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Encyclopedia > Multiple sclerosis
Multiple sclerosis
Classification and external resources
MRI FLAIR sequence showing four bright spots (plaques) where multiple sclerosis has damaged myelin in the brain
ICD-10 G35.
ICD-9 340
OMIM 126200
DiseasesDB 8412
MedlinePlus 000737
eMedicine neuro/228  oph/179 emerg/321 pmr/82 radio/461
MeSH D009103

Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminata) is an autoimmune condition in which the immune system attacks the central nervous system (CNS), leading to demyelination. It may cause numerous physical and mental symptoms, and often progresses to physical and cognitive disability. Disease onset usually occurs in young adults, is more common in women, and has a prevalence that ranges between 2 and 150 per 100,000 depending on the country or specific population.[1] MS was first described in 1868 by Jean-Martin Charcot. Image File history File links MRI_of_Multiple_sclerosis. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... A diagram showing the CNS: 1. ... A demyelinating disease is any disease of the nervous system in which the myelin sheath of neurons is damaged. ... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ... Categories: People stubs | French physicians | 1825 births | 1893 deaths | History of medicine ...


MS affects the areas of the brain and spinal cord known as the white matter. White matter cells carry signals between the grey matter areas, where the processing is done, and the rest of the body. More specifically, MS destroys oligodendrocytes which are the cells responsible for creating and maintaining a fatty layer, known as the myelin sheath, which helps the neurons carry electrical signals. MS results in a thinning or complete loss of myelin and, less frequently, the cutting (transection) of the neuron's extensions or axons. When the myelin is lost, the neurons can no longer effectively conduct their electrical signals. The name multiple sclerosis refers to the scars (scleroses - better known as plaques or lesions) in the white matter. Loss of myelin in these lesions causes some of the symptoms, which vary widely depending upon which signals are interrupted. However, more advanced forms of imaging are now showing that much of the damage happens outside these regions. Almost any neurological symptom can accompany the disease. Human brain In animals, the brain (enkephale) (Greek for in the skull), is the control center of the central nervous system, responsible for behavior. ... The Spinal cord nested in the vertebral column. ... White matter is one of the two main solid components of the central nervous system. ... Gray matter redirects here. ... Oligodendrocytes (from Greek literally meaning few tree cells), or oligodendroglia (Greek, few tree glue),[1] are a variety of neuroglia. ... Myelin is an electrically insulating phospholipid layer that surrounds the axons of many neurons. ... Electricity (from New Latin Ä“lectricus, amberlike) is a general term for a variety of phenomena resulting from the presence and flow of electric charge. ... It has been suggested that this article or section be merged with Electrophysiology. ... An axon, or nerve fiber, is a long slender projection of a nerve cell, or neuron, which conducts electrical impulses away from the neurons cell body or soma. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ...


MS takes several forms, with new symptoms occurring either in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms). Most people are first diagnosed with relapsing-remitting MS but develop secondary-progressive MS (SPMS) after a number of years. Between attacks, symptoms may go away completely, but permanent neurological problems often persist, especially as the disease advances.


Although much is known about the mechanisms involved in the disease process, the cause remains elusive: the most widely-held being that the condition results from attacks to the nervous system by the body's own immune system. Some believe it is a metabolically dependent disease while others think that it might be caused by a virus such as Epstein-Barr. Still others believe that its virtual absence from the tropics points to a deficiency of vitamin D during childhood.[2] The nervous system is a highly specialized network whose principal components are nerves called neurons. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... The Epstein-Barr virus (EBV), also called Human herpesvirus 4 (HHV-4), is a virus of the herpes family (which includes Herpes simplex virus and Cytomegalovirus), and is one of the most common viruses in humans. ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ...


This disease does not have a cure, but several therapies have proven helpful. Treatments attempt to return function after an attack, prevent new attacks, and prevent disability. MS medications can have adverse effects or be poorly tolerated, and many patients pursue alternative treatments, despite the paucity of supporting scientific study. Many candidate therapies are still under investigation.


The prognosis, or expected course of the disease, depends on the subtype of the disease, the individual patient's disease characteristics, the initial symptoms, and the degree of disability the person experiences as time advances. Life expectancy of patients, however, is nearly the same as that of the unaffected population, and in some cases a near-normal life is possible. Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... This article is about the measure of remaining life. ...

