Multiple Sclerosis

• weakness of one or more extremities
• paralysis of one or more extremities
• tremor of one or more extremities
• muscle spasticity (uncontrollable spasm of muscle groups)
• muscle atrophy
• movement, dysfunctional
  • slowly progressive
  • beginning in the legs

• numbness , decreased or abnormal sensation in any area
• tingling
• facial pain
• pain in an extremity
• may start suddenly
• loss of vision -- usually affects one eye at a time
• double vision
• eye discomfort
• rapid eye movements, uncontrollable
• eye symptoms worsen on movement of the eyes
• decreased coordination
• loss of balance
• decreased ability to control small or intricate movements
• walking/gait abnormalities
• muscle spasms (especially in the legs)
• dizziness
• vertigo
• urinary hesitancy , difficult to begin urinating
• strong urge to urinate ( urinary urgency )
• frequent need to urinate
• incontinence (leakage of urine, loss of control over urination)
• decreased memory
• decreased spontaneity
• decreased judgment
• loss of ability to think abstractly
• loss of ability to generalize
• depression
• decreased attention span
• slurred speech
• difficulty speaking or understanding speech
• fatigue , tired easily

Additional symptoms that may be associated with this disease:

• constipation
• hearing loss
• positive Babinski's reflex

Note: Symptoms may vary with each attack. They may last days to months, then reduce or disappear, then recur periodically. Fever can trigger or worsen attacks, as can hot baths, sun exposure, and stress .

Signs and Tests:
Symptoms of MS may mimic many other neurologic disorders. A history of at least two attacks separated by a period of reduced or no symptoms may indicate the pattern of attack/remission seen in MS. If there are observable decreases in any functions of the central nervous system (such as abnormal reflexes), the diagnosis of MS may be suspected.

Examination by the health care provider may show focal neurologic deficits (localized decreases in function). This may include decreased or abnormal sensation, decreased ability to move a part of the body, speech or vision changes, or other loss of neurologic functions. The type of neurologic deficit may indicate, to some extent, the location of the damage to the nerves. Eye examination may show abnormal pupil responses, changes in the visual fields or eye movements, nystagmus (rapid eye movements) triggered by movement of the eye, decreased visual acuity , or abnormal findings on a fundoscopy (an examination of the internal structures of the eye).

Tests that indicate or confirm multiple sclerosis include:

• EEG ( electroencephalogram ), including looking for changes in brain waves in response to sounds or visual stimuli
  • BERA (brainstem evoked response audiometry )
  • visual evoked response

• head MRI scan that shows scarring or a lesion
• spine MRI scan that shows scarring or a lesion
• lumbar puncture ( spinal tap )
• CSF cell count
• CSF oligoclonal banding

Treatment:
There is no known cure for multiple sclerosis. Treatment is aimed at controlling symptoms and maintaining function to give the maximum quality of life.

Medications vary depending on the symptoms that occur. Baclofen, dantrolene, diazepam or other anti-spasmodic medications may be used to reduce muscle spasticity . Cholinergic medications may be helpful to reduce urinary problems. Antidepressant medications may be helpful for mood or behavior symptoms. Amantadine may be given for fatigue .

Corticosteroids or ACTH (a hormone that stimulates the body to produce increased amounts of its own corticosteroids) may be used to suppress the inflammation in an attempt to reduce the duration of an attack. See corticosteroids - oral for information on similar medications. Medications that suppress the immune system may be helpful. Interferon may be helpful for some people.

Physical therapy, speech therapy, occupational therapy, or similar forms of therapy may be helpful. This may improve the person's outlook, reduce depression , maximize function, and improve coping skills. A planned exercise program early in the course of the disorder helps to maintain muscle tone. Social work, counseling, and support groups may aid in coping. For this condition, see multiple sclerosis - support group . A healthy lifestyle is encouraged, including good general nutrition. Adequate rest and relaxation help to maintain energy levels. Attempts should be made to avoid fatigue, stress , physical deterioration, temperature extremes, and illness to reduce factors that may trigger an MS attack.

Prognosis:
The expected outcome is variable and unpredictable. Although the disorder is chronic and incurable, life expectancy can be normal or nearly so, with a life span of 35 or more years after diagnosis occurring commonly. Most people with MS continue to walk and function at work with minimal disability for 20 or more years. The amount of disability and discomfort varies with the severity and frequency of attacks and the part of the central nervous system affected by each attack. Commonly, there is initially a return to normal or near-normal function between attacks. As the disorder progresses, there is progressive loss of function with less improvement between attacks.

There is a rare, acute type of MS that can cause death within weeks to a few years. There is also a benign form of MS that develops relatively few symptoms for many years.

Complications:

• progressive disability
• urinary tract infections
• side effects of medications used to treat the disorder

Call Your Healthcare Provider:
Call your health care provider if symptoms indicate that multiple sclerosis may be present. This is a chronic condition, but symptoms may mimic or mask (disguise) symptoms of acute , serious conditions such as stroke .

Call your health care provider if symptoms progressively worsen despite treatment.

Call your health care provider if the condition deteriorates to the point where home care is no longer possible.