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October 16, 2008 By:
Todd H. Goldberg, M.D.
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Multiple sclerosis. The very name strikes fear into the heart of many, as this can be an incapacitating, painful and fatal neurological disease. However, there is much new research and many new treatments giving new hope to MS sufferers and their loved ones.

Though MS is not usually specifically a disease of the elderly, I have had a number of disabled patients with MS in nursing homes, and have several young and middle-aged friends with this serious disease, to whom this article is dedicated.

The affliction is a usually progressive neurological condition in which the myelin linings of nerve cells deteriorate and scar, leading to malfunctioning of various parts of the brain, spinal cord and nerves.

Although not completely understood, it appears that MS is an immune disease. Unlike AIDS, in which the immune system is underactive, in MS the immune system is overactive, attacking the body's own nerve cells.

According to the latest research theories, an unknown environmental trigger, possibly a virus, provokes the immune system to inappropriately attack and damage the nervous system.

A certain percentage of MS patients show abnormally high levels of antibodies against Epstein-Barr virus, which has been linked to several different diseases. Most drugs approved to fight MS work on the immune system.

The disease can attack anyone of any age, but most typically attacks adults in the prime of life, which is particularly unfortunate.

The typical age of onset is 15 to 55, although sometimes we see it in older people. It also occurs, for some reason, more often in women than men (about twice as often), and is more common in Caucasians and those of higher socioeconomic status, unlike a lot of other diseases that disproportionately affect the poor as well as minorities.

The symptoms usually begin with fluctuating neurological signs, such as numbness, weakness, pain, tiredness and blurred vision. These sometimes go away for a while, but usually come back and progress over time.

MRIs will also show multiple scars and abnormalities within the central nervous system (brain and spinal cord).

Other tests, such as "evoked potentials" and cerebrospinal fluid analysis, can also help diagnose the condition more specifically.

A Progressive Disease
Unfortunately, the disease is usually a progressive, incurable condition, but can often develop slowly over a long period of time. Statistics are that more than two-thirds of people diagnosed with MS are still able to walk for 20 years, but 50 percent of those people require a cane by 15 years after the diagnosis. Sixty percent get better for a while but then relapse.

There are several types of categories of MS, including fluctuating or relapsing-remitting disease (which is most common; 80 percent of cases start out this way), progressive and relapsing forms.

Most patients fluctuate unpredictably, but generally get worse over time with more weakness, discomfort and disability. In itself, MS is not usually fatal, unless it gets to such a severe point where the person is unable to eat or move, in which case they can develop complications, such as pneumonia.

I, unfortunately, have seen a number of MS patients so disabled that they had to live in a nursing home for 24-hour care, even at a relatively young age.

Although there is still no cure for MS, there are several new drugs that are approved for helping patients. Various forms of interferon beta (Betaseron, Avonex, Copaxone, Rebif) are injections which help symptoms somewhat. Other biological therapies -- steroids, chemotherapy and even bone marrow transplants -- are tried in difficult cases.

In addition, the physician has to deal with patients' psychological needs and support. Depression and fatigue are often co-existing problems.

Physical therapy and injections may help pain, weakness and spasticity. Bowel, bladder and speech problems also are significant.

Finding good specialists who can help with all these issues may help the patient survive and function as long and well as possible.

Finally, as with most diseases these days, there are many resources, reference sites and sources of support.

Particularly recommended is the National MS Society (www. nationalmssociety.org), which has local branches in most cities, including Philadelphia.

Todd H. Goldberg, M.D., CMD, FACP, is associate professor/director of geriatrics in the department of internal medicine at West Virginia University Health Sciences Center, Charleston Division.

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