Multiple Sclerosis

Signs and Symptoms

Multiple sclerosis (MS) damages the outer covering of nerve cells, called myelin, a fatty tissue that protects nerve cells in the same way that insulation protects electrical wiring in a house. Myelin helps nerve fibers conduct electrical impulses to and from the brain. Scar tissue, called sclerosis, accumulates when multiple areas of myelin are damaged. These damaged areas are known as plaques or lesions. Sometimes the nerve fiber itself is damaged and dies.

The exact cause of MS is not known, but factors such as disease, poisons and drug or alcohol abuse can damage the myelin sheath in children and adults. Heredity may contribute to the development of MS. About 5 percent of patients have a sister or brother who has the disease and about 15 percent have a close relative with MS.

When MS damages the protective myelin sheath of nerve cells, the sheath sometimes repairs itself and nerves work correctly again. In other cases, the myelin is so damaged that the underlying nerve can't be repaired and dies.

The symptoms of multiple sclerosis (MS) depend on which particular pathway of nerve fiber is damaged. Tingling, numbness, sensations of tightness or weakness may result when myelin in the spinal cord is damaged. If nerve fibers to the bladder are affected, urinary incontinence may occur. Likewise, damage to the cerebellum portion of the brain may result in imbalance or a lack of coordination. MS patients can have a wide range of symptoms, depending on where the damage occurs in the central nervous system.

Because MS can cause a wide variety of symptoms in different people, doctors frequently struggle to diagnose the disease. However, common symptoms of MS include changes in sensation or sensory symptoms such as tingling and numbness, and changes in muscle function or motor symptoms such as difficulty walking, stiffness or tremors. Some common symptoms are:

• Clumsiness or weakness
• Difficulty walking or maintaining balance
• Dizziness or vertigo
• Eye problems such as double vision or uncontrolled eye movements
• Fatigue
• Muscle spasms
• Problems with bladder or bowel control
• Stiffness
• Tremors
• Tingling or numbness
• Depression or emotional changes
• Mild intellectual change such as memory problems
• Sexual problems such as difficulty reaching orgasm, lack of vaginal sensation or erectile dysfunction

Symptoms usually appear in people between 20 and 40 years of age.

Diagnosis

When considering a diagnosis of multiple sclerosis (MS), your doctor will be particularly interested in hearing about your symptoms, when they started and how they've eased or progressed over time.

Your diagnosis also will be based on a physical examination and tests. These tests may include:

• Blood and urine tests to help rule out other possible disorders
• Electrocardiogram (ECG or EKG) to measure electrical activity in the heart
• Magnetic resonance imaging (MRI) to look for abnormalities in the brain
• Lumbar puncture or spinal tap to determine if there are abnormalities in the cerebrospinal fluid, one of the signs of MS
• Evoked potentials test, which records electrical activity in the brain when nerves are stimulated

Medical conditions that can mimic MS include metabolic or vitamin deficiencies, unusual infections, inflammation of the blood vessels of the brain, degenerative disorders of the nervous system or cancers that have spread to the brain. This is why blood tests, X-rays, brain and spine MRIs, and spinal taps to analyze cerebrospinal fluid may be required before a diagnosis of MS can be made with certainty.

A diagnosis of MS is based upon an evaluation of your symptoms along with the results of your physical exam and tests.

Treatment

Your neurology team at UCSF Medical Center, along with your primary care physician, will design a treatment plan tailored to your medical condition, state of health and individual needs. You may need more than one kind of treatment, or a treatment requiring several visits to the Multiple Sclerosis Center. Also, you may be referred to other doctors or health professionals.

Doctors and researchers have identified four categories of treatment for patients with MS:

• Treatment that reduces the severity and duration of attacks
• Treatment to cure or eliminate the biological activity of MS in the body
• Treatment to relieve various symptoms such as incontinence, visual disturbances or fatigue
• Treatment that repairs damage caused by MS

Treatments may involve some risks or complications, which will be fully explained to you by your neurologist.

Treatments may include one of many medications such as:

• Beta Interferon -- A family of drugs that help fight viral infection and regulate your immune system
• Glatiramer Acetate -- A drug that doctors believe works by blocking your immune system's attack on myelin
• Immunosuppressive Drugs -- Drugs to suppress or control the immune system

Other medications may be prescribed to treat or control the symptoms of MS such as depression, fatigue, pain, spasticity and tremors. Treatment programs and services may include exercise and physical therapy, occupational therapy to help maintain your independence in daily living and stress-reduction.

Many new treatments, such as the use of statins or cholesterol-lowering drugs, are being developed and tested. Patients who are evaluated at the Multiple Sclerosis Center have the opportunity to participate in these studies of new treatments.