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“Living with Multiple Sclerosis” by Piet Mesmer

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21. Children and Multiple Sclerosis

Though multiple sclerosis is most common in adults between the

ages of 20 to 50, it can also affect children and teenagers.

Children whose fathers have multiple sclerosis will, most likely,

inherit the disease.

Researchers say that there is twice the chance of men with multiple

sclerosis transmitting their disease to their offspring than women

that have the disease. This finding surprised researchers because

multiple sclerosis is more common in women than in men.

In one study, the researchers looked at 444 children that came from

206 different families and whose parents also had multiple sclerosis.

It was found that where the father had multiple sclerosis, the

children had a higher risk of being born with the same disease. In

other words, fathers with multiple sclerosis have more chance to

transmit the disease to their child rather than the mothers.

Children with multiple sclerosis experience similar symptoms as the

adults. The drugs for treating the children are similar to the drugs

used for adults.

Studies indicate that genes and perhaps some unknown

environmental factor is responsible for causing multiple sclerosis. To

understand how the disease works, research on parental inheritance

in multiple sclerosis inheritance might lead to some substantial

findings.

Researchers feel that, since men are less likely to develop multiple

sclerosis than women, those men who have this disease tend to

have a very strong multiple sclerosis-prone genes. The hypothesis is

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that the men are more resistant to multiple sclerosis; therefore,

their genes and the number of those genes are stronger and higher.

It is advisable for men and women with multiple sclerosis to get

guidance from a genetic counselor before planning a family.

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Part-V: Diagnosis and Clinical Aspects

22. When to Seek Medical Care

Multiple sclerosis does not have specific symptoms that always

occur the same in each patient. Some symptoms may not manifest

totally. They may occur at intervals or may not be serious enough

for you to notice and decide to visit your doctor. Some symptoms

could overlap with those of other ailments.

However, it is better to diagnose MS in the early stages and seek

necessary measures to combat the symptoms.

MS Symptoms that Require Medical Care

• Stiffness in limbs, causing involuntary dragging of legs

• Feeling of exhaustion and weakness in legs and hands

• Vision problems - blurred, hazy or foggy vision

• Loss of vision or double vision, or eyeball pain

• Walking problems and clumsiness in moving limbs

• Dizziness

• Intermittent tingling sensation or numbness in arms, hands

or legs

• ‘Electric shock’ sensations moving down your back or spine,

legs and arms

• Problems when trying to retain things in your memory or lack

of attention at times.

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• Problems with maintaining a daily routine

• Unable to communicate effectively, searching for the right

words to give voice to your feelings

• Inability to empty your bladder completely or to hold urine

• Unsteadiness

• Pain when you move your eyes

• A burning sensation while urinating

• Problems when swallowing

• Regular bouts of constipation

• Frequent attacks of cold, chills and high temperatures

• Slurred speech

• Excessive pain in forearms, fingers or neck

• Development of numerous rashes

• Vertigo or muscular spasms

• Excessive urination

If these symptoms occur with great regularity and frequency, it is

advised to consult a medical professional immediately or visit your

nearest health care center for a complete diagnosis.

Some symptoms, like excessive weakness, personality changes or

respiratory problems may signal the presence of other ailments like

strokes, severe infections or chemical imbalances. These symptoms

are also typical of MS.

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So, a medical analysis can help you arrive at the correct diagnosis

and make it easier for you to get appropriate treatment.

Painful eye movements may signal the presence of optic neuritis,

which is one of the earliest signs of MS. Early diagnosis and

appropriate treatment with corticosteroid medication may avert

development of more serious symptoms.

If, after starting with your treatment for MS, you develop

complications (like side effects of any medicines or injections) or if

you do not find any relief from your symptoms, consult your doctor

immediately.

Normally, injections require a minimum of two weeks to give you

any substantial relief. Sometimes, you do not feel your symptoms

while taking your medicine regularly. However, all symptoms come

back as soon as you stop your medications or after the effect of the

medication weans off. It makes sense to keep watch on your

symptoms and seek medical advice whenever appropriate.

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23. Diagnosis of Multiple Sclerosis

There is no single or simple test to diagnose MS.

Doctors examine you and study all the symptoms carefully.

There are international efforts to standardize and establish specific

criteria for diagnosis of MS by using clinical, radiologic, and

laboratory data. However, most symptoms and signs of MS are

similar to those of other nervous ailments like brain inflammation,

strokes, and Lyme disease.

They try to exclude symptoms that are connected to other

conditions.

They look for two episodes of damage to the myelin sheath on the

structures of the nervous system (termed demyelinating) that occur

at least thirty days apart.

If you have had two separate episodes of MS with characteristic

neurological symptoms and you display specific physical symptoms

or abnormalities, doctors may diagnose MS without further testing.

The first attack produces many possible causes - different

neurological disorders and symptoms according to where the

damage occurs. MS causes many lesions on your brain and spinal

cord. This attack could last for many hours or even days.

Some people have additional attacks while some others get medical

advice and treatment soon after the occurrence of the first attack.