Contents

Signs and symptoms

MS presents with a variety of symptoms, including changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia), fatigue and acute or chronic pain syndromes, and bladder and bowel difficulties. Cognitive impairment of varying degrees, or emotional symptomatology in the form of depression or pseudobulbar affect[3] are also common. Neuropathic pain is usual, and this can be in the form of Lhermitte's sign. Neuropathic pain is the most common, distressing and intractable of the pain syndromes in MS. This pain is described as constant, boring, burning or tingling intensely. It usually occurs in the legs. Paraesthesias include pins and needles; tingling; shivering; burning pains; feelings of pressure; and areas of skin with heightened sensitivity to touch. The pains associated with these can be aching, throbbing, stabbing, shooting, gnawing, tingling, tightness and numbness.[4] The main clinical measure of disability progression and severity of the symptoms is the Expanded Disability Status Scale or EDSS.[5] Multiple sclerosis can cause a variety of symptoms, including changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty to move; difficulties with coordination and balance; problems in speech (Dysarthria) or swallowing (Dysphagia), visual problems (Nystagmus, optic neuritis, or diplopia), fatigue and acute or chronic pain syndromes, bladder and... Hypoesthesia refers to a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli. ... For other uses, see Ataxia (disambiguation). ... Look up dysarthria in Wiktionary, the free dictionary. ... Dysphagia () is a medical term defined as difficulty swallowing. ... Nystagmus is involuntary eye movement that can be part of the vestibulo-ocular reflex (VOR), with the eyes moving first in the direction of the lesioned side (slow phase) followed by a quick correction (fast phase) to the opposite side or away from the lesioned side. ... Optic neuritis, sometimes called retrobulbar neuritis, is the inflammation of the optic nerve that may cause a complete or partial loss of vision. ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... Exhaustion redirects here. ... Pain is both a sensory and emotional experience, generally associated tissue damage, or inflammation. ... Chronic pain was originally defined as pain that has lasted 6 months or longer. ... This article is about the urinary bladder. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... Cognitive The scientific study of how people obtain, retrieve, store and manipulate information. ... On the Threshold of Eternity. ... Labile affect or Pseudobulbar affect refers to the pathological expression of laughter, crying, or smiling. ... Lhermittes Sign is a sign used to help diagnose Multiple Sclerosis and is indicated by electric-like sensations caused by flexing ones neck. ... The Kurtzke Expanded Disability Status Scale (EDSS) is a method of quantifying disability in multiple sclerosis. ...


The initial attacks (also known as exacerbations or relapses) are often transient, mild (or asymptomatic), and self-limited. They often do not prompt a health care visit and sometimes are only identified in retrospect once the diagnosis has been made based on further attacks. The most common initial symptoms reported are: changes in sensation in the arms, legs or face (33%), complete or partial vision loss (optic neuritis) (16%), weakness (13%), double vision (7%), unsteadiness when walking (5%), and balance problems (3%); but many rare initial symptoms have been reported such as aphasia or psychosis.[6][7] Fifteen percent of individuals have multiple symptoms when they first seek medical attention.[8] Optic neuritis or focal leg weakness may lead to falls and other serious accidents[9]. For some people the initial MS attack is preceded by infection, trauma, or strenuous physical effort. It has been suggested that this article or section be merged with Sensation and perception psychology. ... Optic neuritis, sometimes called retrobulbar neuritis, is the inflammation of the optic nerve that may cause a complete or partial loss of vision. ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... For other uses, see Aphasia (disambiguation). ... For other uses, see Psychosis (disambiguation). ... Optic neuritis, sometimes called retrobulbar neuritis, is the inflammation of the optic nerve that may cause a complete or partial loss of vision. ... An infection is the detrimental colonization of a host organism by a foreign species. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ...


Diagnosis

T1-weighted MRI scans (post-contrast) of same brain slice at monthly intervals. Bright spots indicate active lesions.

