Multiple Sclerosis: General Information
With few exceptions Multiple Sclerosis patients before becoming disabled are intelligent and vital individuals. Physically they are of average height and weight, and athletic in build and inclination. They are usually attractive. They are nervous (tense) and perceptive.
As the disease progresses, the "inbuilt" nervous tension increases and they become irritable. They rarely lose their inclination to work and produce, unless severely disabled.
In general, they become very well informed about MS, through reading and discussions with one another. It is, therefore, very difficult if not impossible, to keep information concerning MS from them.
These characteristics are so frequently observed in the MSer that their absence in the early phase of the disease, should cause one to reexamine the history, for clues to another diagnosis.
Most patients have cold feet and hands, and they are often cold in a warm room. Some may also have spells of being overheated and many experience night sweats. They bruise easily and often suffer from multiple subcutaneous Hemmorrhages for no known reason.
Effects Of Stress
Patients with established MS, withstand both psychological and physical stress poorly. In the face of anxiety or nervous tension, whatever the cause, patients note fatigue and a reduced ability to perform.
The news of a death in the family, continuing domestic and marital difficulties, loss or threatened loss of the means of financial support, and accidents of a freightening nature are frequently followed by increased disability.
Totally new symptoms are not produced by these stimuli as a rule, but exacerbation of existing systems is common. Such aggravations may last a short time and pass completely.
Sometimes the additional disability is prolonged or permanent. Physical stress or fatigue, particularly when deleterious to patients. Probably a combination of the above stresses explains the high frequency of deep fatigue.
Intolerance To Heat
Patients also have a very low tolerance for heat. The onset of hot and humid weather, or a hot bath, leaves many patients with marked fatigue and increased disability that is usually temporary but can be permanent.
Total immersion of the patient or immersion of an extremity in hot water is followed by an elevation of skin temperature of non-immersed as well as immersed parts of the body, and subsequently by fatigue and increased Neurological disability.
A tourniquet on the immersed extremity, to prevent blood from circulating to and from the immersed part of the body, is said to prevent this.
Immersion of subjects in cold water while they are still suffering the effects of earlier immersion in hot water may quickly remove the disability. We have patients who report marked, though temporary, improvement after a cold bath or a swim in cold water.
Recent studies have shown that the temporary improvement of the patient upon cooling occurs if there is a drop in body temperature of at least 0.6 to 1.2 degrees F.
We feel this degree of temperature change is not necessary since,we often observe improvement in patients who have had only their hands in cold water for a few minutes.
Intolerance To Weather Changes
Our studies have shown that about 5% of attacks occured several days after a weather temperature change of more than 20 degrees F. up or down in a single day. These attacks were usually not severe.
The absolute temperature, wind velocity or direction, precipitation, amount of sunshine, barometric pressure, and other factors seemed not to influence the disease.
Temperature fluctuations are probably the reason for the seasonal variation in the well-being of MSers, twice a year, usually during October and November, and in April and May.
At these times of changing weather, patients experience more than the expected number of exacerbations, fluctuations, or fatigue spells.
Grand Mal Seizures are rarely seen in MS. In our own cases they have occured in about 3/1,000 patients. However, mild focal Seizures of short duration and short confusional or "absence" type seizures have occured in well over 5% of our patients.
These Seizures keep recurring, sometimes frequently for three to six months, then disappear. In most cases they are completely controlled by therapy with Dilantin. In some cases Phenobarbital has been effective.
AntiSeizure therapy usually can be discontinued slowly after six months without recurrence of the Seizures. ElectroEnCephalograms have not been helpful in recognizing these brief Seizures.
Scintillating Scotoma (Focal Impaired Vision), with or without Migraine Headaches, nausa, and vomiting have been observed frequently. These Symptoms were recorded in eight (10%) of eighty consecutive new patients seen during the first half of 1975.
On treatment of MS with the low-fat diet, these headaches usually become much less frequent and less severe, and they often disappear after one or two years.
Headaches from tension, starting usually in the back of the head and neck and radiating to the back of one or both Eyes, also occur and are usually relieved by mild sedation and the reassurance that comes as the patient improves.
Blood Pressure/Hypertension/Diabetes/Hypo & HyperThyroidism
Hypertension is rare, most patients having decidedly low blood pressure. Diabetes has been a rare complication, although it is common for MSers to have a slightly elevated blood sugar curve (but not abnormally elevated).
There seems to be a tendency for a family history of Diabetes. Both hypo & HyperThyroidism are rare. Because of the patient's weakness, a clinical diagnosis of HypoThyroidism is often made early but is not supported by laboratory evidence.
