life, the age-adjusted incidence rate was 82 per 100,000 person-years (95% CI, 41-158).

^ Significant effect found on time to first relapse, proportion of patients relapse free, relapse rate, , number of moderate or severe relapses, and need for hospitalization over two years.

^ Despite an appreciation of the large number of pathways and pathological processes that are involved in these diseases, a few practical targets and several new strategies have emerged from these studies.

.Prevalence is known to depend not only on incidence, but also on survival rate and migrations of affected people.^ People who have only optic neuritis and symptoms that affect the senses have a better outlook than if symptoms are more widespread.

.MS has a prevalence that ranges between 2 and 150 per 100,000 depending on the country or specific population.^ Prevalence rates range from less than 5 per 100,000 (e.g.

^ In the group with seizures at any time in their life, the age-adjusted incidence rate was 82 per 100,000 person-years (95% CI, 41-158).

^ The age-adjusted incidence of first unprovoked seizures in Rochester, Minn, was 61 per 100,000 person-years.

[2] .Studies on populational and geographical patterns of epidemiological measures have been very common in MS,[21] and have led to the proposal of different etiological (causal) theories.^ However, cross-cultural studies show that evolutionarily, a very different sleeping pattern is the norm.
  • Joel's MS paraplegic tai chi journal 28 January 2010 1:31 UTC mstaichi.blogspot.com [Source type: General]

^ Head-to-head comparisons of the psychometric properties of the MSIS-29 and other outcome measures for MS will help to determine the relative advantages of different instruments so that the choice of measures for studies can be evidence based.

^ Very small uncontrolled studies have reported improvement in fatigue, tremors, and other symptoms in patients who were severely affected by MS. Alternative Remedies.

[5][18][19][21]
Ethnic groups such as the Sami have a lower incidence of MS, possibly due to genetic factors.
MS usually appears in adults in their thirties but it can also appear in children.[1] .The primary progressive subtype is more common in people in their fifties.^ Progress has been slower in the genetic dissection of other more common neurological diseases with a complex mode of inheritance.

^ Primary progressive multiple sclerosis (PPMS) is a rather unique form of the more common relapsing inflammatory demyelinative disease.

^ For most people the disease starts between the ages of twenty to forty and it is a little more common in women almost by 2:1 and affects whites more than other races.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[11] .As with many autoimmune disorders, the disease is more common in women, and the trend may be increasing.^ "Vaccination may be associated with autoimmune diseases."

^ DESIGN, SETTING, AND PARTICIPANTS: Men are less susceptible to many autoimmune diseases, including MS. Possible causes for this include sex hormones and/or sex chromosome effects.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ CONCLUSIONS: Transected axons are common in the lesions of multiple sclerosis, and axonal transection may be the pathologic correlate of the irreversible neurologic impairment in this disease.

[1][50] .In children, the sex ratio difference is higher,[1] while in people over fifty, MS affects males and females almost equally.^ Different people will be affected in different ways.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Epidemiologic studies report an ASD prevalence of approximately 3 to 6/1000, with a male to female ratio of 3:1.

^ In Japanese people born after modernisation in the 1960s, the ratio of conventional to opticospinal MS has increased rapidly.

[11]
.There is a north-to-south gradient in the northern hemisphere and a south-to-north gradient in the southern hemisphere, with MS being much less common in people living near the equator.^ Cognitive and emotional problems , which are common in people who have had MS for some time.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Despite this fact, there is a lot of information about the initial relapsing-remitting phase in the literature, but much less about the secondary progressive one.

^ And in July Cladribine was being announced as being available soon in Europe as the (potentially) first oral disease modifying drug available to people with MS: .

[1][50] .Climate, sunlight and intake of vitamin D have been investigated as possible causes of the disease that could explain this latitude gradient.^ DESIGN, SETTING, AND PARTICIPANTS: Men are less susceptible to many autoimmune diseases, including MS. Possible causes for this include sex hormones and/or sex chromosome effects.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Several biological mechanisms have been proposed to explain how vaccines might cause allergic or autoimmune diseases.