Some people with mild MS could suffer from optic neuritis, which is

inflammation of their optic nerve. In such cases, if a brain scan is

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normal, you probably have a very low risk of developing MS. A

percentage of just 10%.

If your MRI discloses multiple lesions at the time of the single

episode, you have more than an 80% chance of developing MS.

Sometimes, the tests do not provide evidence for definitely

diagnosing MS. The case becomes more definite only if your age is

within the range for MS. You should show strong signs of recurring

symptoms too.

Neurologists often suggest a few more tests to confirm MS. Such

tests include:

Lumbar Puncture: This is a spinal tap test. Doctors take a sample

of your cerebrospinal fluid by inserting a needle between two

vertebrae of the spine. If you have MS, this fluid will contain high

protein levels, white blood cells and certain antibodies. This test

confirms the presence of immunoglobulin, which is normally present

as oligoclonal bands in the spinal fluid of people with definite MS.

MRI: MRI is Magnetic Resonance Imaging. Doctors conduct a scan

of the spinal cord and brain by using magnetic waves to create

pictures. Scanning can reveal damage to the spinal cord.

Additionally, such a scan can rule out any other symptoms too, like

abnormal pressure on the spinal cord. Chronic presence of

symptoms is essential to establish MS. This test can reveal previous

lesions, which may not have produced any clinical symptoms.

Neuropsychological tests: Doctors give you specific tasks to

check your abilities in arithmetic, judgment, memory, attention and

reasoning. These tests can show the functioning of your brain and

other sensory activities.

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Potential testing: Doctors stimulate brain functioning by passing

mild electric current through your legs or arms. Wires on your scalp

and legs or arms pass this current. It is then possible to measure

electrical activity in response to such stimulation. They can test your

hearing and sight abilities too. If you have MS, your brain will

respond less actively to such stimulations. This test helps locate the

widespread involvement of nerves needed to make a definite

diagnosis.

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24. Factors for Progression of Multiple Sclerosis

Multiple sclerosis causes severe impairment to your nervous

system as it disrupts functioning of your immune system. Most

treatments can slow down the progression of the disease. With

longer remission periods, you should experience fewer flare-ups and

complications.

Normally, your immune system produces many antibodies to fight

against the antigens. In MS, your immune system loses its normal

functioning abilities and turns against the healthy cells of your body.

Normally, MS patients progress into the chronic stages of the

disease. In the early stages of destruction of the myelin sheath by

your immune system, you suffer from various bouts of minor

illnesses like dizziness, vision problems and some others. Although

you are able to recover from these bouts quickly, you are

progressing into the chronic stages at the same time. There may

not be any specific treatment plan for these later stages.

In the early stages of MS, most symptoms are not prominent. They

come and go. They do not cause much impairment or disability.

Such random occurrences of symptoms could last for many years.

However, over time, all the symptoms of MS occur with increased

frequency and severity because many small attacks on your spinal

cord and brain have caused them to deteriorate.

Your nervous system is unable to bear the assault any more, so it

steadily loses its abilities to work properly for you.

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Some studies suggest that a particular substance, macrophage

migration inhibitory factor, that is made by your immune cells

might be responsible for the progression of MS.

Studies on mice indicate that the absence of this substance caused

occurrence of MS in initial stages. However, it apparently did not

develop into a serious form of the disease in those tests.

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25. Prognosis of Multiple Sclerosis

The cause(s) of Multiple Sclerosis is still being studied. The factors

affecting its progression vary in their effects too. Sometimes,

patients with MS continue to live full lives for more than 35 years

after their first attack.

In very rare cases, MS patients succumb to the disease within

weeks. In some cases, MS patients develop severe symptoms and

die due to numerous complications within five years.

The outcome of your multiple sclerosis may be serious if:

• You are a female

• You had the first symptoms at a young age of around twenty

• Your first symptoms were vision problems or decreased

sensation, and not of coordination or weakness

• You had long gaps of remission between relapses

• Your MS was the relapsing-remitting form

After diagnosis of MS, progress of the disease could be

slow if:

• There are long intervals between episodes

• You recover completely after an episode

• You suffer fewer attacks after your first diagnosis

• Your episodes are mainly sensory in nature and cause tingling

or numbness

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Your MS could progress very fast if:

• You have many frequent attacks

• You do not recover completely from your episodes

• You suffer more attacks after your initial diagnosis

• Initial symptoms disrupt your motor functions and disturb

your coordination

• Early MRI scans reveal many lesions

According to NINDS Multiple Sclerosis Information, the majority of

MS patients do not suffer extreme symptoms and have a normal life

expectancy. Usually, symptoms become a constant feature without

any great regression or progression.

MS may only make you unable to write, read, walk, or speak in very

severe cases. In extremely rare cases, it causes paralysis, blindness

and sometimes premature death.

However, most outcomes are unpredictable and therefore are not

authoritative. There are no clinically established and laboratory-

tested investigations to predict the outcome of most cases of MS

accurately.

