Patient Handbook The following is a good starting point for MS information.  If you have information that you would like to see here, please contact me at: FireLady40@aol.com.    Return to Articles Index Return to MS IndexReturn to Home Page

• Historical Notes
• Who Gets MS?
• Who is at Risk?
• What is the Cause of MS?
• What is MS?
• Symptoms of the Disease

 HISTORICAL NOTES

Medical historians have found descriptions of cases compatible with the diagnosis of Multiple Sclerosis (MS) for centuries. As early as the 14th Century, the life story of St. Lidwina of Schiedam (1430 -1433) described neurological complaints similar to MS. The letters and diaries of Sir Augustus Frederic d’Este (1794 - 1848), grandson of George III of England and the nephew of Queen Victoria, probably give the best literary account of MS: a disorder that lasted for 25 years and was characterized by symptoms that are commonly experienced by MS patients today.

Jean M. Charcot, French Neurologist (1825- 1893), was the first physician to report a patient who presented with speech disturbances, abnormal eye movements and tremors ("Charcot’s triad"). Charcot recognized that these symptoms were specific and different from any other neurological disorder. He observed this patient for many years and the diagnosis of MS was made at autopsy. He was the first to use the term "scerosis en plaques" (MS) We now know that MS symptoms described by Charcot only occur in very severe and advanced cases of MS.

Gender Ratio

MS is slightly more common in females than males (ratio 3:2)

Age of Onset

MS is a disease that affects young adults. The onset of symptoms is usually between the ages of 15 years to 45 years, but cases have been reported in children under 10 years of age and in adults over 59 years of age.

 MS is largely a disease of Caucasians of central and northern European ancestry. Prevalence studies, i.e., the ascertainment of a number of MS cases in a defined area on a given date, he concluded that the worldwide distribution is influenced by latitude and racial origin. High prevalence areas for MS include those in extreme latitudes and temperate climates, e.g., northern and central Europe, northern North America, New Zealand and southern Australia. MS is less common ( i.e., low prevalence rate) closer to the equator and in hot climates. It is thought that the migration of Europeans to North America may account for the high frequency of MS in Canada and northern U.S. Native Black Africans and Orientals have a low prevalence when living in their countries or origin; but their risk to develop MS changes slightly when they move to a high risk country. This risk increases more with the admixture of Caucasian genes through intermarriage.

 Throughout most of Canada, including British Columbia, recent studies have found a prevalence rate of about 1/1000 or 0.1%

 The cause of MS is unknown. Environmental, genetic and epidemiological factors all play an important role in a person’s predisposition for MS. The immune system of individuals with MS may also be a factor. An immune response is the body’s ability to react to a specific foreign agent (virus, bacteria). An autoimmune response occurs when the body goes "haywire" and reacts against its own tissues. In MS this would be a an attack on the central nervous system. Cells of lymphoid tissue initiate and control the immune response. Studies on peripheral blood have shown abnormality in lymphocyte function during an MS attack and in the chronic progressive phase of the disease.

In epidemiological studies, a viral cause has always been considered, but no virus has been isolated. It is known that all viruses behave differently and the immune response to infection can vary from benign to severe. It is possible that a virus affects only those who are genetically susceptible. Once this infection occurs, the body reacts as expected but then a slow abnormal immune response develops and leads to an ongoing autoimmune response. The theory of the slow or latent virus has also been considered . This virus would remain dormant in the central nervous system of the host individual for 10 to 20 years and then produce an immune response. Family data, including very recent work on adoptees with MS, do not support the hypothesis of a transmissible viral agent being responsible for MS.

MS is an inflammatory disease of the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerves. There are four cells in the gray matter of the brain: nerve cells, oligodendroglia, astrocytes and microglia. The nerve cells are the main component of the gray matter. Each nerve cell has a nerve fibre (axon) which connects the cell body with muscles and sensory organs of the body, i.e., eyes, ears, internal organs. The nerve cells and their fibres are responsible for sending messages within the CNS. The nerve fibres vary in length, some are very short and others are several feet long, for example the full length of the spinal cord. Each nerve fibre is wrapped in a substance called myelin, which acts as insulation for the nerve fibres and speeds the transmission of messages along the fibres. Myelin colour to the white matter of the CNS. When inflammation occurs, there is loss of myelin or demyelination. These areas are called patches or plaques. MS refers to multiple scarring of the CNS. The number of plaques in the CNS and the frequency of occurrence vary from person to person. When a plaque develops, there is slowing or blocking of the conduction of messages along the nerve fibres. This may result in MS symptoms, i.e., exacerbation, relapse or attack. Symptoms may take days or weeks to develop. Once the inflammation has subsided, conduction along the nerve fibres is partially or wholly restored, i.e., a remission.

 Sometime the damage is permanent and conduction of messages are not restored. In general, the longer a person has clinical MS, the less likely a complete remission will occur.

Symptoms are subjective complaints experienced by patents. Historical accuracy of the initial symptoms and complaints during subsequent attacks are important in making a diagnosis of MS. MS symptoms tend to show a wide range of variability and few, if any, are specific to MS. They can include minor complaints occurring intermittently during the day or ongoing for days, weeks or months. Symptoms can develop spontaneously, as in a true MS attack, or they can be precipitated by hear, physical activity, infections or stress. Symptoms will be discussed in categories of motor, sensory, visual and other. All possible MS complaints are listed, but this does not mean that a person with MS will experience each symptom during their course of MS.

Motor symptoms

"Heaviness" of a limb

Weakness of legs and arms

Difficulty walking

Inability to move a limb - paralysis of limbs/limb

Facial weakness

Spasticity of limbs - "stiffness, "jerkiness", "involuntary shaking"

Loss of balance leading to difficulty walking

Incoordination

Tremors interfering with dexterity and speech

Sensory Symptoms

Tingling, numbness, "pins and needles"

Tightness of a limb

Girdle sensation of trunk

Hot and cold sensations

Facial pain (Trigeminal Neuralgia)

Pain - burning sensation in extremities

Electric shock sensation in the back, arms and legs with neck flexion (Lhermitte’s sign)

Visual Symptoms

Blurred vision Loss of central vision - associated with pain/tenderness of eye

Weakness of eye muscles resulting in double vision

Abnormal eye movements

Other symptoms

Bladder dysfunction - frequency, urgency, retention, hesitancy, loss of control, frequent voiding at night.

Bowel problems - constipation’s, urgency, loss of control.

Fatigue - feeling of overwhelming weakness, tiredness, lack of energy, and listlessness all resulting in inability to function.

Sexual dysfunction - abnormal genital function resulting in difficulties in attaining and maintaining an erection in males, ejaculation may be retrograde into the bladder. Problems with lubrication and achieving orgasm in females.

Dizziness - feeling of turning or spinning often accompanied by nausea or vomiting.

Mood changes - feelings of frustration, irritability, depression, or euphoria.

Memory - forgetfulness, problems with concentrations and abstract thinking, or memory loss.

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Always research__ never take just one persons view even if that person is a physician__ Learn all you can before you decide on any treatment!