^ Most of us can remember a day when leading minds didn’t believe that pain could be a symptom of a disease which also caused numbness.

[19] .However, there are important exceptions to the north-south pattern and changes in prevalence rates over time;[1] in general, this trend might be disappearing.^ However, as 65 million years of evolution might suggest, there are significant differences.

^ (Once upon a time I would have called it X rated, but things have really changed for me.

^ The importance of NABs has not been completely explained, however it is generally reckoned that they might be one of the factors diminishing treatment efficacy.

[50] .This indicates that other factors such as environment or genetics have to be taken into account to explain the origin of MS.[1] MS is also more common in regions with northern Europe populations.^ The causes of MS are unclear, but it has become evident that both environmental and genetic factors play a role.

^ Critical examination of the more recent data on MS prevalence leads to some revisions of previously held concepts, the most interesting of which is the appreciation of the greater influence of genetic factors on disease acquisition.

^ Moderate disability in one functional area, such as vision or the urinary tract, and possibly more than one minimal disability in several others.

[1] .But even in regions where MS is common, some ethnic groups are at low risk of developing the disease, including the Samis, Turkmen, Amerindians, Canadian Hutterites, Africans, and New Zealand Māori.^ The rarity of MS among Samis, Turkmen, Uzbeks, Kazakhs, Kyrgyzis, native Siberians, North and South Amerindians, Chinese, Japanese, African blacks and New Zealand Maoris, as well as the high risk among Sardinians, Parsis and Palestinians, clearly indicate that the different susceptibilities of distinct racial and ethnic groups are an important determinant of the uneven geographic distribution of the disease.

^ Cognitive and emotional problems , which are common in people who have had MS for some time.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ MS is more common in those who grew up in colder regions that are farther away from the equator.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[18]
.Environmental factors during childhood may play an important role in the development of MS later in life.^ Genetics play a role in the development of MS, but the disease is not directly inherited.
  • Multiple Sclerosis | HealthyWomen 2 February 2010 10:010 UTC www.healthywomen.org [Source type: Academic]

^ Internet can play an important role.

^ A combination of factors, ranging from genetics to childhood infections, may play a role.
  • OhioHealth - Multiple sclerosis 2 February 2010 10:010 UTC www.ohiohealth.com [Source type: FILTERED WITH BAYES]

.Several studies of migrants show that if migration occurs before the age of 15, the migrant acquires the new region's susceptibility to MS. If migration takes place after age 15, the migrant retains the susceptibility of his home country.^ Study shows Lisinopril good for MS .

^ Multiple sclerosis is the third most common cause of severe disability in patients between the ages of 15 and 50 years.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ Despite an appreciation of the large number of pathways and pathological processes that are involved in these diseases, a few practical targets and several new strategies have emerged from these studies.

[1][18] .However, the age–geographical risk for developing multiple sclerosis may span a larger timescale.^ "Development of biomarkers in multiple sclerosis."

^ Your risk of developing multiple sclerosis (MS) increases with: 4 .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Multiple sclerosis (MS) is one of the most common causes of neurological disability in young and middle-aged adults.

[1] .A relationship between season of birth and MS has also been found which lends support to an association with sunlight and vitamin D. For example fewer people with MS are born in November as compared to May.^ For people with relapsing-remitting MS , treatment with interferon beta or glatiramer acetate may reduce the frequency of relapses, and interferon beta may delay disability.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ A small percentage of people diagnosed with MS may never have more than a few mild episodes and may never develop any disability, but the disease is unpredictable.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ This groups adds that treatment with medicine may also be considered after the first attack in some people who are at a high risk for MS. 9 .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

[51]

History

Medical discovery

Detail of drawing from Carswell book depicting MS lesions in the brain stem and spinal cord (1838)
.The French neurologist Jean-Martin Charcot (1825–1893) was the first person to recognize multiple sclerosis as a distinct disease in 1868.[52] Summarizing previous reports and adding his own clinical and pathological observations, Charcot called the disease sclerose en plaques.^ "Reproductive issues in persons with multiple sclerosis."

