In multiple sclerosis, the myelin sheath in the nerve fibers of the central nervous system is damaged, causing pain, tingling, and numbness in the arms and legs. A patient who was eventually diagnosed with multiple sclerosis (MS) developed lower motor neuron syndrome affecting one hand, with evidence of denervation by electromyography. Subsequently, twelve other patients with definitive multiple sclerosis and asymmetric hand atrophy were identified. These patients were studied clinically and electrophysiologically.
Evidence of chronic and continuous denervation was observed in the hands of 12 of the 13 patients; only in 3 patients could electromyography abnormalities be explained by peripheral nerve injuries. Therefore, injuries can occur in MS patients that cause damage to lower motor neurons in the central nervous system. We suggest that demyelination in the region of the ventral root exit zone may explain these findings. Both amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) affect the central nervous system.
ALS affects motor neurons and is more physically impaired. Multiple sclerosis interrupts nerve communication within the brain and spinal cord. People with any of these disorders may experience muscle stiffness and spasms that interfere with movement. Muscle weakness and fatigue can also mark these diseases.
Both diseases can affect the ability to walk, through lack of muscle cooperation, as well as clumsiness. Most MS patients have a normal or near-normal life expectancy, while ALS greatly shortens a person's life expectancy. The average survival time after diagnosis for people with ALS is approximately three to five years, although up to 10% of patients may live 10 years or longer. In most people with multiple sclerosis, periods of relatively good health alternate with episodes of worsening symptoms, but over time, multiple sclerosis gradually worsens.
Doctors usually diagnose multiple sclerosis based on symptoms and the results of a physical exam and magnetic resonance imaging. The term “multiple sclerosis” refers to the numerous areas of scarring (sclerosis) that result from the destruction of the tissues that surround the nerves (myelin sheath) in the brain and spinal cord. This destruction is called demyelination. Overview of demyelinating disorders Most nerve fibers inside and outside the brain are wrapped in many layers of tissue composed of a fat (lipoprotein) called myelin.
These layers form the myelin sheath. Sometimes, the nerve fibers that send messages (axons) are also damaged. Over time, the brain can reduce its size due to the destruction of axons. Around the world, about 2.8 million people have multiple sclerosis and about 107,000 people are diagnosed with multiple sclerosis each year.
Multiple sclerosis usually starts between the ages of 20 and 40, but it can start anytime between the ages of 15 and 60. It's somewhat more common among women. Multiple sclerosis is rare in children. Most people with multiple sclerosis have periods of relatively good health (remissions) that alternate with periods of worsening symptoms (flare-ups or relapses).
Relapses can be mild or debilitating. Recovery during remission is good, but often incomplete. Therefore, multiple sclerosis slowly gets worse over time. The cause of multiple sclerosis is unknown, but a likely explanation is that people are exposed early in life to a virus (possibly a herpesvirus or retrovirus) or to some unknown substance that, in some way, triggers the immune system to attack the body's own tissues (autoimmune reaction) Autoimmune disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues.
What triggers an autoimmune disorder is unknown. The autoimmune reaction produces inflammation, which damages the myelin sheath and the underlying nerve fiber. Genes appear to play a role in multiple sclerosis. For example, having a father or brother (brother or sister) with multiple sclerosis increases the risk of contracting the disease several times.
In addition, multiple sclerosis is more likely to develop in people with certain genetic markers on the surface of their cells. Normally, these markers (called human leukocyte antigen recognition) help the body to distinguish itself from what is foreign and, therefore, to know which substances to attack. These differences may be related to vitamin D levels. When the skin is exposed to sunlight, the body forms vitamin D.
Therefore, people who grow up in temperate climates may have a lower vitamin D level. People with low vitamin D levels are more likely to develop multiple sclerosis. In addition, in people with the disorder and a low vitamin D level, symptoms seem to occur more often and are worse. However, how vitamin D may protect against the disorder is unknown.
The fact that people live later in life, regardless of the weather, doesn't change their chances of developing multiple sclerosis. Previous Epstein-Barr virus infection Infectious mononucleosis The Epstein-Barr virus causes a number of diseases, including infectious mononucleosis. The virus is spread through kissing. Symptoms vary, but the most common are extreme fatigue, fever, and sore throat.
