Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. MS affects an estimated 350,000-500,000 Americans and can cause a spectrum of symptoms such as extreme fatigue, weakness, a lack of balance, difficulty walking, double vision, speech problems, and depression. For reasons that remain mysterious, it strikes more women than men, most often between ages 20-40, and people of northern European descent (in contrast to Asians and Africans). The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another.
MS is characterized by lesions in the central nervous system that interfere with nerve function. These lesions are inflammatory, meaning that immune cells that are normally restricted to the blood have migrated into the brain and the cellular partition between the brain and the blood stream (the blood-brain-barrier) has broken down. Local swelling occurs in the lesion site as cells and water move out of the blood stream into the nervous system tissue. This swelling causes problems with nerve function, because edema and compression of the fibers can block electrical transmission along the nerve fibers.
In addition, the white blood cells called T lymphocytes attack the myelin, the fatty substance that surrounds and protects the nerve fibers in the central nervous system, similar to the plastic insulating electrical wires. Normally, a person’s nervous system would be inaccessible for the white blood cells due to the blood-brain barrier, commonly known as the brain’s defense system. However, it has been shown using Magnetic Resonance Imaging that, when a person is undergoing an MS “attack,” the blood-brain barrier has broken down in a section of the brain or spinal cord, allowing these white blood cells to have access to the myelin. In fact, it has been suggested that, rather than being a disease of the immune system, MS is a disease of the blood-brain barrier. However, current scientific evidence is inconclusive.
The myelin is made by support cells that surround nerve fibers called axons. The myelin sheath supports the ability of neurons to transmit signals through the axon, and it provides special chemicals that neurons need to survive. The nerve fibers themselves can also be damaged. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur. The axon can compensate to some extent by rearranging signaling molecules in the denuded area, but the speed and strength of nerve signals traveling through the axon is impaired. The effect is similar to an electrical short circuit, interrupting the normal transmission of nerve signals.
Most of the time, in the early stages of MS, inflammatory attacks occur over short intervals of acutely heightened disease activity. These episodes are followed by periods of recovery and remission. During the remission period, the local swelling in the nervous system lesion resolves, the immune cells become less active or inactive, and the myelin-producing cells remyelinate the axons. Nerve signaling improves, and the disability caused by the inflammation becomes less severe or goes away entirely. This phase of the disease is called relapsing-remitting MS (RRMS). The lesions do not all heal completely, though. Some remain as chronic lesions, which usually have a demyelinated core region which lacks immune cells. Over time, the cells in the center of such lesions mostly die, although inflammation often continues at their edges. People believed for many years that mainly the myelin was destroyed during the acute attacks and the axons were spared. Recent research has shown this is not the case. Even from the very beginning of MS onset, some of the nerve fibers that cross the lesion are damaged to the point that the axons are severed. This is fatal to the neuron. Broken axons in the brain cannot grow back. The axon eventually degenerates, and the cell body of the neuron may die.
This means that inflammation, which characterizes early, active MS, effectively severs axons. This causes damage to the gray matter of the cerebral cortex which may contribute significantly to the development of permanent physical disabilities and difficulties with higher, cognitive, functions such as memory and thinking. Anti-inflammatory treatment of MS should begin as early in the course of the disease as possible. By extension, suspected MS should be verified as quickly as possible, because many patients have silent lesions for years before their first acute neurological episode, and it is important to minimize this early damage. Likewise, treatment should be continued between relapses, to prevent or minimize damage from clinically silent lesions.
While the cause (etiology) of MS is still not known, scientists believe that a combination of several factors may be involved. Studies are ongoing in the areas of immunology (the science of the body’s immune system), epidemiology (that looks at patterns of disease in the population), and genetics in an effort to answer this important question. Although people with MS may have periods of remission, symptoms typically become worse – and crippling – over the years. On average, the life expectancy of people with MS is about one-fourth less than that of people without the disease.
MS is known to occur more frequently in areas that are farther from the equator. Epidemiologists-scientists who study disease patterns-are looking at many factors, including variations in geography, demographics (age, gender, and ethnic background), genetics, infectious causes, and migration patterns, in an effort to understand why. Studies of migration patterns have shown that people born in an area of the world with a high risk of MS who then move to an area with a lower risk before the age of 15, acquire the risk of their new area. Such data suggest that exposure to some environmental agent that occurs before puberty may predispose a person to develop MS later on.
Some scientists think the reason may have something to do with vitamin D which the human body produces naturally when the skin is exposed to sunlight. People who live closer to the equator are exposed to greater amounts of sunlight year-round. As a result, they tend to have higher levels of naturally-produced vitamin D, which is thought to have a beneficial impact on immune function and may help protect against autoimmune diseases like MS.
