Introduction
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system, which affects both the spinal cord and the brain. MS affects myelin sheaths of the nerves, thus preventing transmissions of nerve impulses in the body.
Myelin sheaths insulate nerves cells in the body, which have a pivotal role of transmitting action potentials from one nerve cell to another. According to Minagar, Jimenez, and Alexander, MS is the leading cause of neurological disability among young people (230). Although MS is a dominant neurological condition among the young people, the disease is still incurable.
However, management interventions are available to alleviate the impact of the condition and help patients to live a normal life. Since the cause of MS is still unknown, most researchers consider it an autoimmune disorder. Therefore, this research paper examines causes, prevalence, types of MS, diagnostic techniques, and management of interventions with a view of enhancing understanding of MS.
Causes
Since the specific causes of MS are still unknown, many researchers have attributed the condition to a complex interaction of genetic, immunological, microbial, and environmental factors.
In the aspect of genetic factors, many cases of MS are attributed to the genetic makeup of an individual. Individuals with certain genetic makeup are prone to MS when compared to the general population. A study done on the United States’ veterans indicates that prevalence rates of MS are higher among the white veterans than in back veterans (Ramagopalan and Sadovnick 207).
Moreover, epidemiology studies have shown that family members with a patient with MS are susceptible to the disorder. Siblings of the patient are about 30 times more susceptible to MS than the general population. Additionally, variation in the major human histocompatibility system is one of the susceptible causes of MS. Therefore, there is enough evidence to believe that genetic factors predispose individuals to MS.
Immunological factors are also responsible for the occurrence of the MS in the population. When antigens enter the human body, they trigger immune responses, which can be unfavorable resulting into autoimmune reactions. Minagar, Jimenez, and Alexander argue that MS is an immune-mediated disorder where astrocytes, activated inflammatory cells, and oligodendrocytes are responsible for the pathogenesis of the MS (230).
Some of the immunological factors and antibodies may fail to recognize myelin sheaths of the nerves as own tissues, thus begin to attack them. The attack of myelin sheaths results into demyelination of nerves, which consequently impairs transmission of nerve impulses in the body.
Microbial factors are also responsible for the occurrence of MS in a given population. According to Tsang and Macdonell, an individual exposed to Epstein-Barr virus has a high chance of developing MS than an individual who has not experienced any infection of the virus before (948).
Epstein-Barr virus stimulates high titer of antibodies that cause autoimmune disorders. People without Epstein-Barr virus infection have low titers of antibodies specific to the virus, hence less prone to autoimmune disorders. Infections by other microbes also stimulate unfavorable immune responses that cause autoimmune disorders. The autoimmune disorders eventually cause demyelination of the nerves in the body leading to the development of MS.
Other evidence indicates that environmental factors such as sunlight determine susceptibility to MS. Ramagopalan and Sadovnick assert that the extent of sunlight exposure correlates negatively with susceptibility of an individual to MS (212). This aspect explains why people living in high latitude regions are more susceptible to MS than people who live in equatorial regions.
Moreover, it explains why people who take seafood or vitamin D supplements are less prone to MS. In this case, insufficient vitamin D and low amount of sunlight predispose people to MS. Other studies have shown that smoking is an environmental factor that contributes to the occurrence of MS.
Prevalence
Prevalence of MS across the word is about 2 per cent, but it varies from one country to another depending on the presence of predisposing factors. The distribution of MS among populations is random and skewed towards women. Women are three times prone to the MS than men are. According to Racke, Anne, Muir, Diab, Drew, and Lovett-Racke, in the United States, about 350,000 people suffer from MS (700).
Projections show that there is an annual increase of MS cases by 10,000, meaning that prevalence rates are increasing gradually. Additionally, most people who experience MS are young adults belonging to the ages of 15 to 50. Hence, in the United States, MS leads in causing neurologic disability among young people. Therefore, the prevalence rates indicate that MS is a disorder that contributes significantly to the number of young people with disabilities.
In Australia, prevalence rates of MS are lower than in the United States due to the difference in latitude and predisposing factors. According to Tsang and Macdonell, in Australia, 13,000 people suffer from MS, out of which women constitute 73 per cent of the MS cases (948).