^ MS, or multiple sclerosis , is a complex disease that affects each person differently.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ Multiple Sclerosis (MS) is an autoimmune disease.
  • Multiple Sclerosis | LIVESTRONG.COM 2 February 2010 10:010 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

The three signs of MS now known as Charcot's triad 1 are nystagmus, intention tremor, and telegraphic speech, though these are not unique to MS. Charcot also observed cognition changes, describing his patients as having a "marked enfeeblement of the memory" and "conceptions that formed slowly".[3]
.Prior to Charcot, Robert Carswell (1793–1857), a British professor of pathology, and Jean Cruveilhier (1791–1873), a French professor of pathologic anatomy, had described and illustrated many of the disease's clinical details, but did not identify it as a separate disease.^ RECENT FINDINGS: The clinical heterogeneity of multiple sclerosis as well as the finding of different pathological patterns suggests that multiple sclerosis may be a spectrum of diseases that may represent different pathological processes.

^ Jean-Martin Charcot, professor of neurology at the University of Paris, wrote the first complete description of MS and the changes in the brain which accompany it.

^ Many trials have shown a reduction of MRI lesions but not clinical disease activity.

[52] Specifically, Carswell described the injuries he found as "a remarkable lesion of the spinal cord accompanied with atrophy".[1]
.After Charcot's description, Eugène Devic (1858–1930), Jozsef Balo (1895–1979), Paul Ferdinand Schilder (1886–1940), and Otto Marburg (1874–1948) described special cases of the disease.^ There are many case reports of DEM erroneously diagnosed as MS, Schilder's, Marburg's, Devic's, and Balo's disease, and, in particular brain tumors.

The disease did not receive its current name until 1955.[1] During all the 20th century there was an important development on the theories about the cause and pathogenesis of MS while efficacious treatments began to appear in 1990.[1]

Historical cases

There are several historical accounts of people who lived before or shortly after the disease was described by Charcot and probably had MS.
.A young woman called Halldora, who lived in Iceland around the year 1200, suddenly lost her vision and mobility, but after praying to the saints, recovered them seven days after.^ I report a 51 year old woman with secondary progressive MS who experienced difficulties with binocular depth perception resulting in frequent falls and injuries.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

.Saint Lidwina of Schiedam (1380–1433), a Dutch nun, may be one of the first clearly identifiable MS patients.^ The occurrence of cognitive deficits in patients with multiple sclerosis (MS) has been recognized since 1877 when Charcot first observed "enfeeblement of memory" in his patients.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

^ One interesting study used MS patients to provide support to other MS patients as part of a telephone intervention program.

^ November 25, 2009 One cannot ignore the fact that the research surrounding CCSVI and its benefits for patients with MS has received a lot of attention lately (prof.

.From the age of 16 until her death at 53, she suffered intermittent pain, weakness of the legs, and vision loss—symptoms typical of MS.[53] Both cases have led to the proposal of a 'Viking gene' hypothesis for the dissemination of the disease.^ NMO is a rare and debilitating disease that attacks the optic nerves and spinal cord, often causing vision loss, paralysis of legs and arms, and sensory disturbances.

^ Chronic fatigue is a typical symptom of neurological diseases, and is most disabling in multiple sclerosis, postpoliomyelitis, poststroke, and in chronic fatigue syndrome.

^ MRI imaging is an important tool in the diagnosis of MS by revealing the characteristic spatial and temporal dissemination of the cerebral and spinal manifestations of this disease.

[54]
.Augustus Frederick d'Este (1794–1848), son of Prince Augustus Frederick, Duke of Sussex and Lady Augusta Murray and the grandson of George III of the United Kingdom, almost certainly suffered from MS. D'Este left a detailed diary describing his 22 years living with the disease.^ It is almost impossible to prognosticate early in the course of MS, to tell whether or not a person is likely to have severe disease.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Recent developments in pharmacological treatment for disease progression and management of cognitive symptoms hold promise for patients suffering from the degenerative aspects of MS. ----- Ann Neurol.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Over the years, we’ve come to understand that medical science is a ways behind those of us living with multiple sclerosis when it comes to the experience of our disease.

