Multiple sclerosis (MS) is one of the most commonly diagnosed neurological disorders among young adults. Most people are diagnosed between the ages of 20 and 50 with the peak incidence around 30. However people may be diagnosed as children and beyond age 50. With the peak incidence around 30, this diagnosis may have an impact on some of the major milestones in life. People around this age are often starting careers, planning for marriage, children, home purchases, etc. The uncertainty of the progression of disease can make decision making very challenging.
In brief, MS is a chronic neurological disorder of the central nervous system (brain, spinal cord, and optic nerves). There is damage to the myelin sheath which surrounds nerve fibers and interrupts nerve transmission and signaling. Sclerotic lesions form in the brain and spinal cord in multiple places, thus the origin of the name, multiple sclerosis. Depending on where these lesions occur, there is usually a loss of function. People with MS may have problems with their vision, loss of sensation, weakness, difficulty with balance, bowel/bladder problems, among other symptoms. These symptoms are often intermittent but some may persist, usually varying in degree of intensity.
There are four recognized classifications of the disease, and while there are not always distinct boundaries between the disease sub-types, it is important to know what type of MS people have when considering treatment options. There may be immunological differences among the classifications which could impact treatment. The four classifications include relapsing-remitting (RRMS), secondary-progressive (SPMS), primary progressive (PPMS) and progressive-relapsing (PRMS). Relapsing remitting MS is characterized by acute episodes, or exacerbations, of symptoms, occurring for at least 24 hours in duration and often lasting for days or weeks. After an episode, there is either full recovery of symptoms or there may be some residual deficit. Approximately 85% of people with MS present with RRMS, and over half of these people develop SPMS over time. In SPMS, there is progression of symptoms between exacerbations, and exacerbations may begin to occur less frequently. About 10 - 15% of people with MS have PPMS which is characterized as an insidious progression of symptoms from the onset without acute exacerbations. Very rarely, people with MS may have PRMS in which there is a progressive form of the disease superimposed by acute relapses.
Before 1993, there were no FDA approved treatments for multiple sclerosis. Since that time, there are now six FDA approved therapies for treating this disease. Unfortunately these treatments are not cures, but they have been shown to delay progression of disease. This is an exciting time to be working in the field of MS because the outlook of disease has changed now that there are approved therapies. The spectrum of disease still varies greatly. Some people with MS may go through life with little or even no disability, while other patients may have more significant symptoms. However, what was once a disease only to be treated symptomatically, now there are several therapeutic options aimed at targeting disease pathology. And in cases when one person may not respond or tolerate a particular therapy, there are several choices. There has been tremendous progress made in better understanding disease pathology which will hopefully lead to achieving the optimal goal of curing MS and ending this devastating disease. However, as of today, this disease exists. The MS community continues to research not only treatments for disease pathology, but also symptomatic therapies and approaches hoping to improve overall quality of life.
Published On: September 24, 2007