Read more (which causes mononucleosis) seems to increase the risk of developing multiple sclerosis. Smoking cigarettes also seems to increase the chances of developing multiple sclerosis. Spending the first 15 years of life in a temperate (rather than tropical) climate increases the risk of multiple sclerosis. Three-quarters of people with multiple sclerosis never need a wheelchair.
If the nerve fibers that carry signals to the muscles become demyelinated, movement problems (motor symptoms) occur. As multiple sclerosis progresses, movements can become unstable, irregular, and ineffective. People may become partially or completely paralyzed. Weak muscles can contract involuntarily (called spasticity) and sometimes cause painful cramps.
Muscle weakness and spasticity can interfere with walking and, over time, make it impossible, even with a walker or other assistive device. Some people are confined to a wheelchair. People who can't walk can develop osteoporosis Osteoporosis (decreased bone density). People with multiple sclerosis may become unable to control emotional responses and may laugh or cry inappropriately.
Depression is common and thinking may be mildly altered. Because symptoms vary widely, doctors may not recognize the disorder in its early stages. Doctors suspect multiple sclerosis in younger people who suddenly develop blurred vision. Vision, blurred and blurred vision is the most common symptom of vision.
When doctors talk about blurred vision, they're usually referring to a decrease in sharpness or clarity that has gradually developed. Read more, double vision, double vision is to see two images of an object. Double vision can occur when only one eye is open (monocular diplopia) or, more commonly, when both eyes are open (binocular diplopia). Read more, or movement problems Overview of movement disorders All body movements, from raising your hand to smiling, involve a complex interaction between the central nervous system (brain and spinal cord), nerves and muscles.
Read more and abnormal sensations in several unrelated parts of the body. Fluctuating symptoms and a pattern of relapses and remissions support the diagnosis. People should clearly describe all the symptoms they have had to the doctor, especially if the symptoms are not present when they visit their doctor. When doctors suspect multiple sclerosis, they thoroughly evaluate the nervous system (neurological exam).
When a neurological disorder is suspected, doctors usually evaluate all body systems during the physical exam, but they focus on different parts of the nervous system. (Read more) during a physical exam. They examine the back of the eye (retina) with an ophthalmoscope What is an ophthalmoscope?. The optic disc (the point where the optic nerve joins the retina) may be unusually pale, indicating that the optic nerve is damaged.
Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) uses a strong magnetic field and very high-frequency radio waves to produce very detailed images. MRI does not use X-rays and is generally very safe. Read more (MRI) is the best imaging test to detect multiple sclerosis. It usually detects areas of demyelination in the brain and spinal cord.
However, the MRI cannot determine if demyelination has been there for a long time and is stable or if it is very recent and is still progressing. The MRI also cannot determine if immediate treatment is required. Therefore, doctors can inject gadolinium (a paramagnetic contrast agent) into the bloodstream and re-perform an MRI. Gadolinium helps distinguish areas of recent demyelination from areas of prolonged demyelination.
This information helps doctors plan treatment. Demyelination is sometimes detected when the MRI is done for another reason, before multiple sclerosis causes any symptoms. Blood tests to measure an antibody specific for neuromyelitis optica Neuromyelitis Optical Spectrum Disorder (NMOSD) Neuromyelitis optica spectrum disorder primarily affects the nerves in the eyes and spinal cord and causes patches of myelin (the substance that covers most nerve fibers) and the nerve fibers underneath. Read more: Spectrum disorder can be done to differentiate that disorder from multiple sclerosis.
No treatment for multiple sclerosis is uniformly effective. For an acute attack, corticosteroids are most often used. They probably work by suppressing the immune system. They are given for short periods to relieve immediate symptoms (such as loss of vision, strength, or coordination) if symptoms interfere with functioning.
For example, prednisone can be taken orally or methylprednisolone can be given intravenously. While corticosteroids can shorten relapses and slow the progression of multiple sclerosis, they don't stop its progression. Glatiramer acetate injections may have similar benefits for people with early mild multiple sclerosis. Fingolimod, ozanimod, ponesimod, siponimod, teriflunomide, cladribine, dimethyl fumarate, monomethyl fumarate, and diroximel fumarate can be used to treat multiple sclerosis that occurs in relapsing patterns.