.His diary began in 1822 and ended in 1846, although it remained unknown until 1948. His symptoms began at age 28 with a sudden transient visual loss after the funeral of a friend.^ Sudden visual loss .
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Bladder symptoms , such as an inability to hold urine ( urinary incontinence ) or to completely empty the bladder, or a loss of bladder sensation—an inability to sense that the bladder becoming full until there is a sudden, urgent need to urinate.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Her symptoms began at the age of 18 with weakness of the right leg and fatigue with long distance walking and over the ensuing years she experienced steady deterioration of functions.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]
  • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

.During the course of his disease, he developed weakness of the legs, clumsiness of the hands, numbness, dizziness, bladder disturbances, and erectile dysfunction.^ NMO is a rare and debilitating disease that attacks the optic nerves and spinal cord, often causing vision loss, paralysis of legs and arms, and sensory disturbances.

^ Thirty-eight percent to 50% of patients with MS develop ON at some point during the course of their disease.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Two separate episodes of neurological symptoms—such as weakness or clumsiness, vision problems, tingling or numbness, or balance problems—that a neurologist can verify.
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

In 1844, he began to use a wheelchair. .Despite his illness, he kept an optimistic view of life.^ Despite his illness, he kept an optimistic view of life.
  • Multiple sclerosis - encyclopedia article - Citizendium 2 February 2010 10:010 UTC locke.citizendium.org:8080 [Source type: Academic]
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Health Information About Multiple Sclerosis 11 September 2009 9:47 UTC www.powerofoxygen.com [Source type: FILTERED WITH BAYES]
  • Multiple sclerosis - encyclopedia article - Citizendium 28 January 2010 1:31 UTC reid.citizendium.org [Source type: Academic]

[55][56]
.Another early account of MS was kept by the British diarist W. N. P. Barbellion, nom-de-plume of Bruce Frederick Cummings (1889–1919), who maintained a detailed log of his diagnosis and struggle with MS.[56] His diary was published in 1919 as The Journal of a Disappointed Man.^ As you will see, the following research descriptions detail the findings published in the most respected journals in the field.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ On January 23rd 2010 the 2-year results from the CLARITY study with Cladribine tablets for MS were published in the NEw England Journal of Medicine: CLARITY Study .

^ June 6, 2009 This is another promising study for the treatment of MS published in Medical News Today (June 5&6 2009): .

[57]

Research directions

Therapies

Chemical structure of alemtuzumab
.Research directions on MS treatments include investigations aimed to better understand its pathogenesis and heterogeneity, research of more effective, convenient, or tolerable new treatments for RRMS, creation of therapies for the progressive subtypes, neuroprotection strategies, and the search of effective symptomatic treatments.^ Also there is so much going on in MS research that treatments are guaranteed to become more effective.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ As MS progresses, symptoms may become more severe and may include: .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Objective Fatigue management and energy conservation are effective strategies to minimize fatigue in multiple sclerosis (MS).
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

[58] .A number of treatments that may curtail attacks or improve function are under investigation.^ Certain agents called cholinesterase inhibitors, such as donepezil (Aricept), may help improve mental functioning.

^ Orally available treatment strategies are more acceptable for patients and may improve adherence to therapy.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Research concerning cannabis-based treatments shows promising results, and substances which block microglial or astrocytic involvement in pain processing are also under investigation.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

.Emerging agents for RRMS that have shown promise in phase 2 trials include alemtuzumab (trade name Campath), daclizumab (trade name Zenapax), rituximab, dirucotide, BHT-3009, cladribine, dimethyl fumarate, estriol, fingolimod, laquinimod, minocycline, statins, temsirolimus and teriflunomide.^ NEJM 2008 CAMMS223 Campath for RRMS phase 2 trial in press NEJM .

