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Paging Dr. Frischer - Multiple Sclerosis
WRITTEN BY :   Dr. Alan Frischer

Most of us are acquainted with someone who has Multiple Sclerosis (MS), a disease that affects the ability of nerve cells in the brain and spinal cord to communicate effectively with one another. All ages, genders, and ethnic groups can suffer from MS, but major risk factors include:
*being between the ages of 20 to 40, female, and white
*having a family history
*experiencing a variety of infections, especially certain viruses
*having other autoimmune diseases, such as thyroid disease
*living in countries with a temperate climate, decreased sunlight exposure, and decreased vitamin D levels
*exposure to severe stress, cigarette smoking, or occupational toxins
The damage caused by MS is caused by an attack on the nervous system by the victim’s own immune system. A quick review of brain function: Nerve cells in the brain communicate by sending electrical signals down long fibers (axons), which are contained inside of an insulating substance (myelin). With MS, the body’s own immune system attacks and damages the myelin. Without myelin, the axons can no longer effectively conduct signals. The term “multiple sclerosis” refers to many (multiple) scars (sclerosis) in the myelin.
The cause of MS is unclear. As with many other diseases with unknown causes, theories include genetics, infections and the environment. Is MS an inherited disease? Not precisely. There is certainly a genetic component to MS, but this doesn’t appear to explain enough. The risk of acquiring MS is indeed higher if a close relative has the disease. The odds of getting MS rise to as high as 20% if a parent, sibling, or child has it, and identical twins have a 35% rate of both having the disease if one does.
Those with MS might experience a wide variety of neurologic symptoms, including loss of sensitivity, tingling, prickling or numbness, muscle weakness, difficulty moving, difficulties with coordination and balance, problems with speech, swallowing, visual problems, bladder and bowel difficulties, impairment in thinking, and emotional symptoms like depression or mood instability.
These symptoms may occur in separate attacks known as the relapsing form, or slowly accumulate over time in the progressive form…or occur in a combination of both forms.
Relapses are often unpredictable, happening without warning and without clear triggers. Attacks are rarely more than one or two in a year. If there are triggers, they might be particular seasons of the year like spring and summer, or various viral infections. Interestingly, pregnancy tends to decrease the rate of relapse, but immediately after delivery the rate rises.
How do we make the diagnosis of Multiple Sclerosis? The first clue comes with the clinical exam, during which the patient might describe separate episodes of neurologic symptoms characteristic of MS. Typically, the diagnosis is confirmed through an MRI of the brain, an analysis of cerebrospinal fluid, and a test of the optic (eye) nerve.
After diagnosis, what lies ahead? The prognosis depends on a number of factors. The liklihood of a better course is tied to being female, having the “relapsing-remitting” subtype of MS, having the symptoms of early attacks be optic neuritis or sensory, experiencing few attacks in the early years, and being young when symptoms first appear. 90% of MS patients can walk after the first 10 years, and 75% can after 15 years, but most people eventually do lose the ability to walk. This is a disease which evolves and advances over decades, with 30 years being the average length of time that people live with it. Those with MS typically live five to ten fewer years than do those without, and under 40% of patients reach age 70. Two-thirds of the deaths of those with MS are directly related to the disease.
Sadly, as of yet there is no known cure for MS. The goal of treatment is to prevent attacks, to prevent and lessen disability, and to return to function following an attack. During an accute attack, steroids are the routine treatment. They are effective in the short term for relieving symptoms, but have no impact on long-term recovery. Severe attacks are treated with plasmapheresis, a process which removes a patient’s blood, filters out harmful antibodies, and returns the blood back to the body. Medications known as “disease modifying drugs” are effective in reducing the progression of the disease and the number of attacks, but they are expensive, require frequent injections, and do not stop the disease. Because of these imperfect medications and their significant side effects, many of those who suffer seek as-yet unproven alternative treatments.
There is quite a lot of literature on nutrition and MS, and patients claim that certain diets have a positive impact on their day-to-day symptoms. However, there are no conclusive studies as of yet proving that nutritional therapy affects the course of MS. Practicing a healthy life-style is always a worthwhile goal. In general, having sensible eating habits will have a beneficial impact on most aspects of wellbeing.
If you or a loved one suffers from Multiple Sclerosis, I recommend:
*Being physically active, preferably under the supervision of a physiotherapist. Activity has been shown to improve mobility, mood, bowel health, general conditioning, and consequently, quality of life.
*Preserving and nurturing connections to friends and family, and pursuing hobbies.
*Paying attention to getting plenty of rest, keeping a cool body temperature, a balanced diet, and practicing stress control.
*Keeping in close contact with your health care professionals.
*Just as for those who suffer from any serious chronic disease, both patient and caregivers benefit from good in-person and on-line support groups.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: April 26, 2012 – Volume 11 – Issue 02



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