Multiple Sclerosis

Before we get into the disease I will explain what a neuron is, where it is located and where is the problem with multiple sclerosis.

A neuron is the brain type of cell. It is unique in the sense that they do not replicate for most of our lives. Neurons are electrically excitable and are able to produce an electrical signal. Through this signals we are able to feel things ( vision, taste, smell, etc ) and move around.

This electrical signal is of paramount importance. If the electrical signal is delayed, sensation might be lost. The speed through which the signal is transmitted depends considerably on a sheath of fat that the neuron has, which is called a myelin sheath. When the myelin sheath is gone the speed at which the signal travels is slow. This is called demyelination.

Multiple sclerosis (abbreviated MS ) is an autoimmune condition in which the immune system attacks the central nervous system (CNS), leading to demyelination. It was described for the first time in 1835 by Jean-Martin Charcot.

MS has got a prevalence ranges between 2 and 150 per 100,000 depending on the country and the population. MS is five times more prevalent in cold climates -such as those found in the northern United States, Canada, and Europe- than in tropical regions. It is believed that there are currently about 250,000 to 350,000 people in the United States who have been diagnosed with multiple sclerosis. This estimate suggests that approximately 200 new cases are diagnosed each week.

How does MS affect the brain?

MS affects oligodendrocytes ( these are support cells in the brain that help and nourish the neurons ) on areas of the brain and spinal cord known as the white matter. White matter cells carry signals between the grey matter areas, where the processing and signaling is done, and the rest of the body. Oligodendrocytes are responsible for creating and maintaining a fatty layer, known as the myelin sheath.

MS results in a thinning or complete loss of myelin and, less frequently, the cutting (transection) of the neuron's extensions or axons ( see picture ) . When the myelin is lost, the neurons can no longer effectively conduct their electrical signals.

The cause of MS remains unknown, but the most widely believed theory is the auto immune one. This is a result of the harm inflicted to the myelin sheaths by our own immune system. Other theories believe it is a metabolically dependent disease while others think that it might be caused by a virus ( Epstein Barr ). Finally, others believe that because it is virtually absent from the tropics, it might be dependant on a deficiency of vitamin D.

Signs and Symptoms of MS

MS presents with a variety of symptoms such as:

Changes in sensation (hypoesthesia)

Muscle weakness and spasms

Difficulty in moving

Coordination and balance dysfunctions (ataxia)

Speech (dysarthria) or swallowing (dysphagia) difficulty

Visual problems

Fatigue and pain syndromes

Bladder and bowel problems

Neuropathic pain, mostly on lower extremities ( pain is described as constant, boring, burning or tingling intensely)

Paraesthesias ( include pins and needles; tingling; shivering; burning pains; feelings of pressure; and areas of skin with heightened sensitivity to touch )

To notice, the first symptoms of the initial attacks (known as exacerbations or relapses) are often , mild (or asymptomatic), and will go away on their own . They are sometimes identified in retrospect once the diagnosis has been made based.The most common initial symptoms reported are: changes in sensation in the arms, legs or face, vision loss (optic neuritis), weakness, double vision, unsteadiness and balance problems.

How does a doctor diagnose MS?

Multiple sclerosis is said to be a clinical diagnosis, and one of exclusion. this means that your doctor will need to rule out other diseases before it can diagnose you with MS. It makes it then, difficult to diagnose MS in its early stages. For MS of type primary progressive, a slow progression of signs and symptoms over at least 6 months is required. In an effort to standarize the diagnosis of MS, the McDonald criteria is now being used. This integrates clinical, laboratory and radiologic data to increase the likelyhood of diagnosis ( http://www.mult-sclerosis.org/DiagnosticCriteria.html )

Clinical data alone may be sufficient for a diagnosis of MS, provided that the patient has had 2 or more attacks and has consistent abnormalities in physical exam.

Imaging studies usually consisit on Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of the brain and spine . MRI shows areas of demyelination ( are called lesions ) that appear as bright spots on the study. A substance, called Gadolinium, can be administered intravenously to highlight active plaques. This can provide the evidence of chronic disease needed for a definitive diagnosis of MS.

In order to get cerebrospinal fluid (CSF), a doctor might need to perform a lumbar puncture on the patient's back. This fluid can provide evidence of chronic inflammation of the central nervous system. The CSF is also tested for oligoclonal bands, which are immunoglobulins ( defense chemicals the body generates ) found in 75% to 85% of people with definite MS (but also found in people with other diseases). Combined with MRI and clinical data, the presence of oligoclonal bands can help make a definite diagnosis of MS.

Stimulation of the optic nerve and other sensory nerves through visual evoked potentials (VEPs) and somatosensory evoked potentials (SEPs), may show that the brain of a person with MS often responds less actively to it, so decreased activity on either test can reveal demyelination which may be otherwise asymptomatic.