^ Presently, a number of monoclonal antibodies are being studied, including alemtuzumab, daclizumab and rituximab, which have all shown promising results.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ A substantial number of preliminary and pivotal reports have provided promising results for oral therapies, and various phase III clinical trials are currently being initiated or are already underway evaluating the efficacy of a variety of orally administered agents, including cladribine, teriflunomide, laquinimod, fingolimod and fumaric acid.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

[58]
.While there is anecdotal evidence of benefit for low dose naltrexone,[59] only results from a pilot study in primary progressive MS have been published.^ Low dose naltrexone update.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Primary-progressive MS .
  • Health Library 2 February 2010 10:010 UTC www.renown.org [Source type: FILTERED WITH BAYES]

^ Primary progressive MS is rarer.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[60]

Disease biomarkers

.The variable clinical presentation of MS and the lack of diagnostic laboratory tests lead to delays in diagnosis and the impossibility of predicting diagnosis.^ Visual evoked potential (VEP) studies are widely used for the diagnosis of multiple sclerosis (MS) and are also useful in monitoring the effects of various therapeutic modalities in the disease.
  • Multiple Sclerosis Research Database - Therion Research Magnetic Therapy Products 11 September 2009 9:47 UTC www.therionresearch.com [Source type: Academic]

^ This article specifically focuses on the differential diagnosis, diagnostic evaluation, medical management, and rehabilitation issues in MS. Similarly, the differential diagnosis treatment and rehabilitation in Parkinson's disease is discussed.

^ Multiple sclerosis (MS) is the most common cause of neurological disability in young adults in the UK. It is variable in presentation and progression.

New diagnostic methods are being investigated. .These include work with anti-myelin antibodies, analysis of microarray gene expression and studies with serum and cerebrospinal fluid but none of them has yielded reliable positive results.^ Progress in these studies will translate into array-based disease classification schemes and help optimise therapy for individual patients based on gene expression patterns or their genetic background.

^ Comparative study of the presence of Chlamydia pneumoniae in cerebrospinal fluid of Patients with clinically definite and monosymptomatic multiple sclerosis.

^ One of these is anti-antibody antibodies also anti t-cell or immune cell antibodies.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

[61]
.Currently there are no clinically established laboratory investigations available that can predict prognosis.^ At present, there is no effective disease modifying therapy, but a wide range of symptomatic treatments are available.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ REVIEWER'S CONCLUSIONS: Currently available information allows no unbiased statement about safety or efficacy of aminopyridines for treating MS symptoms.

^ Clinical trials are currently underway to establish the therapeutic efficacy and safety of various combination therapies for multiple sclerosis patients.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

.However, several promising approaches have been proposed.^ However, several promising approaches have been proposed.
  • Multiple sclerosis - Psychology Wiki 2 February 2010 10:010 UTC psychology.wikia.com [Source type: Academic]
  • Multiple Sclerosis Clinical Trials 2 February 2010 10:010 UTC www.clinicalconnection.com [Source type: Academic]
  • Health Information About Multiple Sclerosis 11 September 2009 9:47 UTC www.powerofoxygen.com [Source type: FILTERED WITH BAYES]

.Investigations on the prediction of evolution have centred on monitoring disease activity.^ VWMTR is recognized as a powerful instrument for monitoring MS disease activity and effectiveness of therapeutic interventions in patients with MS. .

.Disease activation biomarkers include interleukin-6, nitric oxide and nitric oxide synthase, osteopontin, and fetuin-A.[61] On the other hand since disease progression is the result of neurodegeneration the roles of proteins indicative of neuronal, axonal, and glial loss such as neurofilaments, tau and N-acetylaspartate are under investigation.^ "Nitric oxide neurotoxicity in neurodegenerative diseases."

^ Axonal destruction is another central pathological feature and a contributor to the accumulating disability of disease progression.

^ Other thalidomide applications include Crohn's disease, rheumatoid arthritis, and multiple sclerosis.

