HERIBERTO SEDENO, M.D. LECTURE ON MULTIPLE SCLEROSIS

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HERIBERTO SEDENO, M.D. LECTURE ON MULTIPLE
SCLEROSIS
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Multiple Sclerosis Overview Multiple sclerosis
(MS) affects an estimated 300,000 to 400,000
individuals in the United States and over two
million worldwide. Although it is considered a
relatively rare disease, MS is of particular
interest recently due to new and emerging
therapies to manage the disease. There is
increasing urgency around this illness because it
strikes people, predominantly women, in the prime
of their lives and causes significant morbidity
over many years. The chronic nature of most types
of MS requires a multi-disciplinary approach that
includes healthcare providers, social workers,
and community support to deal with the myriad
issues that stem from the presence a potentially
debilitating illness in a young population.
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Understanding MS To understand MS, one can liken
the structure of the nerves of the body to
telephone wire. Nerves, like wires, consist of
two parts the transmission material and
insulation. In a wire, the transmission material
is metal and the insulation is plastic. In the
nerve, the transmission material is nerve cells
and the insulation is a substance called myelin.
MS is characterized by damage to the myelin
sheath, the covering of the nerves of the central
nervous system. Damage to myelin, referred to as
plaques, can be seen on brain scans. Plaques
can be found in the brain, optic nerves, and the
spinal cord, all of which can interfere with the
transmission of information through nerves and,
therefore, a persons overall function. Damage to
the nerve-myelin unit results in irreversible
disability.
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Causes of and Risk Factors for MS Although the
cause of MS is not clear, researchers believe
that there may be a genetic predisposition to
develop the disease. This predisposition,
combined with a bevy of environmental factors,
may lead to disease. It is speculated that a
viral or bacterial infection might be the initial
trigger for the development of MS but there is no
definitive answer to the question. There is
substantial evidence to suggest that damage to
the nerves is the result of cells of the immune
system inappropriately targeting nerves and
myelin. Symptoms of MS The symptoms of MS can be
classified as primary (directly due to the
disease itself), secondary (due to inadequate
management of primary symptoms), and tertiary
(those that result from complications of the
disease).
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For example, if a person has bladder problems (a
primary symptom) that are uncontrolled, he or she
can have infections (a secondary symptom) and
become socially isolated (a tertiary symptom). He
or she may also stop driving or working due to
this uncontrolled problem (other potential
tertiary symptoms). In many cases, the initial
complaint that leads to MS diagnosis involves
changes in vision. From there, the symptoms of MS
can be subtle and mild (numbness, tingling) or
severe (inability to walk or move) and can vary
from time to time and from person to person.
Therefore, treatment must be individualized to
each person and dynamic, to address ever-changing
problems related to the disease. Frequently
people with MS require a team approach to manage
their disease along with medications,
rehabilitation, counseling, and educational
services.