Multiple Sclerosis

Multiple sclerosis is a disease of the central nervous system, typically slow and fitful in its progress, with effects that can range from relatively minor physical annoyances to major disabilities. The root problem is electrical. Normally, most nerves in the body are insulated by a fatty substance called myelin, which permits the efficient transmission of electrical impulses - the nerve signals. Multiple Sclerosis, or MS, occurs when this protective sheath becomes inflamed and ultimately destroyed in places, short-circuiting the electrical flow. Among the possible consequences of the disruption are loss of muscular coordination, impaired vision, and incontinence.

The initial attack - occurring as early as the teenage years - may be brief and mild, and may not even be recognized. The symptoms temporarily abate or disappear for reasons that are not known, but recurrence is highly likely-although usually after a long latency period. Generally the first full-fledged bout, lasting weeks or months, takes place between the ages of 20 and 40, and further attacks follow at erratic intervals. The repeated inflammation of the nerves produces scarring (sclerosis), and although myelin can normally repair itself, the scarring happens too rapidly for healing to take place; the effects of the lesions become permanent. As a result of such lasting damage, 77 per cent of MS sufferers are limited to some degree in their activities, and about 25 per cent become wheelchair-bound.

Doctors Recognise Four Basic Categories of MS:

Benign

Cases of this kind are typically limited to one attack, and there is no permanent disability. The most common symptoms are limb numbness and temporary vision problems caused by inflammation of the optic nerve. About 20 per cent of MS cases are of the benign type.

Relapse-remitting

This and the next category refer to on-again, off-again cycles of attacks and remissions. Cases of this type involve sudden and strong debilitating attacks followed by periods of almost total remission. About 25 per cent of MS cases are of this kind.

Relapse-progressive

In this type, attacks are less severe, but the recovery is less complete. The cumulative effect of many cycles of attacks slowly leads to some degree of disability. This is the most common form of MS, accounting for about 40 per cent of all cases.

Chronic-progressive

This form of MS quickly becomes disabling and has no periods of remission. It accounts for about 15 per cent of cases.

Multiple sclerosis not only is unpredictable in its on-again, off-again patterns and its broad spectrum of symptoms, it also strikes the population in mystifyingly uneven ways. Women are twice as susceptible as men, and the disease is twice as common among Caucasians as among Asians and Africans. Moreover, the incidence is higher in northerly regions.

Causes

No one is sure what causes MS, but most re-searchers think the immune system plays a major role. Perhaps the disease arises from an inherited problem in the immune system. Perhaps a virus provokes an autoimmune response - a situation in which the immune system attacks the body's own tissue, mistaking it for a foreign invader. It has also been proposed that MS can be triggered by a profound emotional shock or physical trauma, which could affect the immune system.

Dietary factors have also been cited as possible causes. In attempting to explain the higher incidence of MS in northern regions, some re searchers note that people there tend to eat more red meat, milk products, and other foods high in saturated fat. MS patients have a lower-than-normal ability to absorb polyunsaturated fatty acids, which are essential to the body's processing of all foods, especially saturated fat. The result is an excess of saturated fats in their systems. Many remedial diets have been devised to correct this imbalance, and some have met with sustained success-but none can be considered a cure.

Some researchers suspect environmental factors. The list of possible culprits includes lead, pesticides, diesel fumes, chemicals in tap water, solvents, fumes from domestic gas water heaters, and carbon monoxide pollution.

Diagnostic and Test Procedures

A common test for MS is the visual evoked response, in which electrodes attached to the back of the head detect electrical activity in response to visual tracking of a changing checkerboard pattern. Other tests include magnetic resonance imaging (MRI) and lumbar puncture.

Treatment

Multiple sclerosis is difficult to treat - and to study, for that matter - for two reasons: Its diverse symptoms vary greatly, and the cycling of attacks and remissions makes tracking the course of the disease and determining the effectiveness of a given treatment especially problematic. (A remission, for example, could be due to medication or might have occurred on its own.)

In general, medicines are effective only in treating the symptoms of MS, and then only to a limited degree. MS sufferers have thus vigorously explored a wide variety of alternative treatments as well.

Conventional Medicine

Although the unpredictable nature of MS makes treatments difficult to evaluate, a number of medications are regarded as effective. Among them: interferon beta, which can cut the frequency and severity of relapses; corticosteroids, which can shorten attacks and reduce inflammation; baclofen and dantrolene, which act to suppress spasticity; and muscle relaxants, which relieve stiffness and pain. A corticosteroid is frequently recommended to treat inflammation of the optic nerve, the cause of the double vision or involuntary rapid eye movement that some-times occurs with MS. Amantadine, an antiviral drug, may promote stamina.

Some medications specifically target muscle stiffness, bladder and bowel problems, tremors, fatigue, and the pins-and-needles sensation. Others are directed at the immune system. In sever-al trials run in 1994, cladribine, a drug used to treat leukemia, either stabilised or improved the conditions of MS patients; it apparently works by killing lymphocytes that may be attacking the central nervous system.

Researchers are exploring various other treatments. In one study, replacement myelin from cows seemed to greatly reduce the number of attacks. Physical therapy has proved effective in relaxing stiff limbs, maintaining motion in the joints, and improving circulation. A physical therapist can also help design an exercise program tailored to the individual's particular limitations.

Alternative Choices

You will need professional guidance for some of the alternative therapies described below, but you can learn to do many yourself at home.

Acupuncture

With MS patients, the goal of acupuncture is to reduce limb stiffness and relax muscles. Acupuncture, which stimulates nerve pathways, may enable messages to bypass damaged nerve fibers.

