Category Archives: Basic Info

Types of Multiple Sclerosis

MS is very unpredictable and it often defies its own classifications. Many patients note that although they have relapsing/remitting MS, they seem to have lingering symptoms after definite attacks. The same holds true for those who were diagnosed with primary progressive multiple sclerosis and who find themselves experiencing “attacks” as well as steady disease progression. In years past, there were four recognized disease courses, but as of late, neurologists and MS scientists are acknowledging several other multiple sclerosis disease patterns.

Silent MS

Not much is known about this type of multiple sclerosis. Apparently, a small amount of people live their lives with no physical symptoms of multiple sclerosis, and it is only upon death (during autopsies) that doctors learn about this group of patients through their discovered brain and spinal cord lesions.

Benign MS

This form of multiple sclerosis accounts for about 10-20% of the MS population. It is marked by few attacks with long periods of remission, with little accumulated disability. Often doctors use this term for patients who have suffered isolated, single attacks, but the true form of this course can only be judged after years of the disease with few serious attacks. Sometimes this is also referred to as “mild” MS.

Relapsing-Remitting MS

RRMS is the most common form of multiple sclerosis, both at disease onset (85% of all cases) and as a part of the overall, collective types of MS (up to 45% of all patients.) Onset is generally sudden, with an actual attack marking the beginning of the disease, followed by a period of remission with full or partial recovery from the attack. RRMS varies greatly among patients. Some experience small, non-debilitating attacks that last for a week or so, while others have full-blown attacks that can perpetuate for a month or more. Whatever the magnitude of the attacks, it has been observed that they usually become harder to rebound from as time goes on, and about 50% of RRMS patients enter a secondary progressive phase after about 10 years of the disease, while as many as 80% or more of RRMS patients enter it after 20 years of the disease. Statistics for patients who take disease-modifying drugs are not yet conclusive, since these medications have only been around since the early 1990′s.

Secondary-Progressive MS

This form of multiple sclerosis is exactly what its name implies: the second phase in a course of MS. RRMS patients have a 50% chance of developing this variety of MS after 10 years if they are not treated with disease-modifying medication. At the 20 year mark, as many as 80% or more of RRMS patients will enter this phase if not treated with medication. At this time, specific data is not available for the percentage of patients who enter this phase who do take disease-modifying meds. SPMS is defined as the stage where patients stop having clear attacks and clear remissions and begin to have gradual, steady decline and mounting disability. Approximately 40% of the MS population lives with this type of disease.

Primary-Progressive MS

This form of MS is usually more aggressive from the onset. It tends to occur more in men and those who are 40 years or older at the time of disease onset. There are no clear attacks and remissions, and decline and disability are gradual but continuous. This accounts for about 5-10% of the entire MS population.

Progressive-Relapsing MS

This is a little-acknowledged disease course because it overlaps with RRMS and PPMS. What is known is that there is a clear progression of disability from the beginning of disease onset, but there may be overlaps of attacks (relapses) and remissions that may or may not display full recovery. There is no clear percentage of patients who live with this form of the disease.

Marburg’s Disease or Malignant MS

This is a very rare form of MS that has a severely progressive course and can be fatal within several months to several years. It generally strikes at a very young age (under 20 years) and most doctors see very few cases of this during the courses of their medical careers.

References:

  • Barnes, David. Multiple Sclerosis Questions and Answers. Merit Publishing International: Coral Springs, Florida, 2000.
  • Kalb, Rosalind C., PhD. Multiple Sclerosis: The Questions You Have, The Answers You Need, 4th Ed. Demos Medical Publishing, LLC: New York, NY, 2008.
  • Rosner, Louis J., MD, and Shelley Ross. Multiple Sclerosis: New Hope and Practical Advice for People with MS and Their Families. Simon & Schuster: New York, NY, 2008.

A Brief History of Multiple Sclerosis

Medical Research, Google Images
Multiple sclerosis has been around for ages, but only within the past two hundred years has it been correctly identified and extensively researched in order to bring about a world free of its ravages. Here are pivotal moments in the short timeline of multiple sclerosis knowledge:

1838: doctors’ autopsy drawings show changes in brain tissues, but MS is not yet identified

1868: A French neurologist, Dr. Jean Martin Charcot, tracks several patients with neurological symptoms such as tremors, slurred speech, walking difficulties, and muscle spasms. He examines one particular patient’s brain after her death and discovers multiple sclerosis “plaques” or scarring along nerve pathways.