Multiple sclerosis is difficult to diagnose in its early stages. In fact, a definite diagnosis cannot be made until other disease processes (differential diagnoses) have been ruled out and, in the case of relapsing-remitting MS, there is evidence of at least two anatomically separate demyelinating events separated by at least thirty days. In the case of primary progressive, a slow progression of signs and symptoms over at least 6 months is required. Image File history File links Size of this preview: 543 × 437 pixelsFull resolution (543 × 437 pixel, file size: 185 KB, MIME type: image/gif) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Multiple sclerosis ... Image File history File links Size of this preview: 543 × 437 pixelsFull resolution (543 × 437 pixel, file size: 185 KB, MIME type: image/gif) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Multiple sclerosis ... MRI redirects here. ... Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ... Human heart and lungs, from an older edition of Grays Anatomy. ...


Historically, different criteria were used and the Schumacher and Poser criteria were both popular. Currently, the McDonald criteria represent international efforts to standardize the diagnosis of MS using clinical, laboratory and radiologic data.[10] The McDonald criteria are diagnostic criteria for multiple sclerosis. ...

  • Clinical data alone may be sufficient for a diagnosis of MS. If an individual has suffered two separate episodes of neurologic symptoms characteristic of MS, and the individual also has consistent abnormalities on physical examination, a diagnosis of MS can be made with no further testing. Since some people with MS seek medical attention after only one attack, other testing may hasten the diagnosis and allow earlier initiation of therapy.
  • Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of the brain and spine is often used during the diagnostic process. MRI shows areas of demyelination (lesions) as bright spots on the image. A substance, called Gadolinium, can be administered intravenously to highlight active plaques and, by elimination, demonstrate the existence of historical lesions not associated with clinical symptoms. This can provide the evidence of chronic disease needed for a definitive diagnosis of MS.
  • Testing of cerebrospinal fluid (CSF) can provide evidence of chronic inflammation of the central nervous system. The CSF is tested for oligoclonal bands, which are immunoglobulins found in 75% to 85% of people with definite MS (but also found in people with other diseases).[11] Combined with MRI and clinical data, the presence of oligoclonal bands can help make a definite diagnosis of MS. Lumbar puncture is the procedure used to collect a sample of CSF.
  • The brain of a person with MS often responds less actively to stimulation of the optic nerve and sensory nerves. These brain responses can be examined using visual evoked potentials (VEPs) and somatosensory evoked potentials (SEPs). Decreased activity on either test can reveal demyelination which may be otherwise asymptomatic. Along with other data, these exams can help find the widespread nerve involvement required for a definite diagnosis of MS.[12]

Another test, which may become important in the future, is measurement of antibodies against myelin proteins such as myelin oligodendrocyte glycoprotein (MOG) and myelin basic protein (MBP). As of 2007, however, there is no established role for these tests in diagnosing MS. Optical coherence tomography of the eye's retina is also under study,[13] mainly as a tool to measure response to medication and axonal degeneration.[14] In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... MRI redirects here. ... In vivo (that is in the living organism) magnetic resonance spectroscopy is a specialised technique associated with magnetic resonance imaging (MRI). ... Skin lesions caused by Chickenpox A lesion is any abnormal tissue found on or in an organism, usually damaged by disease or trauma. ... General Name, Symbol, Number gadolinium, Gd, 64 Chemical series lanthanides Group, Period, Block n/a, 6, f Appearance silvery white Standard atomic weight 157. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Oligoclonal bands are about two to five bands of immunoglobulins on protein electrophoresis of cerebrospinal fluid (CSF) or blood plasma. ... Schematic of antibody binding to an antigen An antibody is a protein complex used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ... A patient undergoes a lumbar puncture at the hands of a neurologist. ... This article is about the anatomical structure. ... The mechanism of the reflex arc Sensory neurons (neurones) are nerve cells within the nervous system responsible for converting external stimuli from the organisms environment into internal electrical motor reflex loops and several forms of involuntary behavior, including pain avoidance. ... A visual evoked potential (VEP) is an evoked potential caused by sensory stimulation of a subjects visual field. ... Evoked potentials, also known as evoked responses, are electrical signals elicited by stimulation of sensory organs or nervous tissue, as opposed to spontaneous potentials such as EEG or EMG. Due to their low amplitude, evoked potentials usually require signal averaging to improve the signal-to-noise ratio. ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... A representation of the 3D structure of myoglobin showing coloured alpha helices. ... Myelin Oligodendrocyte Glycoprotein (MOG) is a glycoprotein believed to be important in the process of myelinization of nerves in the central nervous system (CNS). ... Myelin basic protein (MBP) is a protein believed to be important in the process of myelination of nerves in the central nervous system (CNS). ... Optical coherence tomography tomogram of a fingertip. ... For other uses, see Eye (disambiguation). ... Human eye cross-sectional view. ...


