Neurology

Multiple Sclerosis

BY: PHYSICIANS COMMITTEE FOR RESPONSIBLE MEDICINE

Multiple Sclerosis: Types and Symptoms

Multiple sclerosis (MS) is an autoimmune disease in which the body's immune system mistakenly attacks its own nerve cells, causing disruption of nerve signals between the brain and the muscles, skin, eyes, and other areas. As a result, strength, movement, coordination, sensation, vision, and even the ability to think clearly can be affected.

MS affects about 1 million people around the world. Most cases occur in adults between 20 and 50 years of age, and the disease is more common in women and Caucasians. Its cause is not yet known, but genetic, environmental, and viral factors are being investigated.

The severity of disease depends on which nerves are affected and how fast it progresses. Some cases are mild, but others can be debilitating and even life-threatening. In some patients, the visual nerves are primarily affected, resulting mostly in visual disturbances. In other patients, the muscular nerves are mostly affected, resulting in difficulty walking or performing daily tasks. In still others, the sensory nerves are primarily affected, resulting in numbness or tingling. Many patients have combinations of all of these symptoms.

Types of MS

  • Relapsing remitting: This is the most common type, and is characterized by symptom flare-ups that last several weeks or months, followed by remission.
  • Primary progressive: This pattern of MS is most common in older patients. It is characterized by gradual deterioration of function without remission.
  • Secondary progressive: This pattern initially begins as relapsing remitting disease, but then begins to follow a course of gradual deterioration without remission.

Symptoms

Symptoms vary widely and depend on the location of damaged nerve fibers. In some cases, the disease is asymptomatic. In others, patients are severely affected and follow a rapid downhill course.

  • Sensory symptoms: Numbness, tingling, or pain in one or more limbs
  • Motor (muscular) symptoms: Weakness, stiffness, muscle spasm, tremor, lack of coordination, unsteadiness or difficulty walking, or paralysis
  • Visual disturbances: Partial or complete loss of vision (usually one eye at a time), eye pain, double vision, or blurring of vision
  • Mental changes: Poor concentration, forgetfulness
  • Electric-shock sensations down the back may occur during head movement
  • Slurred speech
  • Dizziness
  • Fatigue
  • Loss of bladder or bowel control

Diagnosis

  • A complete history, physical, and neurologic examination is the initial diagnostic step. The neurologic examination includes testing of muscles, nerves, reflexes, sensation, posture, coordination, balance, and gait.
  • Magnetic Resonance Imaging (MRI) scan of the brain and spinal cord is the most important test to diagnose MS.
  • In some cases, a lumbar puncture (spinal tap) may be necessary to look for proteins and cells in the spinal fluid that are common in MS and to rule out other conditions, such as infection.

Treatment

There is no definitive cure for MS (however, see Nutritional Considerations). In some cases, when only mild disease occurs, it may be reasonable to carefully monitor the disease without treatment. In most cases, however, treatment is beneficial. Medications are available to improve symptoms and others may slow the course of the disease.

  • Acute attacks are treated with medications that reduce inflammation and relieve specific symptoms.
    • Corticosteroids (e.g., methylprednisolone and prednisone) usually shorten the duration of flare-ups. Therapy may include several days of intravenous corticosteroids, followed by a few more days or weeks of oral corticosteroids. Unless specifically directed by a physician, steroids should not be used for more than a few weeks. Side effects of prolonged use may include osteoporosis and hypertension.
    • Muscle relaxants (e.g., Baclofen and Zanaflex) are used to treat muscle spasms, stiffness, and pain. However, they may cause side effects, such as weakness in the legs, drowsiness, or dry mouth.
    • Several other types of medications have been used successfully to reduce fatigue (antivirals and antidepressants), pain (anticonvulsants), and bladder control (oxybutynin).
  • Disease-modifying medications that may protect nerve cells are often prescribed for patients with relapsing disease. However, these medications should not be used in women who are pregnant or may become pregnant.
    • Beta interferons (Betaseron, Avonex, and Rebif) are genetically engineered proteins that help regulate the immune system. They are given as injections on a daily, weekly, or monthly basis. They usually reduce flare-ups of disease, but will not reverse existing nerve damage and are generally only used in patients with relapsing disease that have more than one attack per year. Flu-like symptoms may occur as a side effect.
    • Glatiramer may be used in patients with relapsing remitting disease who cannot take interferons.
    • Mitoxantrone is a chemotherapy drug that is now FDA-approved for the treatment of aggressive relapsing remitting MS or rapidly progressive disease, and may slow the progression of disease. However, serious side effects may occur, including heart damage, so this medication must be used cautiously.
  • Plasma exchange may dilute the blood of damaging antibodies that would otherwise attack nerve cells. This is generally used in patients with sudden, severe attacks who do not respond to steroid treatments.
  • Physical therapy may help to improve strength, balance, and movement, and improve daily activities.
  • Stress, depression, and frustration are common in patients with MS, and may increase the risk of flare-ups. As much as possible, it is important to stay active, maintain normal daily activities and hobbies, and stay connected with friends. Counseling and support groups are often very helpful for family members and caregivers.

Multiple Sclerosis: Nutritional Considerations

Although there is no known cure for MS, clinical studies show that the disease may be slowed significantly with some dietary changes:

  • Smoking cessation: Smoking has been shown to increase the risk of disease.
  • Lower saturated fat intake: Long-term studies, first pioneered by physician Roy Swank, M.D., showed that diet changes can have a dramatic effect. Studies following MS patients for over 50 years revealed that those who eat the least saturated fat (less than 10 to 15 grams per day) live longer and better. Also, in Japan and Africa where there are very low amounts of saturated fat in the diet, there is also a very low incidence of MS. The main food sources that contain saturated fats are animal products (meat, dairy products, and eggs) and tropical oils (e.g., palm oil and coconut oil). A low-fat, vegan diet leads to the most dramatic reductions in saturated fat.
  • A diet rich in fruits, vegetables, and whole grains: These foods can improve energy levels and functioning of the immune system.
  • Vitamin D: Vitamin D has been shown to significantly decrease the risk of MS. This may be related to its effect on inflammation. Vitamin D normally comes from sunlight's action on the skin. However, many people do not get enough vitamin D from sun exposure or from their diet. And many foods that are high in vitamin D are also high in saturated fat. Some breakfast cereals are enriched with vitamin D, but this is probably not enough. So, it is important to take a supplement with 400 IU of vitamin D on a daily basis.
  • Consult with a qualified dietitian to help make healthy food choices.
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Sometimes the most elegant solution is the most simple. Why plant-based nutrition? Why not? Why develop heart disease? Cancer? Diabetes? The epidemic of chronic, degenerative disease that is sweeping the western world can not only be stopped, it can be reversed. The power lies in the hands of the consumer, in the choices we make about what to put on our plates.