Partial or complete loss of potency in males, which cannot be alleviated by hormones, and a loss of sexual interest (drive) in females occurs, sometimes early, but usually later during disability.
Irregular or absent Menes, is a frequent complication of MS. These symptoms may develop early or late and are usually accompanied by fatigue. In many cases, potency, sex drive, and normal menstration return after recovering from fatigue - usually after a long rest.
Familial cases (presence of MS in one or more brothers or sisters of a patient) were not considered seriously until the early 1930's. It was then noted that a sibling of a MSer was twenty times more likely to have the disease than someone not related.
Subsequent studies in the late 1940's, 1950's and again in 1981 found the familial incidence of MS to be about eighteen times greater than the occurance of MS in the general population, and to involve second and third degree relatives (two and three generations removed) as well as first.
Four to six percent of the patients' blood relatives were found to have the disease. The incidence in children of MSers may be slightly lower than that observed among brothers and sisters. From these observations it seems likely that genetic factors exert their influence on MSers.
One should not forget, that members of families are subject to similar diets and other enviromental influences. It is therefore possible that the suspected genetic factors are less important than they appear.
Extensive studies of MSers with identical twins have revealed that in about 80%, only one member of each pair developed MS. We have observed five such pairs for up to 26 yrs. and only one of each pair developed MS.
Wives and husbands of MSers have rarely developed the disease. In our own thirty-six year experience with continued observation of more than two thousand cases for ten to thirty-six years.
And a total experience of about thirty-five hundred cases, no husband or wife of a MSer has ever developed the disease, nor has any of their children.
Keep in mind that we insist that the entire family be placed on the same low-fat diet whenever possible.
It is still not understood how or why racial differences influence the frequency of MS. The prevalence of the disease in greater New York City has been shown to be about the same for all racial groups (about 6/10,000).
One exception was a very low prevalance in poor African-Americans (1.4/10,000). This could be due to their tendency to consume more cereals and less meat and other fat foods than do more affluent segments of our populations. But, one cannot dismiss a possible racial difference.
Recently it was shown that Japanese Americans have a higher rate of MS than is known to occur in Japan. Even so, the frequency of cases among Japanese Americans is still well below that of European Americans living in same areas.
Our observation of Japanese Americans in the Pacific Northwest is that they tend to consume a diet not totally different from the diet of their Japanese ancestors.
For many years it has been postulated that the frequency of MS was determined by latitude. The further one lived from the equator, the nearer to the colder areas of the world, the greater the risk of acquiring the disease.
A casual survey of the prevalence data would appear to bear this out. However, when analyzed carefully, several studies indicate that such a relationship is misleading.
The first of these in Switzerland showed a change from very high to very low frequency of MS in the very short distance from northern to southern Switzerland (less than 1 degree latitude change).
The second, in Norway showed a very low frequency of MS along the entire coast from near the Artic Circle south through 13 degrees of latitude to well inside the temperate zone.
A study in Japan revealed the frequency of MS to be very low in two areas, one in the far northern part of the country and another in the near southern most part. The northern area is relatively cold; the southern, warm. They are separated by 10 degrees of latitude.
These particular observations indicate that latitude plays little if any part in the causation of MS or in its frequency of occurance. This conclusion is supported by a recent statistical study of geography and nutrition in relation to Multiple Sclerosis.
Frequency Of MS In Males & Females
In our Norwegian study, the new cases of MS that developed each year were split evenly between males and females.
However, this ratio could have been altered by the long duration of the disease (approximately twenty-five years), and because the disease usually treats males less kindly than females. As a result there are present in the MS population more females than males in the ratio of 3:2.
This is probably related to the greater stress, to which males are subjected; plus less opportunity to rest when fatigued. This difference in prevalence of MS is reflected in our thirty-six year study of MS.
Memory & Mentally Related Functions
Impairment of memory, primarily for recent events, develops in many patients slowly and insidiously. The degree of loss usually parallels the general Neurological involvement, but may be more or less severe.
Later in the disease memory loss may interfere with function and judgement in some patients. Stress, anxiety, fatigue, fever, and overheating usually intensify the memory loss and often lead to mild to severe confusion that is temporary but may be sufficient to interfere with work or schooling.
Patients may experience temporary confusion of varying degrees during an exacerbation, even if they have not experienced stress or fatigue.
Age Of Onset Of Multiple Sclerosis
MS is considered a disease of young adults. About 85% of cases have their first Neurological Symptoms between the ages of twenty to thirty-five, although a diagnosis may be delayed for years.
Most of the remaining cases develop before the age of fifty, but an onset in the fifties or even the sixties is not outside our experience. Less than 1% of our cases have had onset between the ages of fifteen and twenty, and we have rarely seen cases with earlier onsets.