The signs and symptoms of MS can be similar to other medical problems, such as neuromyelitis optica, stroke, brain inflammation, infections such as Lyme disease (which can produce identical MRI lesions and CSF abnormalities[15][16][17][18]), tumors, and other autoimmune problems, such as lupus. Additional testing may be needed to help distinguish MS from these other problems. Devics disease, also known as Devics syndrome, neuromyelitis optica (NMO), or optic-spinal MS, is an autoimmune, inflammatory disorder in which a persons own immune system attacks myelin of the neurons of the optic nerves and spinal cord. ... For other uses, see Stroke (disambiguation). ... Acute disseminated encephalomyelitis (ADEM) is an immune mediated disease of brain. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Lyme disease, or borreliosis, is an emerging infectious disease caused by bacteria from the genus Borrelia. ... For malignant tumors specifically, see cancer. ... Systemic Lupus Erythematosus (SLE or lupus) is a chronic autoimmune disease that can be fatal, though with recent medical advances, fatalities are becoming increasingly rare. ...


Disease course and clinical subtypes

Graph representing the different types of multiple sclerosis

The course of MS is difficult to predict, and the disease may at times either lie dormant or progress steadily. Several subtypes, or patterns of progression, have been described. Subtypes use the past course of the disease in an attempt to predict the future course. Subtypes are important not only for prognosis but also for therapeutic decisions. In 1996 the United States National Multiple Sclerosis Society standardized the following four subtype definitions:[19] Image File history File linksMetadata Size of this preview: 408 × 348 pixelsFull resolution (408 × 348 pixel, file size: 67 KB, MIME type: image/jpeg)I modified this free license picture Public domain Public domain - I, the creator of this work, hereby release it into the public domain. ... Image File history File linksMetadata Size of this preview: 408 × 348 pixelsFull resolution (408 × 348 pixel, file size: 67 KB, MIME type: image/jpeg)I modified this free license picture Public domain Public domain - I, the creator of this work, hereby release it into the public domain. ... Prediction of future events is an ancient human wish. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... The National Multiple Sclerosis Society, a United States-based non-profit organization, and its network of chapters nationwide promote research, educate, advocate on issues relating to multiple sclerosis, and organize a wide range of programs, including support for the newly diagnosed and those living with MS. External Link The National...

Relapsing-remitting
Relapsing-remitting describes the initial course of 85% to 90% of individuals with MS. This subtype is characterized by unpredictable attacks (relapses) followed by periods of months to years of relative quiet (remission) with no new signs of disease activity. Deficits suffered during the attacks may either resolve or may be permanent. When deficits always resolve between attacks, this is referred to as "benign" MS.
Secondary progressive
Secondary progressive describes around 80% of those with initial relapsing-remitting MS, who then begin to have neurologic decline between their acute attacks without any definite periods of remission. This decline may include new neurologic symptoms, worsening cognitive function, or other deficits. Secondary progressive is the most common type of MS and causes the greatest amount of disability.
Primary progressive
Primary progressive describes the approximately 10% of individuals who never have remission after their initial MS symptoms. Decline occurs continuously without clear attacks. The primary progressive subtype tends to affect people who are older at disease onset.
Progressive relapsing
Progressive relapsing describes those individuals who, from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes

