Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neurological disorder thataffects the central nervous system (brain and spinal cord).The disease process results in inflammation and damage to myelin(insulation of the nerve fibers) and other cells within thenervous system. Because myelin aids the conduction of nervesignals, damage to myelin results in impaired nerve signalingand may impair normal sensation, movement, and thinking. Thisdamage occurs in patches that appear as distinct lesions onmagnetic resonance imaging (MRI)—the use of magnetic fieldsto create detailed images of the body. The patches cause differentsymptoms depending on their location within the nervous system.

Multiple sclerosis primarily affects adults, with an age ofonset typically between 20 and 50 years, and is more commonin women than in men. The cause of this disorder is not known,but environmental, viral, and genetic factors are thought toplay a role. The December 20, 2006, issue of JAMA includes anarticle about multiple sclerosis and vitamin D levels. ThisPatient Page is based on one previously published in the January26, 2005, issue of JAMA.


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SYMPTOMS


DIAGNOSIS

In addition to a complete medical history and physical examinationincluding a detailed neurological examination, your doctor mayorder blood tests and refer you to a neurologist (a doctor withspecialized training in diseases of the nervous system). Yourdoctor may also order an MRI scan of your brain and/or spinalcord to look for the characteristic patches of MS and may performa lumbar puncture ("spinal tap")—sampling of the cerebrospinalfluid (the fluid that surrounds the brain and spinal cord)—toanalyze for proteins associated with the disease.


TREATMENTS

Currently there is no cure for MS. However, there are treatmentsavailable that may slow its progression and alleviate associatedsymptoms.

  • Drug therapies—Medications that target the body's immunesystem may decrease the frequency and duration of attacks. Thesemedications can be used on a long-term basis and also to treatspecific attacks. Additional medications may be prescribed forother symptoms, such as pain or depression.
  • Additional therapies—BecauseMS may affect the patient'sability to perform self-care andother activities of daily living,treatment may also includereferral to specialists for physicaland occupational therapy.