WHAT IS MULTIPLE SCLEROSIS?
Multiple sclerosis (MS) is an unpredictable disease of the central nervous system that can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. MS is an autoimmune disease in which the body's own immune system launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, such as a virus or injury.

WHAT ARE THE SYMPTOMS?
The symptoms of MS can vary greatly from one person to the next, and even from time to time for the same person. Most people experience their first symptoms of MS between the ages of 20 and 40. For some people, the initial symptoms of MS can include blurred or double vision, red-green color distortion, or even blindness in one eye. Others might experience abnormal fatigue.   Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations. Some may also experience pain. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. Depression is another common feature of MS.

HOW IS IT DIAGNOSED?
Several tests and procedures are needed to identify multiple sclerosis. Some of the information used in making a diagnosis comes from:

Medical history - to determine a person's overall health and when symptoms began
Nervous system tests - to check reflexes, balance, coordination and vision
MRI - to identify any lesions or damage to the brain
Evoked potential tests - to measure how the nervous system responds to certain stimulation
Spinal tap - to check spinal fluid for disease indicators

One type of evoked potential test is called the Visual Evoked Potential test (VEP.) VEP tests measure the speed of the brain's response to visual stimuli. VEP can sometimes detect lesions that the scanners miss and is particularly useful when abnormalities seen on an MRI do not meet the specific criteria for MS. Auditory and sensory evoked potentials have also been used in the past, but are no longer believed to contribute significantly to the diagnosis of MS. Like imaging technologies, VEP is helpful but not conclusive because it cannot identify the cause of lesions.

Examination of cerebrospinal fluid can show cellular and chemical abnormalities often associated with MS. These abnormalities include increased numbers of white blood cells and higher-than-average amounts of protein, especially myelin basic protein and an antibody called immunoglobulin G. Physicians can use several different laboratory techniques to separate and graph the various proteins in MS patients' cerebrospinal fluid. This process often identifies the presence of a characteristic pattern called oligoclonal bands.

While it can still be difficult for the physician to differentiate between an MS attack and symptoms that can follow a viral infection or even an immunization, our growing understanding of disease mechanisms and the expanded use of MRI is enabling physicians to diagnose MS with far more confidence than ever before. Today, most patients who undergo a diagnostic evaluation for MS will be classified as either having MS or not having MS, although there are still cases where a person may have the clinical symptoms of MS but not meet all the criteria to confirm a diagnosis of MS. In these cases, a diagnosis of "possible MS" is used.

A number of other diseases may produce symptoms similar to those seen in MS. Other conditions with an intermittent course and MS-like lesions of the brain's white matter include polyarteritis, lupus erythematosus, syringomyelia, tropical spastic paraparesis, some cancers, and certain tumors that compress the brainstem or spinal cord. Progressive multifocal leukoencephalopathy can mimic the acute stage of an MS attack. Physicians will also need to rule out stroke, neurosyphilis, spinocerebellar ataxias, pernicious anemia, diabetes, Sjogren's disease, and vitamin B12 deficiency. Acute transverse myelitis may signal the first attack of MS, or it may indicate other problems such as infection with the Epstein-Barr or herpes simplex B viruses. Recent reports suggest that the neurological problems associated with Lyme disease may present a clinical picture much like MS.

HOW IS IT TREATED?
There is no cure for MS yet. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks.  

Beta interferon
Three forms of beta interferon (Avonex, Betaseron, and Rebif) are approved by the Food and Drug Administration for treatment of relapsing-remitting MS. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe.  

Copaxone
The FDA also has approved a synthetic form of myelin basic protein, called copolymer I (Copaxone), for the treatment of relapsing-remitting MS. Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third.

Novantrone
An immunosuppressant treatment, Novantrone (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic MS.

Steroids
While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. Solu-Medrol is one of the most commonly used corticosteroids. It is given intravenously to help reduce inflammation and alleviate exacerbations.  

Intravenous Immune Globulin (IVIG)
IVIG is sometimes used to treat relapsing-remitting multiple sclerosis. Recent studies have shown that IVIG may reduce the frequency of acute exacerbation and the intensity and duration of acute exacerbations.  

Non-drug treatments
Physical therapy and exercise can help preserve remaining function, and patients may find that various aids -- such as foot braces, canes, and walkers -- can help them remain independent and mobile. Avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue.  

WHAT IS THE PROGNOSIS?
Because the course of multiple sclerosis can vary so widely from one individual to another, it is difficult to give an overall prognosis. Most people with MS can expect to live 95% of the normal life expectancy. Many people are able to manage the symptoms of their disease with one or more of the therapies listed above and lead a fulfilling life.

SUPPORT GROUPS?
The National Multiple Sclerosis Society is an excellent resource for both clinical information and support.