Nevertheless the earliest clinical presentation of relapsing-remitting MS (RRMS) is the clinically isolated syndrome (CIS). In CIS, there is a subacute attack suggestive of demyelination but the person does not fullfill the criteria for multiple sclerosis.[20] Several studies have shown that starting treatment with interferons during the initial attack can decrease the chance that a patient will develop clinical MS.[21][22][23] Suspected cases of MS before the CIS are sometimes referred to as possible Preclinical MS cases.[24] A relapse (etymologically, who falls again) occurs when a person is affected again by a condition that affected them in the past. ... Remission is the state of absence of disease activity in patients with known chronic illness. ... Look up Benign in Wiktionary, the free dictionary. ... Neurocognitive is a term used to describe cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain. ... Look up disability in Wiktionary, the free dictionary. ... In neuroscience, myelin is an electrically insulating fatty layer that surrounds the axons of many neurons, especially those in the peripheral nervous system. ... The McDonald criteria are diagnostic criteria for multiple sclerosis. ... Interferons (IFNs) are natural proteins produced by the cells of the immune system of most vertebrates in response to challenges by foreign agents such as viruses, bacteria, parasites and tumor cells. ...


Special cases of the disease with non-standard behavior have also been described although many researchers believe they are different diseases. These cases are sometimes referred to as borderline forms of multiple sclerosis and are Neuromyelitis optica (NMO), Balo concentric sclerosis, Schilder's diffuse sclerosis and Marburg multiple sclerosis.[25] This article or section is in need of attention from an expert on the subject. ... Devics disease, also known as Devics syndrome, neuromyelitis optica (NMO), or optic-spinal MS, is an autoimmune, inflammatory disorder in which a persons own immune system attacks myelin of the neurons of the optic nerves and spinal cord. ... Balo concentric sclerosis is one of the borderline foms of multiple sclerosis. ... Schilder disease or diffuse myelinoclastic sclerosis is a a very infrequent neurodegenerative disease that presents clinically as pseudotumoural demyelinating lesions, what difficults its diagnosis. ... Marburg multiple sclerosis, also known as malignant, acute or fulminant multiple sclerosis, is one of the multiple sclerosis borderline diseases, which is a collection of diseases clasified by some as MS and by others as different diseases. ...


Factors triggering a relapse

Multiple sclerosis relapses are often unpredictable and can occur without warning with no obvious inciting factors. Some attacks, however, are preceded by common triggers. In general, relapses occur more frequently during spring and summer than during autumn and winter. Infections, such as the common cold, influenza, and gastroenteritis, increase the risk for a relapse.[26] Emotional and physical stress may also trigger an attack,[27][28][29] as can severe illness of any kind. Statistically, there is no good evidence that either trauma or surgery trigger relapses.[30] People with MS can participate in sports, but they should probably avoid extremely strenuous exertion, such as marathon running. Heat can transiently increase symptoms, which is known as Uhthoff's phenomenon. This is why some people with MS avoid saunas or even hot showers. However, heat is not an established trigger of relapses.[31] Acute viral nasopharyngitis, or acute coryza, usually known as the common cold, is a highly contagious, viral infectious disease of the upper respiratory system, primarily caused by picornaviruses or coronaviruses. ... Flu redirects here. ... See also Bacterial gastroenteritis and Diarrhea Gastroenteritis is a general term referring to inflammation or infection of the gastrointestinal tract, primarily the stomach and intestines. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... “Surgeon” redirects here. ... Modern day marathon runners The word marathon refers to a long-distance road running event of 42. ... Uhthoffs phenomenon is the worsening of neurologic symptoms in multiple sclerosis after periods of exercise and increased body heat. ... For the music festival in Finland, see Sauna Open Air Metal Festival. ...


Pregnancy can directly affect the susceptibility for relapse. The last three months of pregnancy offer a natural protection against relapses. However, during the first few months after delivery, the risk for a relapse is increased 20%–40%. Pregnancy does not seem to influence long-term disability. Children born to mothers with MS are not at increased risk for birth defects or other problems.[32] This article is about human pregnancy in biological females. ... A congenital disorder is any medical condition that is present at birth. ...


Many potential triggers have been examined and found not to influence relapse rates in MS. Influenza vaccination is safe, does not trigger relapses, and can therefore be recommended for people with MS. There is also no evidence that vaccines for hepatitis B, varicella, tetanus, or Bacille Calmette-Guerin (BCG—immunization for tuberculosis) increases the risk for relapse.[33] A vial of the vaccine against influenza. ... This article does not cite any references or sources. ... “HBV” redirects here. ... Varicella is a Latin name for chickenpox. ... Tetanus is a medical condition that is characterized by a prolonged contraction of skeletal muscle fibers. ... Bacillus of Calmette and Guérin (BCG) is a vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis that has lost its virulence in humans by specially culturing in artificial medium for years. ... Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ...


