Biology 202
2000 Third Web Report
On Serendip

-- Randall T. Schapiro, M.D. (1)

She spoke like any other determined woman, with dignity and clarity, who had her mind set on making the world hear her. She was a woman whom many of my mother's friends thought of as an extremist, always complaining and challenging others in her neighborhood about the conditions in which people like her faced. I listened when my mother told me about how courageous her friend was in this struggle. Somehow, I sensed that my mother felt that her friend believed in who she was and what she was fighting for. Her goal was not solely hers, but today many millions of women and men stand together, united, in a quest to find equality and justice for others handicapped like her. Without their voices being heard, it would leave many handicapped and disabled individuals without the necessary provisions that they need in order to try to live a normal life.

Having recently visited someone who is suffering from multiple sclerosis, I decided to write my third web paper on this topic. Imagine being one of these people, afflicted with a life-long disease that currently has no cure. Imagine not being able to walk, throw a baseball, or even go to the bathroom when you want to without someone's assistance. Imagine feeling pain even at the slightest of a move. This is what a person with multiple sclerosis has to deal with on a day-to-day basis. (2)This paper aims to cover all aspects of the disease, including the causes, symptoms, and treatments.

Multiple Sclerosis (MS) is a chronic neurological disease characterized by multiple areas of damage and scarring (sclerosis) to the nerve fibers of the central nervous system. It is often a disabling disease affecting most people between the ages of twenty and forty. (3)About 1.1 million people worldwide have MS. Like other immune-mediated diseases, females are affected more frequently than males (three times as many women than men are affected). (4)It is a life-long, potentially debilitating autoimmune disease that affects the brain and spinal cord. In the United States, an estimated 400,000 people have MS. An interesting fact about those who are debilitated with the disease is that people in the northern latitudes are more likely to be afflicted with MS. People near the equator have not been found to have MS. (5)

MS is a demyelinating disease. Specifically, degeneration of myelin, a material that is composed mainly of fats and serves as an insulation for the nerves, much like the covering of an electric wire, degenerates. This fatty insulation allows a nerve to transmit its impulses with lightning-like speed, enabling people to move almost without thinking. The loss of this myelin insulation causes what is, in effect, a short-circuiting so that a person loses the ability to make smooth, rapid, and coordinated movements. With multiple sclerosis, the loss of myelin appears to the naked eye as a hardened sclerotic (scar) area. These areas are multiple within the central nervous system, thus the term multiple sclerosis. (6)

With the evidence of degeneration of myelin, one would ask what is the cause of MS? Though the cause of MS is currently unknown, researchers have suggested that the damage to the myelin in MS may be due to an abnormal response of the body's immune system. The immune system mistakes myelin for a foreign substance and immune cells attack and destroy myelin. Many of the characteristics of MS suggest an autoimmune disease in which the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors. One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the autoimmune process. A great deal of research has taken place in trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells (lymphocytes) in the blood stream, which enter the brain by making the brain's defense mechanisms vulnerable to B cells, T cells, antibodies and microphages (i.e. the blood/brain barrier). Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin. Specifically, the macrophages strip the myelin directly, exposing the axons and normal transmission of nerve impulses is slowed or blocked. (7)

Early MS may show up with a variety of vague symptoms, such as problems with vision, co-ordination, strength, sensation, speech and swallowing, bladder control, and cognitive function. The characteristic symptoms of MS include mild numbness in the limbs, severe paralysis, loss of vision, double vision, optic neuritis, altered sensation, ataxia, bladder control and bowel problems, prominent upper motor neuron signs, such as increased spasticity (increased muscle tone produces muscle stiffness), increasing para- or quardriparesis. Vertigo, coordination and other problems associated with the cerebellum, depression, emotional disturbances, abnormalities in gait, dysarthria, fatigue and pain are also commonly experienced. (8) Cognitive dysfunction occurs in about 50% of patients with MS. Fortunately only about 10% of MS patients develop cognitive dysfunction enough to significantly impact daily life. (9)

MS is commonly diagnosed using four main categories. The first is a consistent course (relapsing/remitting) with at least 2 bouts, separated by at least 1 month; or slow, stepwise progressive course for at least 6 months. The second is documented neurological signs of lesions in more than one area of brain or spinal cord white matter. The third is an onset of symptoms between 10 and 50 years of age. The fourth is absence of any other more likely neurological explanation. (10)

Other important factors in diagnosing MS are 1) medical history, which includes past signs and symptoms and current health, 2) neurological examination, which tests for abnormalities in nerve pathways, 3) testing of visual and auditory evoked potentials, which is the time taken for the brain to receive and interpret messages (nerve conduction velocity using small electrodes on the head which monitor brain waves in response to visual and auditory (hearing) stimuli, 4) Magnetic Resonance Imaging (MRI), which takes detailed pictures of brain and spinal cord, showing any size, quantity and distribution existing areas of sclerosis (lesions or plaques), 5) Lumbar Puncture, which tests the cerebrospinal fluid (the fluid which flows around the brain and spinal cord) for the presence of antibodies. The diagnosis of MS is not always clear cut. The initial symptoms may be transitory and vague and confusing to both the person and their doctor. There is no accurate test for detecting MS. (6)

There are four main levels of MS. Relapsing-Remitting MS is a form where there are unpredictable relapses (exacerbation, attacks) during which new symptoms appear or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be inactive for months or years. Benign MS is a form where there is no permanent disability. Benign MS can only be identified when there is minimal disability ten to fifteen years after onset and initially would have been categorized as relapsing-remitting MS. Benign MS tends to be associated with less severe symptoms at onset, such as those associated with sensory system. Secondary Progressive MS is a form where there is the development of progressive disability later in the course of the disease often with superimposed relapses. Primary Progressive MS is a form of MS that is characterized by a lack of distinct attacks, but with slow onset and steadily symptoms. There is an accumulation of deficits and disability, which may level off at some point or continue over months and years. (6)

There is no cure as of yet for MS. Thankfully, there are some therapies for MS. The most common ones are plant-derived colloidal minerals and vitamins, procarin, mercury removal, Avonex (a once-a-week treatment that slows the progression of disability in relapsing Multiple Sclerosis), Betaseron, steroids or corticotropin (ACTH) (for immunosuppression and treatment of exacerbations of MS), and Prednisone. (4), (11)Also it has been shown that diet changes can substantially decrease the progression of the disease. (5)

It is my goal that this web paper can help those who want to learn more about MS, whether they are afflicted with the disease or not. While there is still no cure, there are new therapies for MS that appear to reduce the frequency and severity of flare-ups, and some that may actually slow disease progression. Never before has there been so much hope for people with MS, many of who lead full, productive lives. It is my hope that treatment for MS may be more accessible to patients in the future and clinicians and medical researchers can find ways to prevent the disease and treat the patients.

It is my hope that there will eventually be treatments that will be so effective against MS that the slogan, MS is "The Great Crippler of Young Adults," (11) will be abolished from the media and will no longer be a true statement.

WWW Sources

3) What is Multiple Sclerosis? An article by Pamela Martin who has the disease.

4) Multiple Sclerosis Lectures and videos on MS.

5) The Multiple Sclerosis Foundation website.

6) The World of Multiple Sclerosis: A website about MS with great visual aids in understanding the immune disfunction that results from the disease.

7) Immunology in Pictures Destructive immune response associated with MS.

8) A website about MS, including diagnosis, symptoms and stages.

9) Life Extension Foundation: Multiple Sclerosis

10) Diagnosing MS

11) Karan's Korner: A website about a woman with MS.

Other Sources

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