These medications can be taken by mouth. Fingolimod, dimethyl fumarate, monomethyl fumarate, and diroximel fumarate also increase the risk of progressive multifocal leukoencephalopathy, although the risk is much lower than with natalizumab. Ocrelizumab is a monoclonal antibody used to treat multiple sclerosis that occurs in primary relapsing or progressive patterns. It is given as an intravenous infusion every 6 months.
It can cause infusion reactions, which may include a rash, itching, difficulty breathing, swelling of the throat, dizziness, low blood pressure, and fast heart rate. Alemtuzumab (used to treat leukemia), also a monoclonal antibody, is effective in treating multiple sclerosis that presents with relapse patterns (relapse-remission pattern and progressive relapse pattern). However, it increases the risk of serious autoimmune disorders and certain types of cancer. Consequently, alemtuzumab is generally used only when treatment with two or more medications has not been effective.
Ofatumumab is used to treat relapsing forms of multiple sclerosis and multiple sclerosis that are actively progressing. It is injected under the skin (subcutaneously). People with multiple sclerosis can be taught to manage it themselves. Ublituximab is also used to treat relapsing forms of multiple sclerosis and multiple sclerosis that are actively progressing.
Ublituximab increases a person's susceptibility to infections (such as urinary tract infections, upper respiratory tract infections, and herpesvirus infections) herpesvirus infections because it suppresses the immune system. People with multiple sclerosis can often maintain an active lifestyle, although they can easily get tired and may not be able to meet a demanding schedule. Because people with low levels of vitamin D tend to have more severe multiple sclerosis and because taking vitamin D can reduce the risk of developing osteoporosis, osteoporosis is a condition in which decreased bone density weakens bones and causes breaks (fractures) to occur. Aging, estrogen deficiency, low vitamin D or calcium intake and.
Read more, doctors often recommend that people take vitamin D supplements. Whether vitamin D supplements can help slow the progression of multiple sclerosis is being studied. If people are disabled, occupational, physical and speech therapists can help with rehabilitation. They can help people learn to function despite disabilities caused by multiple sclerosis.
Social workers can recommend and help organize necessary services and equipment. The effects of multiple sclerosis and the speed with which it progresses vary widely and unpredictably. Remissions can last for months up to 10 years or longer. However, some people, such as men who develop the disorder during middle age and who have frequent attacks, can quickly become disabled.
However, about 75% of people with multiple sclerosis never need a wheelchair, and in about 40%, normal activities are not interrupted. Unless multiple sclerosis is very serious, life expectancy is usually not affected. However, they have a few key differences. Multiple sclerosis is an autoimmune disease that causes the body to attack itself.
ALS, also called Lou Gehrig's disease, is a nervous system disorder that wears out nerve cells in the brain and spinal cord. Motor neuron disease (MNS) is a rare condition that progressively damages parts of the nervous system. This leads to muscle weakness, often accompanied by visible atrophy. Amyotrophic lateral sclerosis (ALS) is the most common form of MND.
Cerebral palsy affects people in different ways: some people experience minor motor skill problems, while others may be completely physically dependent. Fatigue in MS is thought to be due in part to MS itself (known as primary fatigue) and in part to other factors (secondary fatigue) that affect people with MS, rather than those without it. You lose control of your motor functions and, as the motor neurons break down, the myelin sheaths harden. Both MS and ALS are neurodegenerative diseases that affect the central nervous system and ultimately affect a person's mobility.
They may be mild or interfere with the ability to use the affected part of the body, such as difficulty writing with a pen. Symptoms may last a short time or only occur during the brief period of relapse, depending on the areas affected and the degree of inflammation present. These tests can measure motor neuron activity and can show certain patterns that are consistent with a diagnosis of ALS. In people with multiple sclerosis, the brain's response to stimuli may be slow because demyelinated nerve fibers can't carry nerve signals normally.
Incontinence can occur in both men and women at any age, but it is more common among women and older people, affecting approximately 30% of older women. Most experts believe it's a combination of factors affecting motor neurons or the cells that support them. .