Pathophysiology

Demyelinization in MS. On Klüver-Barrera myelin staining, decoloration in the area of the lesion can be appreciated (Original scale 1:100).
Demyelinization in MS. On Klüver-Barrera myelin staining, decoloration in the area of the lesion can be appreciated (Original scale 1:100).
Demyelinization in MS. Immunohistochemstry for CD68 demonstrates Macrophages (brown) in the area of the lesion(Original scale 1:100).
Demyelinization in MS. Immunohistochemstry for CD68 demonstrates Macrophages (brown) in the area of the lesion(Original scale 1:100).

Although much is known about how multiple sclerosis causes damage, the reasons why multiple sclerosis occurs are not known. Multiple sclerosis is a disease in which the myelin (a fatty substance which covers the axons of nerve cells, important for proper nerve conduction) degenerates. ... CD68 is a glycoprotein which binds to low density lipoprotein. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, from makros large + phagein eat) are cells within the tissues that originate from specific white blood cells called monocytes. ...


Multiple sclerosis is a disease in which the myelin (a fatty substance which covers the axons of nerve cells) degenerates. According to the view of most researchers, a special subset of lymphocytes, called T cells, plays a key role in the development of MS. Myelin is an electrically insulating phospholipid layer that surrounds the axons of many neurons. ... Some common lipids. ... An axon or nerve fiber, is a long, slender projection of a nerve cell, or neuron, that conducts electrical impulses away from the neurons cell body or soma. ... This article is about cells in the nervous system. ... A scanning electron microscope (SEM) image of a single human lymphocyte. ... T cells are a subset of lymphocytes that play a large role in the immune response. ...


According to a strictly immunological explanation of MS, the inflammatory process is triggered by the T cells. T cells gain entry into the brain via the blood-brain barrier (a capillary system that should prevent entrance of T-cells into the nervous system). The blood brain barrier is normally not permeable to these types of cells, unless triggered by either infection or a virus, where the integrity of the tight junctions forming the blood-brain barrier is decreased. When the blood brain barrier regains its integrity (usually after infection or virus has cleared) the T cells are trapped inside the brain. These lymphocytes recognize myelin as foreign and attack it as if it were an invading virus. That triggers inflammatory processes, stimulating other immune cells and soluble factors like cytokines and antibodies. Leaks form in the blood-brain barrier. These leaks, in turn, cause a number of other damaging effects such as swelling, activation of macrophages, and more activation of cytokines and other destructive proteins such as matrix metalloproteinases. A deficiency of uric acid has been implicated in this process.[34] The blood-brain barrier (BBB) is a membranic structure that acts primarily to protect the brain from chemicals in the blood, while still allowing essential metabolic function. ... Diagram of Tight junction. ... A scanning electron microscope (SEM) image of a single human lymphocyte. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Cytokines are a category of less-widely-known signalling proteins and glycoproteins that, like hormones and neurotransmitters, are used extensively in cellular communication. ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... The blood-brain barrier (BBB) is a membranic structure that acts primarily to protect the brain from chemicals in the blood, while still allowing essential metabolic function. ... This page is about the condition called edema. ... Macrophages (Greek: big eaters) are cells found in tissues that are responsible for phagocytosis of pathogens, dead cells and cellular debris. ... A representation of the 3D structure of myoglobin showing coloured alpha helices. ... Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases; other family members are adamalysins, serralysins, and astacins. ... Uric acid (or urate) is an organic compound of carbon, nitrogen, oxygen and hydrogen with the formula C5H4N4O3. ...