The distribution of the 13,000 cases of MS varies from one place to another depending on latitude. Since sunlight influences the level of vitamin D in the body, people who live at high latitudes are likely to develop MS than those who live at lower latitudes. Thus, this aspect explains why prevalence rates of MS vary from “10 cases per 100,000 people in Tasmania to 4 cases per 100,000 people in northern parts of Australia” (Tsang and Macdonell 950).
Types of Multiple Sclerosis
There are different types of MS depending on the stage of inflammation. When MS develops, it starts as a relapsing-remitting form. According to Tsang and Macdonell, relapses and remissions characterize initial phases of the MS in an individual (949).
The relapsing-remitting form of MS occurs in about 80 per cent of patients and is unique because it has intermittent flare-ups of symptoms. Intermittent flare-ups of symptoms happen in a period of one to three months after which an individual experiences partial or complete recovery.
A period of remissions can be years and the patient may not feel any symptoms of MS. If a patient with relapsing-remitting form of MS does not receive appropriate treatment, the condition progresses to secondary-progressive form (SPMS). Approximately, 90 per cent of patients with relapsing-remitting form of MS progress to SPMS, which is the second phase of MS that occurs within a period of 25 years.
Primary progressive MS is a severe form of MS as it affects the brain and spinal cord; moreover, it is not responsive to any form of treatment (Tsang and Macdonell 949). It is exceptionally difficult to treat and manage the primary progress MS because it has complex effects on the central nervous system.
Therefore, early diagnosis of the MS is crucial in preventing it from progressing into chronic MS, which is difficult to treat or manage. Other types of MS are benign and malignant MS. Benign MS has little impact on an individual because it does not result into neurological disability. In contrast, malignant MS is extremely complex as it results into neurological disability.
Diagnosis
There are two common methods applicable in the diagnosis of MS, viz. Magnetic Resonance Imaging (MRI) and Cerebrospinal Fluid (CSF). Concerning MRI, the diagnosis involves the use of a computer, electromagnetic device, and radio frequency stimulator. Diagnosis using MRI involves the process of scanning the brain to detect the abnormalities in it.
To diagnose patients suffering from MS, the MRI scan shows the size and position of plagues and lesions in the brain. Presence of lesions in the brain shows that a patient is suffering from MS due to demyelination of nerves in the brain. Thus, MRI scanning provides the status of myelin sheaths in the brain.
The use of cerebrospinal fluid is another diagnostic technique. The method is appropriate in determining disease activity as well as providing the extent of the disease in the spinal cord. The diagnostic technique involves the use of cerebrospinal fluid in detecting the level and type of antibodies.
A patient with MS usually has abnormal levels of antibodies, which shows that there is an infection of the central nervous system or autoimmune activity (Tsang and Macdonell 949). Analysis of cerebrospinal fluid is accurate because it can detect the presence of microbes and antibodies, which MRI cannot detect.
Symptoms
Autonomic dysfunction is one of the symptoms of MS. It occurs due to a range of disorders that affect autonomic nervous system (ANS). Tsang and Macdonell note, “Availability of lesions within the brainstem, the spinal cord, and the hypothalamus are the characteristics of this disorder” (954). Patients with MS also have impaired thermoregulation because thermo-receptors are not sensitive in this condition.
Hence, impaired thermoregulation leads to fluctuation in the body temperatures depending on the surrounding environment. A patient with impaired thermoregulation easily responds to changes in the internal and external environments. Thus, caregivers of patients with impaired thermoregulation must identify environmental conditions that increase or decrease body temperatures and manage them appropriately according to the demands of the patient.
Other renowned symptoms of MS are cardiovascular dysfunction, sleep dysfunction, and bladder dysfunction. Cardiovascular dysfunction is a symptom of MS characterized mainly by reduction in the rate of heartbeat and low blood pressure. Characteristics of this symptom include dizziness, hypertension, and headache.
Management of the situation requires routine assessment of patient’s blood pressure and heartbeat rate in response to physical exercise. Sleep dysfunction, on the other hand, is a symptom of MS that causes breathing difficulties, leg muscle spasms, restless leg syndrome, body pains, as well as generating feelings of anxiety and depression (Ramagopalan and Sadovnick 211).
