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Multiple Sclerosis

Multiple sclerosis is a chronic, autoimmune, inflammatory, neurodegenerative (causing destruction/degeneration of the nerves) disease that affects the central nervous system, including the brain, spinal cord, and optic nerves. Multiple sclerosis (MS) is the most common non-traumatic disabling disease that typically affects young adults. MS presents with progressive demyelination (damage to the protective covering, called the myelin sheath, present around the nerve fibers; a nerve fiber and its myelin sheath are comparable to an electric wire and its outer protective covering, respectively) and subsequent axonal (the long threadlike part of a nerve cell along which impulses are conducted from the cell body to other cells) degeneration. This disease has a huge impact on the quality of life of the affected individuals, both functionally and financially.

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Symptoms

The symptoms of MS depend on the anatomic location of the plaques along the neural axis and major symptoms include:

  • Paraparesis (partial inability to move one’s legs) 

  • Paraplegia (paralysis of the legs and/or lower body)

  • Tremor (shaking movements in one or more parts of the body.)

  • Ataxia (lack of muscle control)

  • Aphasia (communication disorder that makes it hard to use words)

  • Dysarthria (difficulty/ slurred speech)

  • Dysphagia (difficulty in  swallowing)

  • Bladder and bowel problems

  • Visual defects 

  • Cognitive decline

Diagnosis

The diagnosis of MS is based on the presence of CNS lesions that are disseminated in time and space (i.e., occur in different regions of the CNS, at least 3 months apart), with no better explanation for the disease process. The diagnostic modalities include:

  • MRI scans of the brain and spinal cord reveal lesions.

  • Spinal fluid analysis may identify antibodies that suggest a previous infection or proteins consistent with a diagnosis of MS.

  • An evoked potential test measures electrical activity in response to stimulation.

Management

There is no cure for MS, but medication that can slow the progression of the disease, reduce the number and severity of relapses, and relieve symptoms, is available. Physical therapy can build muscle strength and ease some of the symptoms of MS. FDA has approved a few drugs to be used as disease-modifying agents in MS that are mayzent (siponimod) and mavenclad (cladribine)  to treat adults with relapsing forms of MS, the clinically isolated syndrome (CIS) form of MS, relapsing-remitting disease, and the active secondary progressive disease.

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