It is known that a repair process, called remyelination, takes place in early phases of the disease, but the oligodendrocytes that originally formed a myelin sheath cannot completely rebuild a destroyed myelin sheath. The newly-formed myelin sheaths are thinner and often not as effective as the original ones. Repeated attacks lead to successively fewer effective remyelinations, until a scar-like plaque is built up around the damaged axons, according to four different damage patterns.[35] The central nervous system should be able to recruit oligodendrocyte stem cells capable of turning into mature myelinating oligodendrocytes, but it is suspected that something inhibits stem cells in affected areas. Oligodendrocytes (from Greek literally meaning few tree cells), or oligodendroglia (Greek, few tree glue),[1] are a variety of neuroglia. ... In neuroscience, myelin is an electrically insulating fatty layer that surrounds the axons of many neurons, especially those in the peripheral nervous system. ... Multiple sclerosis is a disease in which the myelin (a fatty substance which covers the axons of nerve cells, important for proper nerve conduction) degenerates. ... Mouse embryonic stem cells with fluorescent marker. ...


The axons themselves can also be damaged by the attacks.[36] Often, the brain is able to compensate for some of this damage, due to an ability called neuroplasticity. MS symptoms develop as the cumulative result of multiple lesions in the brain and spinal cord. This is why symptoms can vary greatly between different individuals, depending on where their lesions occur. An axon or nerve fiber, is a long, slender projection of a nerve cell, or neuron, that conducts electrical impulses away from the neurons cell body or soma. ... Neuroplasticity challenges the idea that brain functions are fixed in certain locations. ... Skin lesions caused by Chickenpox A lesion is any abnormal tissue found on or in an organism, usually damaged by disease or trauma. ... The Spinal cord nested in the vertebral column. ...


Causes

Although many risk factors for multiple sclerosis have been identified, no definitive cause has been found. MS likely occurs as a result of some combination of both environmental and genetic factors. Various theories try to combine the known data into plausible explanations. Although most accept an autoimmune explanation, several theories suggest that MS is an appropriate immune response to one or several underlying conditions (the etiology could be heterogeneous[37]). The need for alternative theories is supported by the poor results of present therapies, since autoimmune theory predicted greater success.[38][39][40] For other uses, see Ecological Systems Theory. ... This article is about the general scientific term. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... This article is about the medical term. ...


Environmental

The most popular hypothesis is that a viral infection or retroviral reactivation primes a susceptible immune system for an abnormal reaction later in life. On a molecular level, this might occur if there is a structural similarity between the infectious virus and some component of the central nervous system, leading to eventual confusion in the immune system. This article is about biological infectious particles. ... Genera Subfamily: Orthoretrovirinae Alpharetrovirus Betaretrovirus Gammaretrovirus Deltaretrovirus Epsilonretrovirus Lentivirus Subfamily: Spumaretrovirinae Spumavirus A retrovirus is any virus belonging to the viral family Retroviridae. ... 3D (left and center) and 2D (right) representations of the terpenoid molecule atisane. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ...


Since MS seems to be more common in people who live farther from the equator, another theory proposes that decreased sunlight exposure[41] and possibly decreased vitamin D production may help cause MS. This theory is bolstered by recent research into the biochemistry of vitamin D, which has shown that it is an important immune system regulator. A large, 2006 study by the Harvard School of Public Health, reported evidence of a link between vitamin D deficiency and the onset of multiple sclerosis.[2] Other data comes from a 2007 study which concluded that sun exposure during childhood reduces the risk of suffering MS, while controlling for genetic factors.[42] Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... Biochemistry (from Greek: , bios, life and Egyptian kēme, earth[1]) is the study of the chemical processes in living organisms. ...


Other theories, noting that MS is less common in children with siblings, suggest that less exposure to illness in childhood leads to an immune system which is not primed to fight infection and is thus more likely to attack the body. One explanation for this would be an imbalance between the Th1 type of helper T-cells, which fight infection, and the Th2 type, which are more active in allergy and more likely to attack the body[citation needed]. Antigen presentation stimulates T cells to become either cytotoxic CD8+ cells or helper CD4+ cells. ... Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ...