While MS is not hereditary in a strict sense, having a first-degree relative such as a parent or sibling with MS increases an individual’s risk of developing the disease several-fold above the risk for the general population. Studies have shown that there is a higher prevalence of certain genes in populations with higher rates of MS. Common genetic factors has also been found in some families where there is more than one person with MS. Some researchers theorize that MS develops because a person is born with a genetic predisposition to react to some environmental agent that, upon exposure, triggers an autoimmune response. Sophisticated new techniques for identifying genes may help answer questions about the role of genes in the development of MS.
No two people have exactly the same symptoms, and each person’s symptoms can change or fluctuate over time. Stress can worsen symptoms, and may worsen the disease itself. One person might experience only one or two of the possible symptoms while another person experiences many more. Because MS essentially interferes with the transmission of nerve signals between the brain and spinal cord and other parts of the body, the primary symptoms experienced by each patient can vary greatly depending upon which nerve signals have been damaged and where that damage has occurred in the body. In addition, over the course of the disease, some symptoms will come and go, while others may be more lasting.
A vision problem is the first symptom of MS for many people. The sudden onset of double vision, poor contrast, eye pain, or heavy blurring is frankly terrifying-and the knowledge that vision may be compromised can make people with MS anxious about the future. Numbness of the face, body, or extremities (arms and legs) is one of the most common symptoms of MS, and is often the first symptom experienced by those eventually diagnosed as having MS.
Difficulty in walking is the most common mobility limitation in MS and is related to several factors:
- Weakness: Muscle weakness is a common cause of gait difficulty. Weakness can cause problems such as toe drag, foot drop, “vaulting” (a compensatory technique that involves raising the heel on the stronger leg to make it easier to swing the weaker leg through), compensatory hip hike, trunk lean, or circumduction (swinging leg out to the side). Weakness in both legs is known as paraparesis; weakness in only one leg is called monoparesis. Weakness can often be compensated for with the use of appropriate exercises and assistive devices, including braces, canes or walkers.
- Spasticity: Spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms (sustained muscle contractions or sudden movements). Spasticity may be as mild as the feeling of tightness of muscles or may be so severe as to produce painful, uncontrollable spasms of the extremities, in and around joints, and can cause low back pain. Although spasticity can occur in any limb, it is much more common in the legs.
- Loss of Balance: Balance problems typically result in a swaying and “drunken” type of gait known as ataxia. People with severe ataxia generally benefit from the use of an assistive device.
- Sensory Deficit: Some people with MS have such severe numbness in their feet that they cannot feel the floor or know where their feet are. This is referred to as a sensory ataxia.
- Fatigue: Many people experience increased gait problems when fatigue increases.
Most gait problems can be helped to some extent by physical therapy (including exercises and gait training), the use of appropriate assistive devices and, in some cases, medications. Careful evaluation by a trained health care professional is essential for creating the appropriate therapy program for each individual.
Fatigue and bladder dysfunction occurs in 80 percent of MS patients. Dizziness is also common causing patients to feel off balance or lightheaded. Much less often, they have the sensation that they or their surroundings are spinning, a condition known as vertigo.
Constipation is a particular concern as is loss of control of the bowels. Diarrhea and other problems of the stomach and bowels also can occur.
In more than 50 percent of MS patients, pain syndromes are common with at least half of these patients experiencing chronic pain. Cognitive changes are also common and half of people with MS will develop problems with a range of high-level brain functions, including the ability to learn and remember information: organize, plan, and problem-solve; focus, maintain, and shift attention as necessary; understand and use language; accurately perceive the environment, and perform calculations.
Sexual problems are often experienced by people with MS, but they are very common in the general population as well. Sexual arousal begins in the central nervous system, as the brain sends messages to the sexual organs along nerves running through the spinal cord. If MS damages these nerve pathways, sexual response-including arousal and orgasm-can be directly affected. Sexual problems also stem from MS symptoms such as fatigue or spasticity, as well as from psychological factors relating to self-esteem and mood changes.
Emotional changes are very common in MS as a reaction to the stresses of living with a chronic, unpredictable illness and because of neurologic and immune changes caused by the disease. Bouts of severe depression (which is different from the healthy grieving that needs to occur in the face of losses and changes caused by MS), mood swings, irritability, and episodes of uncontrollable laughing and crying (called pseudobulbar affect) pose significant challenges for people with MS and their family members. In addition, studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions.