1878: myelin, the protective covering of the nerves, is discovered by a Dr. Ranvier

1919: abnormalities in spinal fluid are discovered

1928: the cells that make myelin, oligodendrocytes, are discovered

1935: Dr. Thomas Rivers (U.S.) demonstrates an MS-like illness in rats when he injects them with healthy myelin and it produces an autoimmune reaction much like multiple sclerosis in the subjects. The animal variety of MS is called experimental allergic encephalomyelitis, or EAE. This opens up the idea that MS is caused by an incorrect autoimmune response, not soley by a viral or bacterial infection.

1946: the National Multiple Sclerosis Society is started in the U.S. by Sylvia Lawry, a woman whose brother has the disease

1948: oligoclonal bands are discovered in spinal fluid and they become a criterion for positive multiple sclerosis diagnosis

1965: a correlation between elevated white blood cells and MS activity is made

Read more »

What is Multiple Sclerosis?

Erase MSMultiple sclerosis is a mysterious, unpredictable disease that even has doctors puzzled. It is thought to be autoimmune in nature (the body’s own immune system, for whatever reason, attacks its own tissue.) MS is also a neurological disease, because the nerves of the central nervous system (within the brain and the spinal cord) are the targets of the attacks. The myelin, or protective nerve covering, is what is damaged during an MS attack, causing scarring or lesions on the nerves. The name “multiple sclerosis” is derived from the various scarrings that are found on an MS patient’s MRIs. Because of these nerve scarrings, nerve functions can be impaired or completely lost.

MS Statistics

Doctors are currently trying to make connections to different reasons why some people develop this neurological illness and are considering genetic, environmental, or even possible viral links as contributing factors. Currently, researchers can trace patterns of increased cases of MS to individuals who live in cooler, more temperate climates, and have noticed that the closer a person lives to the equator, the less likely they will be to contract the disease. Although there is no conclusive genetic link, siblings and particularly identical twins have the greatest chance of developing multiple sclerosis if another sibling already has the disease. Doctors are also investigating the possibility of people contracting MS if they suffered from a certain viral infection at a younger age. Finally, there appears to be a gender preference as women are more likely than men to develop multiple sclerosis; however, the disease has been known to affect men more severely.

MS Symptoms

Patients develop symptoms due to multiple sclerosis attacks. These can also be considered areas of impairment, since they signify nerve damage. MS symptoms can include:

  • tingling/numbness in the limbs, torso, and/or face
  • pain
  • burning sensations
  • weakness
  • fatigue
  • tightening sensations (especially in the torso or legs)
  • bladder and bowel weakness
  • visual problems
  • tremors
  • muscle spasms
  • vertigo
  • unsteady gait or trouble walking
  • swallowing/speech issues
  • cognitive problems
  • seizures

Symptoms/impairments depend on the areas of nerve damage, and the symptoms can fluctuate throughout the day or throughout a lifetime. Some are permanent and others are transient.

Types of MS

The patterns for multiple sclerosis tend to fall into one of four categories. The first, relapsing/remitting, is the most common form at onset. There are attacks on the nerves (relapses), then the body recuperates (remittance.) Nevertheless, damage from these attacks is cumulative, and disability can increase as a person suffers more attacks. Secondary progressive MS can emerge after years of the relapsing/remitting variety (although not always), and is characterized by a steady decline with no more attacks or recoveries. Primary progressive multiple sclerosis is characterized by a continual decline from the onset of the disease. Finally, relapsing/ progressive MS seems to exhibit occasional flare-ups while all along the progression is continuous.

MS Treatments and Outlook

Current treatments for multiple sclerosis include disease-modifying drugs, such as Avonex, Betaseron, Copaxone, and Rebif. These medications are taken as injections and are known to slow the progression of multiple sclerosis in many patients. Certain types of steroids are used on patients with serious relapses in order to stop inflammation and damage to nerves. Novantrone & Tysabri, other multiple sclerosis drugs, are used in MS cases when treatment with the above ABC drugs fail to show results. Future prospects include oral medications and possible stem-cell remedies. A cure is thought to be around the corner, and with so many new medications created in just the past 15 years, this seems like a definite possibility.

*For further reference, please visit The National Multiple Sclerosis Society and The Mayo Clinic.