Multiple Sclerosis

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Multiple Sclerosis ( this post is for the article "New Shoes")

 Multiple Sclerosis (MS) is one of those “romantic” diseases. To be up in the popular consciousness a disease must affect younger people, have an interesting nature history or epidemiology (to attract the professionals, and be generally considered fatal (which is perhaps why genital herpes doesn’t qualify). It helps if a famous person gets the disease and or someone writes a popular book.

 The symptoms in MS are caused by an autoimmune process that chews up the myelin proteins of the central nervous system. Normally your brain doesn’t let too much of your immune system in, as the immune systems scorched-earth, take no prisoners approach is particularly destructive in this setting.  Unfortunately, in MS the immune cells not only get into the brain, they think the brain proteins are foreign bodies and attack. This results in neuronal processing speed being reduced and disrupted because essentially the insulation is eaten away. The lesions produced do heal, but gradually scarring builds up and finally cerebral atrophy become noticeable.

The clinical presentation varies because the location and acuity of the CNS lesions varies. Not all lesions produce noticeable symptoms, and there are elaborate scoring systems to establish the diagnosis.  Classically, the early symptoms of MS are visual changes such as blurry vision or reduced color vision. Other symptoms are weakness, balance problems, parasthesias, mental status changes, incontinence –basically anything involving the central nervous system. MS tends to start with what is called a relapsing-remitting course, although remissions fail overall to keep up with relapses. Later on it can turn into a more steadily disabling course without remissions. There are other variant courses as well. Not everyone has the same symptoms or course and some people have much milder course than others. Many people with MS have a normal lifespan and do not die from the disease.

The treatment of MS has changed dramatically in the past decade or so. Not so long ago there was no treatment for MS except high-dose steroids when the relapse was especially troublesome or acute. Now the mainstays of treatment are immunomodulators.  These are drugs either injected under the skin or infused at regular intervals. Current thinking is that these should be used sooner not later to try and prevent as much central nervous system damage as possible. They do have a variety of side effects, some very serious, but they also offer that hope that we are moving to a time when MS will loss the “romance” of tragedy.

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