[61]
A final investigative field is work with biomarkers that distinguish between medication responders and nonresponders.[61]

Chronic cerebrospinal venous insufficiency

.Vascular surgeon Paolo Zamboni has conducted research suggesting that MS may involve a vascular disease process he refers to as chronic cerebrospinal venous insufficiency (CCSVI, CCVI), in which veins from the brain are constricted.^ He further suggested that iron was damaging the blood vessels and allowing the heavy metal, along with other unwelcome cells, to cross the crucial brain-blood barrier, a process termed Chronic Cerebrospinal Venous Insufficiency (CCSVI).

^ RECENT FINDINGS: The clinical heterogeneity of multiple sclerosis as well as the finding of different pathological patterns suggests that multiple sclerosis may be a spectrum of diseases that may represent different pathological processes.

^ Intravenous immunoglobulin (IVIG) has several effects on the immune system that could have a beneficial influence on disease processes in multiple sclerosis (MS).

.He found what he believes to be CCSVI in the majority of MS patients, performed a surgical procedure to correct it and claims that 73% of patients improved.^ Clinical and electrophysiological improvement of motor function, reflected by a reduction in expanded disability status scale, and of cognitive performance was found upon high-dose EPO treatment in MS patients, persisting for 3 to 6 months after cessation of EPO application.
  • Multiple Sclerosis 28 January 2010 1:31 UTC www.aetna.com [Source type: Academic]

^ Dr Zamboni claims from his studies of MS literature to have discovered what he believes could be a revolution for the treatment and diagnosis of the life-long condition.

^ November 25, 2009 One cannot ignore the fact that the research surrounding CCSVI and its benefits for patients with MS has received a lot of attention lately (prof.

Surgeries were neither controlled nor randomized. .The neurology community has criticized the methodology of Zamboni's research and recommends not to use the proposed treatment until its effectiveness is confirmed by controlled studies, the need for which has been recognized by the scientific bodies engaged in MS research.^ The truth of the matter is that these designations are used mostly for research purposes to find which treatments are effective and for what group of patients.
  • Understanding Multiple Sclerosis 2 February 2010 10:010 UTC www.pneuro.com [Source type: FILTERED WITH BAYES]

^ Therefore, 10 men with relapsing-remitting MS were studied using a crossover design whereby each patient served as his own control.
  • Multiple Sclerosis: Free Medical and Health Information on Multiple Sclerosis Research and Treatment 2 February 2010 10:010 UTC www.lifestages.com [Source type: Academic]

^ Initially, a survey of occupational therapy practice for MS patients including the characteristics and needs of these patients is necessary to develop a research agenda for efficacy studies.

[62]

See also

References

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd Compston A, Coles A (October 2008). "Multiple sclerosis". Lancet 372 (9648): 1502–17. doi:10.1016/S0140-6736(08)61620-7. PMID 18970977. 
  2. ^ a b Rosati G (April 2001). "The prevalence of multiple sclerosis in the world: an update". Neurol. Sci. 22 (2): 117–39. doi:10.1007/s100720170011. PMID 11603614. 
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Further reading

  • Langgartner M, Langgartner I, Drlicek M (April 2005). ."The patient's journey: multiple sclerosis".^ The poster describing the study Natalizumab (Tysabri®) Promotes Remyelination in Patients with Multiple Sclerosis.

    ^ The occurrence of cognitive deficits in patients with multiple sclerosis (MS) has been recognized since 1877 when Charcot first observed "enfeeblement of memory" in his patients.
    • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

    ^ Weak electromagnetic fields increase the amplitude of the pattern reversal VEP response in patients with multiple sclerosis.
    • Magnetic Fields and Multiple Sclerosis;transcranial magnetic stimulation and pulsed magnetic fields 28 January 2010 1:31 UTC www.earthpulse.net [Source type: Academic]

    BMJ 330 (7496): 885–8. doi:10.1136/bmj.330.7496.885. PMID 15831874. PMC 556161. http://bmj.bmjjournals.com/cgi/content/full/330/7496/885.
     

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