Speech disorders, swallowing problems, headache, hearing loss, seizures, tremors, respiration/breathing problems and itching are also symptoms of MS but occur much less frequently. In addition to these primary symptoms, secondary symptoms are the complications that can arise as a result of the primary symptoms and include bladder dysfunction, loss of muscle tone and disuse weakness (not related to demyelization), poor postural alignment and trunk control, decreased bone density (and resulting increased risk of fracture), and shallow, inefficient breathing. Immobility can also lead to pressure sores. While secondary symptoms can be treated, the optimal goal is to avoid them by treating the primary symptoms.
Although there is still no cure for MS, effective strategies are available to modify the disease course, treat exacerbations (also called attacks, relapses, or flare-ups), manage symptoms , improve function and safety, and provide emotional support. In combination, these treatments enhance the quality of life for people living with MS.
FDA approved agents that can reduce disease activity and disease progression for many individuals with relapsing forms of MS, including those with secondary progressive disease who continue to have relapses include: Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (glatiramer acetate), Novantrone (mitoxantrone), Rebif (interferon beta-1a) and Tysabri (natalizumab)
An exacerbation of MS is caused by inflammation in the central nervous system (CNS) that causes damage to the myelin and slows or blocks the transmission of nerve impulses. To be a true exacerbation, the attack must last at least 24 hours and be separated from a previous exacerbation by at least 30 days. However, most exacerbations last from a few days to several weeks or even months. Exacerbations can be mild or severe enough to interfere with a person’s ability to function at home and at work. Severe exacerbations are most commonly treated with high-dose corticosteroids to reduce the inflammation.
Symptoms of MS are highly variable from person to person and from time to time in the same individual. While symptoms can range from mild to severe, most can be successfully managed with strategies that include medication, self-care techniques, rehabilitation (with a physical or occupation therapist, speech/language pathologist, cognitive remediation specialist, among others), and the use of assistive devices.
Rehabilitation programs focus on function-they are designed to help the patient improve or maintain the ability to perform effectively and safely at home and at work. Rehabilitation professionals focus on overall fitness and energy management, while addressing problems with accessibility and mobility, speech and swallowing, and memory and other cognitive functions.
Rehabilitation is an important component of comprehensive, quality health care for people with MS, at all stages of the disease. Rehabilitation programs include:
- Physical Therapy
- Occupational Therapy
- Therapy for Speech and Swallowing Problems
- Cognitive Rehabilitation
- Vocational Rehabilitation
Complementary and alternative medicine includes everything from exercise and diet to food supplements, stress management strategies, and lifestyle changes. These therapies come from various disciplines and traditions-yoga, hypnosis, relaxation techniques, traditional herbal healing, Chinese medicine, macrobiotics, naturopathy, and many others. They are referred to as complementary when they are used in conjunction with conventional medical treatments and alternative when they are used instead of conventional treatments. However, much research shows that nnutrition can play a critical role in treating MS.
Extensive research has revealed that there are three main factors that cause a person’s immune system to attack and destroy their myelin.
1. Genetic Susceptibility- It appears as if about .5% of northern Europeans carry the genes that make them susceptible to MS. People of other heritages tend to have a much lower susceptibility.
2. Immune activators- The immune system is activated by the introduction of foreign proteins into the body. Autoimmune disease is mainly caused by foreign proteins which have a molecular structure similar to self proteins in the body. Thus, when immune cells are activated against such foreign proteins, the immune cells also attack similar-looking self proteins. In MS, self-proteins in myelin in the central nervous system are “mimicked” by foreign proteins and consequently attacked by the immune system.
3. Immune Suppressants- The activation of immune cells against one or more self proteins seems to occur in many people, especially following an infection. Thus the immune system has evolved a system of shutting down such autoimmune reactions before they cause any noticeable damage. Persons with MS seem to have a defective immune suppressant mechanism due to various deficiencies. This allows autoimmune reactions to get out of control and to cause damage to the central nervous system.
Nutritional supplements, diet and exercise can be key in minimizing the primary and secondary symptoms of Multiple Sclerosis. For detailed information, refer to the MyoTechnology Nutritional Supplement Guide for MS, the MyoTechnology Diet Guide for MS and/or the MyoTechnology Exercise Guide for MS. In addition to supplements, diet and exercise, the cr17 Hurricane combined with the Camara Myofascial Method can be a critical tool for promoting better health for MS patients. The cr17 treatment transmits vibrational waves that travel deep into the body delivering therapeutic benefits to problem areas. The cr17 Hurricane utilizes vibration and percussion to promote greater blood flow, enhancing the uptake of oxygen and nutrients at the areas being treated.