may differ depending on the individual’s disease course (relapsing-remitting, primary-progressive, etc.), but there
does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction.
(National Multiple Sclerosis Society)
?Depression, which is unrelated to cognitive problems, is another common feature of MS.
(Brunnscheiler) In addition, about 10 percent of patients suffer from more severe psychotic disorders such as
manic-depression and paranoia. Five percent may experience episodes of inappropriate euphoria and
despair–unrelated to the patient’s actual emotional state known as “laughing/weeping syndrome.” This syndrome
is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and
emotions, and is usually seen only in severe cases. (National Multiple Sclerosis Society)
As the disease progresses, sexual dysfunction may become a problem. Bowel and bladder control may
also be lost. (Health Central)
In about 60 percent of MS patients, heat, whether generated by temperatures outside the body or by
exercise may cause temporary worsening of many MS symptoms. In these cases, eradicating the heat eliminates
the problem. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For
the same reason, ?swimming is often a good exercise choice for people with MS.? (Wenzel)
The erratic symptoms of MS can affect the entire family as patients may become unable to work at the
same time they are facing high medical bills and additional expenses for housekeeping assistance and
modifications to homes and vehicles. The emotional drain on both patient and family is immeasurable. Counseling
may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause.
(Lambert)
?There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many
medications have serious side effects and some carry significant risks.? (Health Central) Naturally occurring or
spontaneous remissions make it difficult to determine therapeutic effects of experimental treatments; however, the
emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new
therapies.
Until recently, the principal medications physicians used to treat MS were steroids possessing
anti-inflammatory properties; these include adrenocorticotropic hormone (better known as ACTH), prednisone,
prednisolone, methylprednisolone, betamethasone, and dexamethasone. Studies suggest that intravenous
methylprednisolone may be superior to the more traditional intravenous ACTH for patients experiencing acute
relapses; no strong evidence exists to support the use of these drugs to treat progressive forms of MS. Also, there is
some indication that steroids may be more appropriate for people with movement, rather than sensory, symptoms.
(Mayo Clinic)
While steroids do not affect the course of MS over time, they can reduce the duration and severity of
attacks in some patients. The mechanism behind this effect is not known; one study suggests the medications work
by restoring the effectiveness of the blood/brain barrier. ?Because steroids can produce numerous adverse side
effects (acne, weight gain, seizures, psychosis), they are not recommended for long-term use.? (Bernard)
One of the most promising MS research areas involves naturally occurring antiviral proteins known as
interferons. Two forms of beta interferon (Avonex and Betaseron) have now been approved by the Food and Drug
Administration for treatment of relapsing-remitting MS. A third form (Rebif) is marketed in Europe. Beta
interferon has been shown to reduce the number of exacerbation?s and may slow the progression of physical
disability. When attacks do occur, they tend to be shorter and less severe. In addition, MRI scans suggest that beta
interferon can decrease myelin destruction. (Mayo Clinic)
Investigators speculate that the effects of beta interferon may be due to the drug’s ability to correct an
MS-related deficiency of certain white blood cells that suppress the immune system and/or its ability to inhibit
gamma interferon, a substance believed to be involved in MS attacks. Alpha interferon is also being studied as a
possible treatment for MS. (Mayo Clinic) ?Common side effects of interferons include fever, chills, sweating,
muscle aches, fatigue, depression, and injection site reactions.? (Health Central)
Scientists continue their extensive efforts to create new and better therapies for MS. Goals of therapy are
threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease
progression.
In conclusion, MS is a disease that is well known but poorly understood by the medical and nursing
community as well as the general public. It has no known cure and the genes that are accountable for it have yet
been pin pointed. The United States is capable of finding a cure for this disease; over the years, medical researchers
have found cures for many diseases that were thought incurable. Not only time and money are needed to find a cure
for this disease, but faith and heart are needed to realize the importance
Glossary
antibodies — proteins made by the immune system that bind to structures
(antigens) they recognize as foreign to the body.
antigen — a structure foreign to the body, such as a virus. The body usually
responds to antigens by producing antibodies.
ataxia — a condition in which the muscles fail to function in a coordinated
manner.
autoimmune disease — a disease in which the body’s defense system
malfunctions and attacks a part of the body itself rather than foreign matter.
blood/brain barrier — a membrane that controls the passage of substances
from the blood into the central nervous system.
cerebrospinal fluid — the colorless liquid, consisting partially of substances
filtered from blood and partially by secretions released by brain cells, that
circulates around and through the cavities of the brain and spinal cord.
