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"Multiple Sclerosis Fact Book"

by: Richard Lechtenberg, M.D. 1988


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Basic Features Of The Disease

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Multiple Sclerosis injuries the Central Nervous System. The Brain, Spinal Cord and closely related structures, such as the Optic Nerves to the eyes, are all part of the CNS. The nerves extending from the spine to the limbs, internal organs and blood vessels are not part of the CNS and are not affected by MS.

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Within the CNS, nerve cells communicate with one another along fibers that cluster into bundles. Nerve fibers concerned with strength may run alongside other bundles concerned with Pain Perception, Coordination, Bladder Control or Sexual Function.

These nerve fiber bundles are the information carrying pathways that are damaged in MS. Nerves to the limbs and internal organs, such as the Bladder and Intestines, are not affected, but information pathways in the Brain and Spinal Cord that connect these peripheral nerves may be damaged.

p5

Damage in the CNS causes problems with Strength, Coordination and Sensation in the limbs and other structures that connect to the Brain and Spinal Cord.

The name Multiple Sclerosis refers to two features of this disease. The first feature is that scattered areas in the Brain and Spinal Cord are affected. Problems caused by MS are also likely to be multiple, whether they are tempory or persistent.

The second feature is the appearance of Sclerosed (Scar Tissue) patches in the involved areas of the Brain and Spinal Cord. These patches are called plaques and consist of nervous system tissue that has been altered by the disease.

They are not necessarily regions of irreparable damage, but they do persist for life. A single plaque may extend across several nerve pathways. If it does, the patient will abruptly develop problems involving several Nervous System functions.

Bladder problems and leg weakness may appear along with disturbed pain perception. If an individual plaque is very small, it may cause a fairly isolated disturbance, such as facial pain or double vision.

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Several areas of plaque may develop in the CNS at the same time, causing multiple but unrelated problems such as disturbed vision, impaired sexual function and poor finger coordination. None of these complaints, however, is specific for MS.

Other Nervous System disorders, some of which are curable, can disturb the nerve pathways that are affected in MS and so any patient developing these neurologic complaints must be investigated for reversible causes of the disturbed nerve function.

Outlook

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There are several different courses the disease may follow:
1 - If an individual has only one or a few episodes of abruptly appearing problems that resolve quickly and leave no permanent deficits, the pattern is called Benign. About one out of five MSers have this type.

2 - If episodes of neurologic disease are more severe and occur more than a few times, but recovery from each episode is good or complete, the pattern is referred to as Relapsing or Remitting.

3 - If one problem after another appears with no apparent or significant respite from disease, the condition is referred to as Progressive.

Some MSers have Remitting disease initially but develop Progressive disease after years of relatively minor problems.

These Progressive forms of MS account for about one half of all cases, but even with Progressive MS the extent of difficulty faced by the individual varies from case to case. Men are more likely to have Chronic/Progressive disease than are women.

Most MSers have very discrete episodes of Nervous System Disease at some time in the course of the illness but there are individuals who have few identifiable attacks. The disease may start insidiously and progress inexorably, but this type of Progressive MS is unusual.

p27

Terms such as Relapsing and Remitting are somewhat misleading, as they suggest that MS is entirely inactive between obvious symptoms, and this is not so. Inapparent damage may occur in certain areas of the Nervous System that will not cause immediate complaints.

If the progression between major flair-ups of disease is slight, that progression may be greatly overshadowed by the problems developing during the flair-up.

p44

Fatigue
- loss of energy, persistent fatigue and limited tolerance of exercise.
- chronic fatigue can cause depression.

p126

With any Nervous System Disorder, the affected person often notices that he or she fatigues more rapidly. This is true whether the injury is a from concusion or DeMyelination.

Attempts to manage the fatigue that appears with MS have been frustrated by the unpredictability of the symptom. It is likely to come and go whether the patient recieves treatment or not. p127

Whenever fatigue becomes a major problem, the individual should have a thorough medical re-evaluation. Fatigue cannot be assumed to arise from the CNS simply because one has MS. Chronic infection, anemia, or even inapparent fractures may all be the source of the fatigue.

A thorough physical examination with laboratory studies of the blood count and urine components may reveal a correctable basis for the fatigue. If the CNS disease is the sole basis for the fatigue, the person should adjust his or her level of activity to avoid exhaustion.

p128

Several drugs have shown some promise in managing fatigue over the long term. Amantadine (Symmetrel), an antiviral agent that is widely used in the treatment of Parkinson Disease, has been of value in some patients.

It is presumed to affect chemical transmitters in the brain. The value of this drug usually lessens after a few months, but intermittent treatment may help some people. END




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