Signs and tests
Symptoms of MS may mimic many other neurologic disorders. Diagnosis is made by ruling out other conditions.A history of at least two attacks separated by a period of reduced or no symptoms may indicate one pattern of attack/remission seen in MS (known as relapsing-remitting pattern). If there are observable decreases in any functions of the central nervous system (such as abnormal reflexes), the diagnosis of MS may be suspected.
Examination by the health care provider may show focal neurologic deficits (localized decreases in function). This may include decreased or abnormal sensation, decreased ability to move a part of the body, speech or vision changes, or other loss of neurologic functions. The type of neurologic deficits usually indicates the location of the damage to the nerves.
Eye examination may show abnormal pupil responses, changes in the visual fields or eye movements, nystagmus (rapid eye movements) triggered by movement of the eye, decreased visual acuity, or abnormal findings on a fundoscopy (an examination of the internal structures of the eye).
Tests that indicate or confirm multiple sclerosis include:
- head MRI scan that shows scarring or a new lesion
- spine MRI scan that shows scarring or a new lesion
- Lumbar puncture (spinal tap)
- CSF oligoclonal banding
- CSF IgG index
There is no known cure for multiple sclerosis at this time. However, there are promising therapies that may slow the disease. The goal of treatment is to control symptoms and maintain a normal quality of life. Types of treatment include:
- Immune modulators. Patients with a relapsing-remitting course of the disease are often placed on an immune modulating therapy. This requires injection under the skin or in the muscle once or several times a week. It may be in the form of interferon (such as Avonex, Betaseron, or Rebif) or another medicine called glatiramer acetate (Copaxone). They are all similar in their effectiveness and the decision on which to use depends on concerns about particular side effects.
- Steroids. Steroids are given to decrease the severity of attacks when they occur. These shut the immune system down to stop cells from causing inflammation.
- Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine may be used to reduce muscle spasticity.
- Cholinergic medications to reduce urinary problems.
- Antidepressants for mood or behavior symptoms.
- Amantadine for fatigue.
- Physical therapy, speech therapy, occupational therapy, and support groups can help improve the person's outlook, reduce depression, maximize function, and improve coping skills.
- Exercise. A planned exercise program early in the course of the disorder can help maintain muscle tone.
Support Groups
For additional information, see multiple sclerosis resources.Expectations (prognosis)
The outcome is variable and unpredictable. Although the disorder is chronic and incurable, life expectancy can be normal or nearly so. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.The factors felt to best predict a relatively benign course are female gender, young age at onset (less than 30 years), infrequent attacks, a relapsing-remitting pattern, and low burden of disease on imaging studies.
The amount of disability and discomfort varies with the severity and frequency of attacks and the part of the central nervous system affected by each attack. Commonly, there is initially a return to normal or near-normal function between attacks. As the disorder progresses, there is progressive loss of function with less improvement between attacks.
Complications
- urinary tract infections
- side effects of medications used to treat the disorder
(published with permission in writing from:http://medlineplus.gov)
