About Multiple Sclerosis
Multiple sclerosis (MS) is a chronic, frequently debilitating neurologic disease that is most often diagnosed beween 20 and 40 years of age.
Demographics and Prevalence of MS*
- It is believed that there are more than 400,000 people in the US with MS and nearly 2.5 million patients worldwide.
- MS strikes at the prime of life without warning.
- MS casts a wide circle, affecting not only patients, but also families, employers and communities.
- MS affects women almost four times more often than men.*
- MS takes an enormous physical, emotional, financial and spiritual toll on all those affected by the disease.
* Data derived from the CMSC Global MS Patient Registry.
Pathology and Etiology and MS
MS is a disease of the central nervous system (CNS) in which the myelin sheath surrounding nerve fibers becomes damaged, interrupting the conduction of nerve impulses. Axons, the fibers themselves, become irreversibly damaged early in the course of the disease.
The etiology, or cause, of MS is not known although there is believed to be a genetic predisposition in susceptible individuals combined with an unknown environmental trigger. (The environmental factor is not known, but is thought to possibly be viral in origin.)
Course of the Disease
One of the hallmarks of MS is its unpredictability from person to person and within the individual him/herself over time.
The diagnosis of MS is made by a neurologist after two or more episodes of neurologic symptoms have occurred. While there is no specific laboratory test for the diagnosis of MS, emerging technology has shortened the diagnostic period from years to months or even days after the first onset of symptoms.
Patients can be characterized as having either a relapsing form or a progressive form of the disease. There is evidence that MS can follow a benign or malignant course (mild versus severe) but these extremes tend to be rare.
Relapsing-remitting MS is defined by periods of stability and disease quiescence with intermittent relapses or exacerbations that occur without warning and are not caused by any known factor. While there are no definite causes of relapses, there is a definite link following pregnancy in which the mother runs a 70% risk of an attack 3-8 months post-partum.
Over time, patients with relapsing-remitting MS may enter a secondary progressive phase in which relapses result in incomplete recovery or relapses cease altogether. The risk for this occurrence is delayed by active treatment.
Primary progressive MS patients do not experience relapses and gradually worsen over time. This type of MS previously was called chronic-progressive disease.
Relapsing-progressive MS patients have gradual worsening of the disease and yet experience relapses requiring dynamic treatment protocols.
Immunology and Multiple Sclerosis
Research on the cause of MS has recently focused on the understanding that MS may be an autoimmune disease in which elements of cellular immune function are misdirected, and instead of doing their job of defending, turn against a part of our body – the white matter or myelin insulation in the central nervous system and the nerve fibers themselves.
Demyelination – The Cause of Symptoms
The damage done by an immune reaction against myelin and nerve fibers in the brain and spinal cord might truly be considered the cause of MS, since it is this process that results in symptoms.
Immune system T-cells normally in the blood stream become activated and cross the blood-brain barrier, which normally separates the bloodstream from the central nervous system. Local inflammation results in damage to the myelin insulation around nerve fibers. Nerve fibers themselves are affected and may be damaged or severed. While much of the “reversible” disability seen in MS may be due to inflammation, myelin loss with subsequent natural regeneration, and loss of nerve fibers can result in permanent, irreversible disability and this damage becomes more prominent over time in many people with MS.
Research and New Treatments
Efforts to regenerate nerve fibers themselves are a major research focus, particularly in spinal cord injury, but little progress has been made. As a consequence, protection against initial damage – neuroprotection – is an area of growing cross-disciplinary research emphasis.
While not necessarily associated with myelin or nerve fiber damage or loss, attention has been drawn to the loss of brain volume in MS. Use of magnetic resonance imaging (MRI) and other advanced imaging techniques confirm that brain atrophy occurs in MS, can occur early in the disease, and may worsen progressively.
Until recently, treatment was focused on symptomatic management rather than on disease alteration or eradication of the disease. There is currently no cure for MS. With the advent of potentially disease modifying agents, the focus of MS care has changed from one of merely maintenance to a more positive outlook.
The Foundation of the CMSC has supported and will continue to provide funding for new and exciting research studies. Investigations range from basic research projects by medical studies to investigations into topics such as spasticity, depression, cognition and other issues that affect quality of life.
Role of the Comprehensive Care Team
The world of multiple sclerosis has changed during the past two decades. There is a global movement towards a deeper understanding of the disease process, improving the quality of life for those with MS and developing safe and effective treatments. There is also a new understanding in both the patient and professional community that quality care in MS is a collaboration between the patient/family and the many members of the MS comprehensive care team.
The complex nature of MS and its lifelong problems require the skills and direct services of numerous healthcare professionals – neurologists, nursing colleagues, rehabilitation specialists, social workers, counselors and other medical specialists urologists, orthopedists, psychologists, orthopedists, physiatrists, ophthalmologists and physician assistants.
New therapies, knowledge and ongoing research have created a new vision of multiple sclerosis. Specialized care, new technology and commitment to excellence have changed the face of multiple sclerosis, but there is still more to do to increase our understanding of MS and to sustain this specialty in the next generation of healthcare professionals.
The Foundation of the CMSC aims to address MS from this multi-disciplinary platform and to support MS healthcare professionals in every aspect of their professional life, including education, research and treatment.
Data derived from multiple sources, including:
- Advanced Concepts in Multiple Sclerosis Nursing Care
Halper, J. Editor. New York: Demos Medical Publishing. 2006.
- Comprehensive Nursing Care in Multiple Slerosis.
Halper, J. Editor. New York: Demos Medical Publishing. 2002.
- Multiple Sclerosis: The Guide to Treatment and Management, 6th Ed
Polman, CH, Thmpson, AJ., Murray, TJ, McDonald, WI. New York: Demos Medical Publishing. 2006.
- Blue Books of Practical Neurology Multiple Sclerosis 2
McDonald, Wi, Noseworthy, JH. Editors. Philadelphia: Butterworth-Heinemann. 2003.
- Curing MS
Weiner, HL. New York: Crown Publishers. 2004.