In this case, management intervention is for the patient to seek medical attention from MS nurses or attend sleep clinics to receive appropriate assistance. Bladder dysfunction is also another symptom of MS that renders the patient unable to control bladder function. Proper management of the bladder dysfunction requires use of anti-cholinergic drugs and intermittent catheterization.
Management Interventions
Since there is no feasible treatment for MS, different management interventions have proven significant in dealing with the condition. The main objective of using management interventions is to prevent the disorder from progressing into chronic phase where it causes permanent disability. Chemotherapy is a management intervention that is applicable in alleviating acute relapses of MS.
Acute relapses are symptomatic attacks of MS characterized by tremor, spasticity, depression, pain, anxiety, and fatigue. According to Tsang and Macdonell, intravenous administration of methylprednisolone is an effective chemotherapy that helps the patient to recover quickly and prevent subsequent relapses (951). Although the treatment is effective, it has short-term impact on recovery from relapses.
Chemotherapy is also significant in patients with clinically isolated syndrome. In this context, disease-modifying treatments vary from one country to another depending on the regulatory agencies in different countries. The treatment comes in two phases of treatment, which are effective but have some complications. Interferon and Natalizumab are applicable in the first and the second phases of treatment respectively.
Conclusion
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system, which affects both the spinal cord and the brain. The disorder is common in young adults and is responsible for neurological disability. Despite its impact on humans, researchers have not established the true causes of MS, but they link the condition to many causative factors. Genetic, immunological, microbial, and environmental factors are some of the factors that predispose people to MS.
These factors act in concert and cumulatively increase predisposition to MS. Since MS is incurable, management interventions such as chemotherapy, psychotherapy, and physiotherapy have proved as effective methods in alleviating the impact of MS on individuals. Effective treatment of MS requires early diagnosis using Magnetic Resonance Imaging and analysis of cerebral spinal fluid. Therefore, patients who experience symptoms of MS should seek early medical treatment before the condition becomes incurable or chronic.
Annotated Bibliography
Minagar, Alireza, Wenche Jimenez, and Steven Alexander. “Multiple sclerosis as a vascular disease.” Neurological Research 28.6 (2006): 230-235. Print.
The article postulates that occurrence of MS could be due to abnormalities in vascular system. It proposes that MS is a vascular disease that occurs because central nervous system connects with vascular components. Hence, the authors argue that endothelia pathophysiology affects blood-brain barrier and allow migration of activated leukocytes into the brain and spinal cord.
Racke, Michael, Gocke Anne, Mark Muir, Asim Diab, Paul Drew, and Amy Lovett – Racke. “Nuclear receptors and autoimmune disease: The potential of PPAR agonists to treat multiple Sclerosis.” The Journal of Nutrition 136.1 (2006): 700-703. Print.
The authors is article of argue that MS is an autoimmune disease and thus requires interventions that prevent autoimmunity. They assert that T-cells mediate inflammation and demyelination of nerves in central nervous system. Therefore, the article seeks to suggest that agonists of proliferated-activated receptors have potential of treating MS.
Ramagopalan, Sreem, and Dessa Sadovnick. “Epidemiology of Multiple Sclerosis.” Neurologic Clinics 29.5 (2011): 207-217. Print.
The article focuses on the epidemiology of MS. It mainly examines factors that are responsible for the occurrence of MS. Since there are many factors that predispose people to MS, the authors argue that MS is a product of complex interactions of many factors rather than having one causative agent. Hence, the article suggests that proper understanding of MS is necessary.
Tsang, Benjamin, and Richard Macdonell. “Multiple sclerosis: diagnosis, management and prognosis.” Australian Family Physician 40.12 (2011): 948-955. Print.
The article examines causes, diagnosis, management and prognosis MS with view of summarizing it. To enhance understanding of MS, the article begins by stating factors that cause or predispose an individual to MS. The article then examines different phases of MS and outlines different management strategies. Eventually, the article proposes that first and second lines of treatment are essential in the management of MS.