Video:Multiple sclerosis

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Definition

Multiple sclerosis (MS) is a demyelinating disease, where the insulating covers, of nerve cells in the brain and spinal cord, are damaged.[1]

Symptoms

This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems.[2][3][4]

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Localized symptoms

Specific symptoms can include double vision, blindness in one eye, muscle weakness, trouble with sensation, or trouble with coordination.[1]

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Types of MS

New symptoms for MS can occur in different forms, as isolated attacks (called relapsing forms), or building up over time (called progressive forms).[5] The disease usually begins between the ages of 20 and 50, and is twice as common in women as in men.[6]

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Remission

Between attacks, symptoms may disappear completely; however, permanent neurological problems often remain, especially as the disease advances.[5]

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Cause

While the cause is not clear, the underlying mechanism is thought to be either destruction by the immune system, or failure of the myelin-producing cells.[7]

Genetics and environment

What initiates the process is uncertain, but it may include genetics, and environmental triggers, such as a viral infection.[3][8]

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Diagnosis

MS is usually diagnosed based on the presenting signs and symptoms, and the results of supporting medical tests.[9] The most commonly used diagnostic tools are neuroimaging, analysis of cerebrospinal fluid, and evoked potentials. Magnetic resonance imaging of the brain and spine, may show areas of demyelination, as lesions or plaques.[10][11][12]

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Treatment

There is no known cure for multiple sclerosis.[1] Treatments attempt to improve function after an attack, and prevent new attacks,[3] although medications used to treat MS, while modestly effective, have side effects and may be poorly tolerated.[1]

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Physical therapy

Physical therapy can help with people's ability to function.[1] Many people pursue alternative treatments, despite a lack of evidence of benefit.[13]

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Outcome

The long-term outcome is difficult to predict, but people with MS live, on average, 5 to 10 years less than those unaffected.[2] Good outcomes are more often seen in women, those who develop the disease early in life, those with a relapsing course, and those who initially experienced few attacks.[14]

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Epidemiology

Multiple sclerosis is the most common immune-mediated disorder affecting the central nervous system.[15]

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Global burden

In 2015, about 2.3 million people were affected globally, with rates varying widely in different regions, and among different populations.[16][17] That year about 18,900 people died from MS, up from 12,000 in 1990.[18][19]

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History

MS was first described in 1868 by Jean-Martin Charcot.[20] The name multiple sclerosis refers to the numerous scars (better known as plaques, or lesions) that develop on the white matter of the brain, and spinal cord.[20] 100px|left

References

  1. 1.0 1.1 1.2 1.3 1.4 "NINDS Multiple Sclerosis Information Page". National Institute of Neurological Disorders and Stroke. 19 November 2015. Archived from the original on 13 February 2016. Retrieved 6 March 2016.
  2. 2.0 2.1 Compston A, Coles A (October 2008). "Multiple sclerosis". Lancet. 372 (9648): 1502–17. doi:10.1016/S0140-6736(08)61620-7. PMID 18970977.
  3. 3.0 3.1 3.2 Compston A, Coles A (April 2002). "Multiple sclerosis". Lancet. 359 (9313): 1221–31. doi:10.1016/S0140-6736(02)08220-X. PMID 11955556.
  4. Murray ED, Buttner EA, Price BH (2012). "Depression and Psychosis in Neurological Practice". In Daroff R, Fenichel G, Jankovic J, Mazziotta J (eds.). Bradley's neurology in clinical practice (6th ed.). Philadelphia, PA: Elsevier/Saunders. ISBN 1-4377-0434-4.
  5. 5.0 5.1 Lublin FD, Reingold SC (April 1996). "Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis". Neurology. 46 (4): 907–11. doi:10.1212/WNL.46.4.907. PMID 8780061.
  6. Milo R, Kahana E (March 2010). "Multiple sclerosis: geoepidemiology, genetics and the environment". Autoimmunity Reviews. 9 (5): A387-94. doi:10.1016/j.autrev.2009.11.010. PMID 19932200.
  7. Nakahara J, Maeda M, Aiso S, Suzuki N (February 2012). "Current concepts in multiple sclerosis: autoimmunity versus oligodendrogliopathy". Clinical Reviews in Allergy & Immunology. 42 (1): 26–34. doi:10.1007/s12016-011-8287-6. PMID 22189514.
  8. Ascherio A, Munger KL (April 2007). "Environmental risk factors for multiple sclerosis. Part I: the role of infection". Annals of Neurology. 61 (4): 288–99. doi:10.1002/ana.21117. PMID 17444504.
  9. Tsang BK, Macdonell R (December 2011). "Multiple sclerosis- diagnosis, management and prognosis". Australian Family Physician. 40 (12): 948–55. PMID 22146321.
  10. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Annals of Neurology. 50 (1): 121–7. doi:10.1002/ana.1032. PMID 11456302.
  11. Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L, Lublin FD, Metz LM, McFarland HF, O'Connor PW, Sandberg-Wollheim M, Thompson AJ, Weinshenker BG, Wolinsky JS (December 2005). "Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria"". Annals of Neurology. 58 (6): 840–6. doi:10.1002/ana.20703. PMID 16283615.
  12. Rashid W, Miller DH (February 2008). "Recent advances in neuroimaging of multiple sclerosis". Seminars in Neurology. 28 (1): 46–55. doi:10.1055/s-2007-1019127. PMID 18256986.
  13. Huntley A (January 2006). "A review of the evidence for efficacy of complementary and alternative medicines in MS". International MS Journal. 13 (1): 5–12, 4. PMID 16420779.
  14. Weinshenker BG (1994). "Natural history of multiple sclerosis". Annals of Neurology. 36 Suppl (Suppl): S6-11. doi:10.1002/ana.410360704. PMID 8017890.
  15. Berer K, Krishnamoorthy G (November 2014). "Microbial view of central nervous system autoimmunity". FEBS Letters. 588 (22): 4207–13. doi:10.1016/j.febslet.2014.04.007. PMID 24746689.
  16. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  17. World Health Organization (2008). Atlas: Multiple Sclerosis Resources in the World 2008 (PDF). Geneva: World Health Organization. pp. 15–16. ISBN 92-4-156375-3. Archived (PDF) from the original on 4 October 2013.
  18. GBD 2015 Mortality and Causes of Death Collaborators (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  19. "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. January 2015. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
  20. 20.0 20.1 Clanet M (June 2008). "Jean-Martin Charcot. 1825 to 1893" (PDF). International MS Journal. 15 (2): 59–61. PMID 18782501.
    * Charcot, J. (1868). "Histologie de la sclerose en plaques". Gazette des hopitaux, Paris. 41: 554–5.