Physicians use a variety of tests–electrophoresis, isoelectric focusing, capillary
isotachophoresis, and radioimmunoassay–to study cerebrospinal fluid for
abnormalities often associated with MS.
cytokines — powerful chemical substances secreted by T cells. Cytokines are
an important factor in the production of inflammation and show promise as
treatments for MS.
demyelination — damage caused to myelin by recurrent attacks of
inflammation. Demyelination ultimately results in nervous system scars, called
plaques, which interrupt communications between the nerves and the rest of the
body.
experimental allergic encephalomyelitis (EAE) — a chronic brain and
spinal cord disease similar to MS which is induced by injecting myelin basic
protein into laboratory animals.
fatigue — tiredness that may accompany activity or may persist even without
exertion.
gadolinium — a chemical compound given during MRI scans that helps
distinguish new lesions from old.
human leukocyte antigens (HLAs) — antigens, tolerated by the body, that
correspond to genes that govern immune responses. Also known as major
histocompatibility complex.
immunoglobulin G (IgG) — an antibody-containing substance produced by
human plasma cells in diseased central nervous system plaques. Levels of IgG
are increased in the cerebrospinal fluid of most MS patients.
immunosuppression — suppression of immune system functions. Many
medications under investigation for the treatment of MS are
immunosuppressants.
interferons — cytokines belonging to a family of antiviral proteins that occur
naturally in the body. Gamma interferon is produced by immune system cells,
enhances T-cell recognition of antigens, and causes worsening of MS
symptoms. Alpha and beta interferon probably exert a suppressive effect on
the immune system and may be beneficial in the treatment of MS.
lesion — an abnormal change in the structure of an organ due to disease or
injury.
magnetic resonance imaging (MRI) — a non-invasive scanning technique
that enables investigators to see and track MS lesions as they evolve.
myelin — a fatty covering insulating nerve cell fibers in the brain and spinal
cord, myelin facilitates the smooth, high-speed transmission of electrochemical
messages between these components of the central nervous system and the
rest of the body. In MS, myelin is damaged through a process known as
demyelination, which results in distorted or blocked signals.
myelin basic protein (MBP) — a major component of myelin. When myelin
breakdown occurs (as in MS), MBP can often be found in abnormally high
levels in the patient’s cerebrospinal fluid. When injected into laboratory animals,
MBP induces experimental allergic encephalomyelitis, a chronic brain and
spinal cord disease similar to MS.
oligodendrocytes — cells that make and maintain myelin.
optic neuritis — an inflammatory disorder of the optic nerve that usually
occurs in only one eye and causes visual loss and sometimes blindness. It is
generally temporary.
paresthesias — abnormal sensations such as numbness, prickling, or “pins and
needles.”
plaques — patchy areas of inflammation and demyelination typical of MS,
plaques disrupt or block nerve signals that would normally pass through the
regions affected by the plaques.
receptor — a protein on a cell’s surface that allows the cell to identify antigens.
retrobulbar neuritis — an inflammatory disorder of the optic nerve that is
usually temporary. It causes rapid loss of vision and may cause pain upon
moving the eye.
spasticity — involuntary muscle contractions leading to spasms and stiffness or
rigidity. In MS, this condition primarily affects the lower limbs.
T cells — immune system cells that develop in the thymus gland. Findings
suggest that T cells are implicated in myelin destruction.
transverse myelitis — an acute spinal cord disorder causing sudden low back
pain and muscle weakness and abnormal sensory sensations in the lower
extremities. Transverse myelitis often remits spontaneously; however, severe or
long-lasting cases may lead to permanent disability.
white matter — nerve fibers that are the site of MS lesions and underlie the
gray matter of the brain and spinal cord.
Bernard, Bobby. ?Multiple Sclerosis Continues to Puzzle Scientists.? The Vermillion
March 1998.
Brunnscheiler, H. ?Problems Associated with MS?
(July 28, 1999)
?Inteli Health? http://www.intelihealth.com/ (28 July 1999).
Boyden, Kathleen M. ?Compolmer-1 in the Treatment of Multiple Sclerosis.?
Journal of Neuroscience Nursing 5 October 1998.
Waxman, Stephen. ?Demyelinating Diseases — New Pathological Insights, New Therapeutic Targets.?
New England Journal of Medicine29 Jan. 1998, Vol. 338, No. 5, 323-327.
Health Central ?General Information about Multiple Sclerosis?
(July 16, 1999)
Hofmann, Robert. ? Multiple Sclerosis? American Journal of Human Genetics June 1998,
62:492-495
Kaser, Arthur. ?Inter