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Part-VI: Treatment and Medications

26. Treatment and Medications

for Multiple Sclerosis

There is no conclusive evidence of the actual cause of multiple

sclerosis and no specific treatment available for an effective cure.

You need medical supervision and medications to provide some

relief for your symptoms.

Sometimes, MS patients recover completely and do not suffer any

relapse. Another extreme is that MS could cause severe damage to

your nervous system very early in the disease itself or even before

the MS symptoms show up.

Sometimes, the symptoms prove to be very mild and the patient

may not even notice them.

Medications for MS reduce the severity of the disease by:

• Reducing further damage to lesions

• Preventing accumulation of lesions

• Reducing the number of days you suffer from MS symptoms

• Slowing down all disabilities due to MS

• Preventing development of new symptoms

• Preventing relapses

Current medications can sometimes slow down the progress of the

disease and prevent its natural course.

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Available Medications and Treatments for MS

The most common drugs for treating MS symptoms are popular as

ABC drugs. They are Avonex, Betaseron and Copaxone. These

medications quieten the immune system through different biological

mechanisms. They reduce the intensity and frequency of your

attacks and the numbness, disability and severe fatigue. Each drug

needs a separate type of administration and provides different

effects.

Avonex: (Beta-interferon-1a): Administration of this drug is

through intramuscular injection. This drug effectively reduces

further inflammations of MS lesions by about a third. It also reduces

disabilities associated with MS like gait disturbance, weakness,

visual problems and cognitive impairments. It is best to use

ibuprofen (Motrin) or acetaminophen (Tylenol) before taking the

injection to reduce the severity of side effects.

Common side effects of Avonex are:

• Fever

• Muscle aches

• Chills

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Betaseron (Beta-interferon-1b): This drug is slightly stronger

than Avonex. It is more effective in cases of secondary progressive

MS. This type of MS registers steady progression of the disease

rather than recurrent remissions and exacerbations. It can help

reduce the appearance of new lesions on your nerves.

Common side effects of this drug are:

• Chills

• Fever

• Muscle aches

• Injection site reactions

Copaxone (Glatiramer acetate or Copolymer-1): Administration

of this drug is as a daily subcutaneous injection. This drug also

produces extensive reduction in the frequency of MS attacks. It

does not cause any flu-like symptoms of side effects.

Common side effects are:

• Tenderness, swelling, redness, or pain at the place of

injection

• Anxiousness for around twenty minutes after the injection

Steroids

Steroids prove effective at speeding the recovery process from an

episode. Steroids are not a permanent cure for MS. Steroids are

anti-inflammatory drugs that arrest further inflammation. These

drugs are only for very severe cases of MS. In such cases, MS could

affect your daily functioning like walking and vision.

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Steroids do cause severe side effects and therefore, you should

discuss the situation in detail with your doctor before using any

steroid treatment for your MS symptoms.

Doctors prescribe administration of these drugs by mouth or

through intravenous injections, depending on the severity of MS

attack. You can either administer injections at the nursing home or

at your home with the help of any nurse. Normally, doctors

prescribe steroid treatments for a few days to a week only.

Common side effects of steroidal treatments are:

• Insomnia

• Mood swings

• Weight gain

• Increasing glucose levels

All these side effects disappear once you stop your steroidal

treatment.

Medications to Reduce Stiffness

Muscular stiffness is a very common feature of Multiple Sclerosis.

Some doctors prescribe Baclofen (Lioresal) for treating such

stiffness. Although doctors prescribe many dosages during a day,

you can, with your doctor’s approval, adjust your dosages to take

them during severe attacks. You should start the drug at low doses

and thereafter increase in small increments to get relief from your

symptoms. This medicine relaxes muscles and reduces muscular

weakness. It can calm you.

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However, if Baclofen is unable to provide the necessary relief from

your muscular spasms, you can take tizanidine (Zanaflex) in

combination with it. This drug is very potent and therefore, you

have to start at low doses and increase them over time. This is very

effective at reducing spasms and does not cause much weakness.

Doctors sometimes use dantrolene (Dantrium) if both these

medications do not provide the necessary relief.

Medications to Reduce Neuropathic Pain

There are many medications to treat Neuropathic pain that occurs

due to MS. Most of these medications are similar to depression

medications. They include gabapentin (Neurontin) or

antidepressants like amitriptyline (Elavil), paroxetine (Paxil),

and sertraline (Zoloft). All these medications help relieve pain.

Medications to Cure Bladder problems

Medications to cure bladder problems are tolterodine (Detrol) and

Oxybutynin (Ditropan). These reduce excessive urination and

urgency in urination.

Medications to Combat Fatigue

Multiple sclerosis causes fatigue, a general feeling of weakness

where you feel very sleepy. Amantadine (Symmetrel) and

Modafinil (Provigil) can help improve these symptoms.

Medications for Treating More Chronic

and Progressive Forms of MS

There is presently no conclusive report of effective treatments for

treating chronic and progressive cases of MS. There are a few

reports of beneficial effects of some medications for some chronic

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cases. Howev