The Spinal Cord and MS
When people think about Multiple Sclerosis, there is often fixation on the brain. After all, the brain, characteristically struck by MS, is the organ that affords us the ability to think and to have self-awareness.
Yet it is not uncommon to discover multiple silent brain lesions on MRI in MS and find the patient afflicted with only spinal cord problems due to the disease. Sometimes the symptomatic spinal cord lesions are more difficult to identify on scans than some clinically quiet but MRI evident brain lesions.
As a central relay station for sensation, movement, balance and coordination for so much of the body, the spinal cord is crucial for limb function and the muscles involved in respiration.
Many with spinal cord problems and MS have numbness on one side of the body and weakness on the opposite side. They may lose standing balance or have a gait problem characterized by ataxia, i.e. the inability to walk a straight line.
Spinal cord plaques (patches of myelin loss) due to MS in the neck (cervical) region can cause cape like sensation loss in both shoulders and in the upper arms. Quadriplegia is the great danger in cervical region MS. Anesthesia in a band like distribution around the trunk can be experienced in MS patients with mid spinal cord inflammation. Such patients may become paraplegic. All spinal cord MS patients can potentially have bladder or bowel control problems. However, a patient with spinal cord MS of the lumbar region (the spinal cord ends at the beginning of the lumbar spine) can have symptoms dominated by retention of urine.
During some research activity at the University of Miami Project to Cure Paralysis, I learned of investigations that revealed that for many patients, pain below the level of spinal cord involvement and sexual problems were the greatest complaints, even when there were motor difficulties in the limbs. Spinal cord induced pain can be excruciating. It often shoots down the spine (Lhermitte’s Sign) or to the limb that is involved due to spinal cord damage.
Erectile dysfunction is common in men with spinal cord MS. Orgasmic and fertility problems can strike both sexes with cord lesions. Spasticity is another major problem in patients with spinal cord problems of all types. This increase in muscle tone can also be painful and movement limiting.
Medication and certain devices such as spinal cord stimulators can be valuable for many of these issues. Dyssnergia (movement incoordination) involves bladder muscle difficulties due to cord MS. The incontinence/ bladder emptying problems that results can be treated with medication as well.
Christopher Reeve, the late actor/advocate did much to call attention to spinal cord injury. He is honored at the Miami Project, as his activism was quite important in generating funds needed to support spinal cord regeneration research. Generation spawns regeneration. My own daughter coincidentally has been involved in research at The Project on spinal cord injured mice. It’s amazing how much queasiness can be overcome in the interest of science (not that the mice are particularly thrilled).
The man who played Superman suffered something called “autonomic instability” which is a very dangerous problem in those with any kind of spinal cord derangement whether due to trauma or a disease such as MS. This means that pulse, blood pressure, temperature and breathing can all be impaired due to abnormalities in the spinal cord influenced autonomic nervous system.
Therapeutic research in spinal cord disorders including MS involves consideration for the transplantation of stem cells, the injection of Nerve and Brain Derived Growth Factors and medicines that stimulate Cyclic AMP which can provide the energy source for spinal cord regrowth.
In addition, rehabilitation of the patient with spinal cord problems is critical by way of special conditioning and strengthening programs.
In MS, an acute spinal cord attack is called Myelitis. Immunomodulator and steroid therapy is often utilized with success. Dramatic reversal is possible. If the MS patient has persistent neurological signs and symptoms from the spinal cord inflammatory attack, he is said to have a** Myelopathy**.
Often the severity of MS is very much related to how bad the Myelopathy is. Progressive MS can be characterized by spinal cord shrinkage (atrophy) over time. Reversal of this aspect of advancing MS remains a great challenge for ongoing research. Defeating the immunological process that triggers both the brain and spinal cord damage in MS is the best defense against the terrible effects of spinal cord involvement in demyelinating disease.
Kenneth Gross, M.D. wrote about multiple sclerosis for HealthCentral. He is the head of Fusion Clinical Multimedia, Inc., a medical education company in Miami, Florida, dedicated to areas that involve interspecialty issues.