Apitherapy

The administering of stings from honeybees (Apis mellifica) has been used to treat arthritis for centuries - and recently, MS sufferers, too, have found relief with apitherapy, also known as bee venom therapy (BVT). The recommended treatment involves three weekly sessions of painful stings (from a live bee) for six months. Apitherapy stimulates the immune system. When an al-ready inflamed area is stung and becomes swollen, the body's natural anti-inflammatory agents act to shrink swelling, reducing the inflammation of the original condition in the process.

Bee venom may be beneficial in other ways. It is rich in polyunsaturated fatty acids, which MS patients lack.

BVT has short-lived side effects: itching, swelling, and skin reddening. It has been known to cause fatal shock in some people and severe allergic reactions in others. Be sure to check with your doctor before embarking on a series of treatments. Some doctors will administer the stings themselves, or they may refer you to someone more experienced.

Bodywork

Although multiple sclerosis cannot be cured through physical movement or exercise, regularly working your muscles is advised in order to keep them from atrophying.

The Feldenkrais method involves a series of lessons designed to retrain your neuromuscular system and expand your range of motion. More than a thousand different exercises are covered in the lessons, which you can take either in a group session or in a one-on-one meeting with a practitioner. Movements are performed lightly, slowly, and without strain.

Proprioceptive Neuromuscular Facilitation, or PNF Stretching, is another body-work technique that operates on the principle of reeducating the body. Proprioceptors are sensory receptors-concentrated in muscle tissue around the joints-that monitor physical movements and enable the brain to coordinate the body's motions. In PNF Stretching, a therapist arranges your body in a stretched position and holds you stationary while urging you to move; as you try to respond, your muscles stretch farther. With repetition, the muscles flexibility increases and, in effect, the proprioceptors "learn" how to achieve a fuller range of motion.

Lifestyle

Exercise is highly recommended for MS patients - although it should not be performed during an attack, nor too strenuously at other times, since overexertion can bring on an attack. Because muscle contractions are stimulated by nerve impulses, the exercise of muscles where nerves have been damaged can be difficult. Nonetheless, swimming, stretching, and low-impact aerobics are all within the capabilities of many people with MS, and even patients in wheelchairs can exercise to some degree.

Gentle stretching is particularly helpful for the spasticity, stiff gait, and foot and toe dragging that can accompany the disease. Performing gentle stretches in cool water, a form of hydrotherapy, can also help relax spastic limbs.

Studies have demonstrated that regular yoga exercises increase secretions of the adrenal medulla, a nervous-system stimulator, which can help to slow degeneration.

Nutrition And Diet

Certain foods can bring on attacks in some MS sufferers. Among problem foods are milk and dairy products, caffeine, yeast, and gluten (found in wheat, barley, oats, and rye). Ketchup, vinegar, wine, and corn can also prove problematic. The best way to isolate sensitivity to a particular food is to stop eating it for a month, then reintroduce it into your diet to see if it provokes a reaction.

A number of special diets attempt to correct the fatty imbalance in MS sufferers. Two approaches (sometimes used together) appear to have the greatest impact in managing the disease: One is to increase the intake of fatty acids; the other, to decrease the intake of saturated fats. The latter tactic is the more common, although in many recommended diets, saturated fats are not the only targets for reduction or elimination. For example, allergen-free diets forbid foods known to produce allergic reactions such as hives, hay fever, and asthma attacks. Diets that are gluten-free eliminate wheat, rye, barley, and oats.

Pectin- and fructose-free diets ban fruits and fruit juices. The Evers Diet consists primarily of raw food. The MacDougal Diet is gluten- and fructose-free and includes megadoses of vitamins. The Cambridge Liquid Diet is a balanced, very low-calorie diet usually used for obese MS patients.

The best-known diet for MS sufferers is the Swank Diet, devised by Dr. Roy Swank of the Oregon Health Sciences University, USA.

In many cases, it has apparently slowed the course of the disease and reduced attacks. Very low in saturated fats, it calls for specific amounts of polyunsaturated oils -sunflower, safflower, olive, and sesame oils, for example, as well as oils in beans, leafy green vegetables such as spinach and kale, and most fish.

The diet also includes proteins, supplements of codliver oil, and high doses of vitamins. Butter, margarine, shortening, and hydrogenated oils (such as coconut and palm oil) are strictly forbidden. In the first year, you are advised to avoid red meat entirely, as well as peanut butter, cheese, sour cream, sauces, gravies, pastries, whole milk, and snack foods - all of which are high in saturated fats.

Supplements figure in many diets recommended for MS sufferers. Linoleic acid, found in sunflower oil and known for its role in regulating the immune system, is said to reduce the severity of MS attacks and to produce longer remissions.

Evening primrose oil (Oenothera biennis) is beneficial because of its specialised fatty-acid content. Nerve sheaths may be strengthened with 5 daily grams of lecithin (kept refrigerated). Coenzyme Q, or CoQ10, in 30 mg doses two or three times a day, may help cells utilize more oxygen. Niacin may help with tingling and numbness.

Symptoms

The first attack is generally mild, lasts only a few days, and is followed by a long period of remission - perhaps years - before the next episode. Symptoms vary considerably. They include:

weakness, stiffness (spasticity), or numbness in one or more limbs.
sensations of tingling, pins and needles, heaviness, a bandlike tightness around one or more limbs or the trunk of the body.
tremors, instability, or a lack of balance or coordination.
blurred or double vision, or voluntary eye movement.
bladder or bowel incontinence.

Fatigue:

either a feeling of general tiredness or extreme exhaustion.

Call Your Doctor If:

you or someone you know has symptoms associated with Multiple Sclerosis. Because other diseases share some of the same symptoms, a proper diagnosis is essential to your treatment.
you are suffering from an acute attack; steroid injections can help relieve pain.

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