Advanced Care Scripts - MSCareďż˝

MSCareďż˝

What is it? Multiple Sclerosis (MS) is characterized by damage to the myelin sheath, or covering, surrounding nerves in multiple areas of the central nervous system (brain, spinal cord, and the optic nerves). Nerves with damaged myelin become scarred (called plaques, lesions, or sclerosis) and no longer function normally because it is more difficult to send electrical signals to the rest of the body without myelin to "grease" the way.

Examples of areas that may be attacked include the blood-brain barrier (a membrane that helps to keep harmful substances out of the brain) and the optic nerves, which are responsible for eyesight. Depending on which nerves are affected and how extensive the damage is, the patient may develop symptoms of impaired body function such as movement, speech and vision.

Hillary's case is an extreme example; MS is an extremely unpredictable and variable disease. The four main types of MS are described in the following table.

Four Types of Multiple Sclerosis (MS)

Relapsing/Remitting MS	Secondary Progressive MS
The most common form of MS, affecting about 85 percent of people with the condition. Relapsing/remitting MS is characterized by sporadic attacks of degeneration (relapses) intermingled with remissions, periods of near-normal health that can last for months or years. Some people even go into permanent remission, but most experience a slow increase in permanent nerve damage.	A later stage of the relapsing/remitting form of MS where attack rate is reduced and the condition changes to a gradual but steady deterioration of body functions unrelated to acute attacks. Within 10 years, 50 percent of all patients with relapsing/remitting MS will move into the secondary progressive type.
Primary Progressive MS	Progressive/Relapsing MS
After onset of symptoms, there is a gradual but steady deterioration of body functions without acute attacks in about 10 percent of people. In the very worst cases, primary progressive MS can accelerate, leading to complete disability or death within just a few months.	The most severe form of MS, affecting about 5 percent of people with the condition. Progressive/ relapsing MS begins with a progressive course although these people also experience acute attacks.

What causes it?

MS is an autoimmune disorder in which the body's natural defenses (the immune system) suddenly attack the central nervous system. Several types of white blood cells are involved in the process in which the myelin sheath is mistaken for a harmful substance. Although the exact cause of MS remains unknown, a combination of factors are probably involved in its development.

Genetic susceptibility has been established and is a result of an unlikely combination of several genes (US citizens have a 1 in 750 chance of developing MS where as children of a parent with MS have a 1 in 40 chance of getting the disease). It is recognized, however, that the development of MS is not solely determined genetically, since identical twin studies reveal only a 1 in 3 chance of getting MS.

Several theories have been proposed to explain how MS begins. One is that unidentified environmental factors trigger a genetically expressed immune response. A second theory is that a virus, possibly acquired during childhood, either attacks the cells that make myelin, attacks the myelin itself, or changes cells in the immune system.

MS is usually diagnosed with a magnetic resonance imaging scan (an MRI). An MRI is a type of x-ray that looks for problems in the body that cannot be found by other means. In MS, an MRI is useful in locating plaques.

Who has it?

In the United States, approximately 400,000 people have MS, with roughly 200 new cases diagnosed each week. Worldwide, MS may affect 2.5 million individuals. Because it is not contagious, which would require U.S. physicians to report new cases, and because symptoms can be completely invisible, the numbers are estimated. Women are affected twice as often as men. The average age of onset is between 20 and 40, and is rarely seen before age 14 or after age 60. MS occurs more frequently in whites of Anglo-Scandanavian ancestry than in other ethnic groups. The cost of MS in the United States is estimated to exceed $2.5 billion annually.

What are the risk factors?

ďż˝ Female
ďż˝ Age 20-40
ďż˝ Family history of MS
ďż˝ Caucasians of Anglo-Scandinavian or North Sea ancestry
ďż˝ Living in a geographical area with increased incidence of the disease: above the 37th parallel (in general, the further away from the equator you live, the greater your risk)

What are the symptoms?

MS has three distinct types of symptoms. Primary symptoms are caused directly by myelin destruction. Often, they can be controlled with therapy and medication, but they can also lead to secondary symptoms. For instance, bladder spasms, a primary symptom, can cause the secondary symptoms of urinary tract infections and kidney stones. Treating primary symptoms is the best way to avoid secondary ones. The third type - called tertiary symptoms - represents the effects the disease has on individual quality of life. Since it strikes a relatively young population, MS is associated with significant emotional and social impact.

Symptoms of Multiple Sclerosis

Primary Symptoms	Secondary Symptoms	Tertiary Symptoms
Changes in vision Problems walking Prickly, tingling feeling of the skin Pain Muscle spasms Weakness Problems with muscle movement Loss of balance and muscle coordination Speech difficulty Psychological changes Changes in ability to concentrate Fatigue Bowel/bladder problems Sexual dysfunction Tremor	Frequent urinary tract infections Kidney stones Skin sores Muscle abnormalities Respiratory infections Poor nutrition	High medical bills Need for assistance in the home Inability to work Sleep Disorders Depression

How is it treated?

The treatment of MS focuses mainly on decreasing the rate and severity of relapse, reducing the number of MS lesions, delaying the progression of the disease, and providing symptomatic relief for the patient. Several different drugs have been developed to treat the symptoms of MS. The following summary of the most recent treatment guidelines that outlines medications for each type of MS, describes the ways they work, and discusses their benefits for MS patients.

Relapsing/Remitting Multiple Sclerosis Treatment

Drug Therapy	How It Works	Benefits
Interferon beta-1b (Betaseron) Injection given every other day.	Interferons are substances produced by the body to regulate the immune system. In this case, diminishing the activity of the specific white blood cells causing disease.	Decreases rate of relapse Decreases development of new lesions Delays progression of disability
Interferon beta-1a (Avonex) Injection given once a week	Interferons are substances produced by the body to regulate the immune system. In this case, diminishing the activity of the specific white blood cells causing disease	Lower incidence of disease resistence associated with this dosing regimen
High-dose/frequency Interferon beta-1a (Rebif) Injection given three times a week	Interferons are substances produced by the body to regulate the immune system. In this case, diminishing the activity of the specific white blood cells causing disease	Decreases rate of relapse Decreases development of new lesions Delays progression of disability * There is currently no data comparing the effectiveness of Rebif with Betaseron.
Glatiramer (Copaxone) Injection given daily	Exactly how glatiramer works is unknown, but it is believed to modify the immune process that causes MS.	Decreases rate of relapse Moderately decreases development of new lesions May delay progression of disability

Secondary Progressive Multiple Sclerosis Treatment

Drug Therapy	How It Works	Benefits
Interferon beta (Betaseron, Avonex, Rebif)	Interferons are substances produced by the body to regulate the immune system. In this case, diminishing the activity of the disease causing white blood cells.	Decreases rate of relapse Delays increase in the size of lesions May delay progression of disability
Mitoxantrone (Novantrone)	Mitoxantrone inhibits specific cells of the body's defense system that destroy myelin in the central nervous system.	Decreases rate of relapse May delay progression of disability

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