Clinical subtypes of MS and disease progresion

The course of MS is difficult to predict because the disease may at times either be dormant or progress steadily.

The following subtypes have been described for MS ( See above diagram )

A. Relapsing-remitting: This describes the initial course of 85% to 90% of individuals with MS. This subtype is characterized by unpredictable periods of time with symptoms called "attacks" (relapses) followed by periods of months to years of relative symptom free time or with no new symptoms. The deficits suffered during the attacks may either resolve or may be permanent. When deficits always resolve between attacks, this is referred to as benign MS.

B. Secondary progressive: This describes the course of around 80% of those initially diagnosed with relapsing-remitting MS, who then begin to have neurologic decline between their acute attacks without any definite periods of remission. Usually, this decline may include new neurologic symptoms, worsening cognitive function, or other deficits. This type is the most common type of MS and causes the greatest amount of disability for the patients.

C. Primary progressive: Not frequent. It describes around 10% of individuals who never have remission after their initial MS symptoms. Decline occurs continuously without clear attacks. Usually tends to affect people who are older at disease onset.

D. Progressive relapsing: Very uncommon and very debilitating, describes a subtype of MS that from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes.

Treatment

A. Medical

I. Acute Relapses: High doses of intravenous corticosteroids, such as methylprednisolone, is the routine treatment. The goal of this kind of treatment is to end the attack sooner and leave fewer lasting deficits in the patient. They are very effective in the short term, but do not appear to have a significant impact on long-term recovery. Side effects include osteoporosis, impaired glucose, obesity and impaired memory.

II. Disease Modifying Medications: These are all very expensive medications with several sometimes severe side effects. As of 2007, six disease-modifying treatments have been approved by regulatory agencies of different countries for relapsing-remitting MS. Three are interferons : two formulations of interferon beta-1a (Avonex and Rebif) and one of interferon beta-1b (Betaseron or Betaferon). A fourth medication is glatiramer acetate (Copaxone). The fifth medication, mitoxantrone, is an immunosuppressant (used also in cancer chemotherapy). Finally, the sixth is natalizumab (Tysabri). All six medications are modestly effective at decreasing the number of attacks and slowing progression to disability, although they differ in their efficacy rate and studies of their long-term effects are still lacking.

B. Alternative

The following recommendations are made for patients with MS:

First, engage on a diet using mainly raw unprocessed foods, with organic foods when possible. Cook from scratch. Try fruits and vegetables with color to them ( color in fruits and veggies are usually the pigments of very strong antioxidants they carry ). Whole grains are prererred and whenever possible you should use brewer's yeast and wheat germ to your foods.

Make smoothies with fresh fruit, flax seed and berries. This will provide you with fiber, esssential fatty acids and antioxidants. Products like Lecithin ( found in tofu, soy derivates and bean sprouts ) help to strenghthen the myelin sheath.

DO NOT:

Eat junk food, processed or packed food

Drink Sodas or artificially sweetened drinks

Eat sugary products or products sweetened with refined sugar or high fructose corn syrup

Do:

Try fasting, with short term ( 1 day at a time ) fruit and vegetable juices fasts. Try a Super greens drink every morning for detox.

With respect to supplements it makes sense to increase your intake of highly concentrated Fish Oil. Go all the way up to 10-20 grams ( 10 to 20 capsules a day ). Start low but increase steadily to minimize flatulence. Even though I usually recommend Nordic Naturals fish Oil, here the cost wil be prohibitive. Try using NSI Fish Oil, Puritan's Pride or Vitamin Shoppe's brand Fish Oil for a larger capsule supply at a good price. Don't forget to put the bottle in the fridge once opened ( fish oil will turn rancid if in direct sunlight or exposed to oxygen, cold helps keep rancidity to a minimum ). Try high dose vitamin B12 ( 400mcg-800mcg sublingual a day). For immunity try a good probiotic ( again, keep on the fridge ), with a minimum of 4 billion units. Also the use of Plan Sterols ( Try commercial sytrinol ). GLA essential fatty acids from Borage oil or evening primrose oil is also recommended. For brain support, try Ginkgo Biloba, a total of 240mg dividad in 2 doses a day.

Homeopathic treatment again, and as usual needs to be tailored to the patient's symptoms. Please follow the next link ( http://www.hpathy.com/diseases/multiple-sclerosis-cause-treatment-cure.asp ).

Acupressure, Acupuncture and Chinese medicine can definitively help treat symptoms, specifically pains and aches, fatigue, etc. Cranial acupuncture is specifically useful for neurological symptoms. Also oriental medicine is very good at balancing the body function and optimizing its organs to effectively fight the disease.

Stress reduction is a must. Feel free to use back flower herbs, Saint John's Wort, SAM-e, Valerian, Biofeedback, Yoga, Tai Chi, gentle excercise, etc and/or formal counseling to help you manage Stress.

Video presenting MS:



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