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Multiple sclerosis - Highlights

Description

An in-depth report on the causes, diagnosis, and treatment of MS.

Highlights:

What Is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic disease that affects the central nervous system. MS is thought to be an autoimmune disease. In MS, the body� ' s immune system produces cells and proteins (antibodies) that attack myelin, a fatty substance that protects nerve fibers. The cause of MS is unknown. It is not an inherited disease, but it appears that genetic factors play a role in making some people more susceptible to developing it.
MS affects significantly more women than men. Most patients first begin to have symptoms between the ages of 20 - 50.
The course of MS varies among patients. The disease may be mild, moderate, or severe. 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.

Symptoms

Symptoms of MS include:

Fatigue
Visual problems such as blurred or double vision
Tingling, numbing, or burning sensations
Muscle weakness, stiffness, tremor, and spasms
Walking and gait problems
Bladder and bowel dysfunction
Sexual dysfunction
Cognitive and memory problems
Swallowing and speech problem
Pain
Depression

Not all patients experience all symptoms.

Treatment

Patients with multiple sclerosis are treated with drug and rehabilitation therapy. Six disease-modifying drugs are approved to treat multiple sclerosis. These drugs can help reduce the frequency and severity of relapses and slow disease progression and disability. The FDA-approved drugs are:

Interferon beta-1b (Betaseron)
Interferon beta-1a (Avonex)
Interferon beta-1a (Rebif)
Glatiramer acetate (Copaxone)
Natalizumab (Tysabri)
Mitoxantrone (Novantrone)

Resources

www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke
www.aan.com -- American Academy of Neurology
www.msassociation.org -- Multiple Sclerosis Association of America
www.nationalmssociety.org -- National Multiple Sclerosis Society
www.msfacts.org -- Multiple Sclerosis Foundation
www.abledata.com -- National database of assistive devices and rehabilitation equipment

References

Calabresi P. Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 436.

Correale J, Fiol M, Gilmore W. The risk of relapses in multiple sclerosis during systemic infections. Neurology. 2006 Aug 22;67(4):652-9. Epub 2006 Jul 26.

Farinotti M, Simi S, Di Pietrantonj C, McDowell N, Brait L, Lupo D, Filippini G. Dietary interventions for multiple sclerosis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004192.

Goodin DS, Cohen BA, O'Connor P, Kappos L, Stevens JC; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: the use of natalizumab (Tysabri) for the treatment of multiple sclerosis (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008 Sep 2;71(10):766-73

International Multiple Sclerosis Genetics Consortium, Hafler DA, Compston A, Sawcer S,Lander ES, Daly MJ, et al. Risk alleles for multiple sclerosis identified by a genomewide study. N Engl J Med. 2007 Aug 30;357(9):851-62. Epub 2007 Jul 29.

Kappos L, Freedman MS, Polman CH, Edan G, Hartung HP, Miller DH, et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet. 2007 Aug 4;370(9585):389-97.

Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007256002819.

Lovera J, Bagert B, Smoot K, Morris CD, Frank R, Bogardus K, et al. Ginkgo biloba for the improvement of cognitive performance in multiple sclerosis: a randomized, placebo-controlled trial. Mult Scler. 2007 Apr;13(3):376-85. Epub 2007 Jan 29.

Multiple Sclerosis Therapy Consensus Group (MSTCG), Wiendl H, Toyka KV, Rieckmann P, Gold R, Hartung HP, et al. Basic and escalating immunomodulatory treatments in multiple sclerosis: current therapeutic recommendations. J Neurol. 2008 Oct;255(10):1449-63. Epub 2008 Oct 29.

Prakash RS, Snook EM, Lewis JM, Motl RW, Kramer AF. Cognitive impairments in relapsing-remitting multiple sclerosis: a meta-analysis. Mult Scler. 2008 Nov;14(9):1250-61. Epub 2008 Aug 13.

Ransohoff RM. Natalizumab for multiple sclerosis. N Engl J Med. 2007 Jun 21;356(25):2622-9.

Rojas JI, Romano M, Ciapponi A, Patrucco L, Cristiano E. Interferon beta for primary progressive multiple sclerosis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006643.

Schippling S, Heesen C, Zander A, Martin R. Stem cell transplantation in multiple sclerosis. J Neurol. 2008 Dec;255 Suppl 6:43-7.

Wiendl H, Hohlfeld R. Multiple sclerosis therapeutics: unexpected outcomes clouding undisputed successes. Neurology. 2009 Mar 17;72(11):1008-15.

Reviewed last on: 6/23/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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