Other theories describe MS as an immune response to a chronic infection. The association of MS with the Epstein-Barr virus suggests a potential viral contribution in at least some individuals.[43] Still others believe that MS may sometimes result from a chronic infection with spirochetal bacteria, a hypothesis supported by research in which cystic forms were isolated from the cerebrospinal fluid of all MS patients in a small study.[44] When the cysts were cultured, propagating spirochetes emerged. Another bacterium that has been implicated in MS is Chlamydophila pneumoniae; it or its DNA has been found in the cerebrospinal fluid of MS patients by several research laboratories, with one study finding that the oligoclonal bands of 14 of the 17 MS patients studied consisted largely of antibodies to Chlamydophila antigens.[45]. Varicella zoster virus is also suspected to be involved[46]. The Epstein-Barr virus (EBV), also called Human herpesvirus 4 (HHV-4), is a virus of the herpes family (which includes Herpes simplex virus and Cytomegalovirus), and is one of the most common viruses in humans. ... Families Brachyspiraceae Leptospiraceae Spirochaetaceae The spirochaetes are a phylum of distinctive bacteria, which have long, helically coiled cells. ... Chlamydophila pneumoniae (previously known as Chlamydia pneumoniae) is a species of chlamydiae bacteria which infects humans and is a major cause of pneumonia. ... Oligoclonal bands are a about two to five bands of immunoglobulins on protein electrophoresis of cerebrospinal fluid. ... Species Human herpesvirus 3 (HHV-3) The Varicella zoster virus (VZV) is one of the eight herpes viruses known to affect humans (and other vertebrates). ...


Severe stress may also be a factor—a large study in Denmark found that parents who had lost a child unexpectedly were 50% more likely to develop MS than parents who had not.[47] Smoking has also been shown to be an independent risk factor for developing MS.[48] The cigarette is the most common method of smoking tobacco. ...


Genetic

MS is not considered a hereditary disease. However, increasing scientific evidence suggests that genetics may play a role in determining a person's susceptibility to MS: For the scientific journal Heredity see Heredity (journal) Heredity (the adjective is hereditary) is the transfer of characters from parent to offspring, either through their genes or through the social institution called inheritance (for example, a title of nobility is passed from individual to individual according to relevant customs and...


Some populations, such as the Roma, Inuit, and Bantus, rarely if ever develop MS. The indigenous peoples of the Americas and Asians have very low incidence rates. Language(s) Romani, languages of native region Religion(s) Romanipen, combined with assimilations from local religions Related ethnic groups South Asians (Desi) This article is about the Indo-Aryan ethnic group. ... For other uses, see Inuit (disambiguation). ... Map showing the approximate distribution of Bantu (light brown) vs. ... For other uses, see Native Americans (disambiguation). ... Asian people[1] is a demonym for people from Asia. ...


In the population at large, the chance of developing MS is less than a tenth of one percent. However, if one person in a family has MS, that person's first-degree relatives—parents, children, and siblings—have a one to three percent chance of getting the disease.


For identical twins, the likelihood that the second twin may develop MS if the first twin does is about 30%. For fraternal twins (who do not inherit an identical set of genes), the likelihood is closer to that for non-twin siblings, at about 4%. This pattern suggests that, while genetic factors clearly help determine the risk of MS, other factors such as environmental effects or random chance are also involved. The actual correlation may be somewhat higher than reported by these numbers as people with MS lesions remain essentially asymptomatic throughout their lives. Fraternal twin boys in the tub The term twin most notably refers to two individuals (or one of two individuals) who have shared the same uterus (womb) and usually, but not necessarily, born on the same day. ...


Further indications that more than one gene is involved in MS susceptibility comes from studies of families in which more than one member has MS. Several research teams found that people with MS inherit certain regions on individual genes more frequently than people without MS. Of particular interest is the human leukocyte antigen (HLA) or major histocompatibility complex region on chromosome 6. HLAs are genetically determined proteins that influence the immune system. However, there are other genes in this region which are not related to the immune system. HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ... Protein images comparing the MHC I (1hsa) and MHC II (1dlh) molecules. ...


The HLA patterns of MS patients tend to be different from those of people without the disease. Investigations in northern Europe and America have detected three HLAs that are more prevalent in people with MS than in the general population. Studies of American MS patients have shown that people with MS also tend to exhibit these HLAs in combination—that is, they have more than one of the three HLAs—more frequently than the rest of the population. Furthermore, there is evidence that different combinations of the HLAs may correspond to variations in disease severity and progression.


A large study examining 334,923 single nucleotide polymorphisms (small variations in genes) in 931 families showed that apart from HLA-DRA there were two genes in which polymorphisms strongly predicted MS; these were the IL2RA (a subunit of the receptor for interleukin 2) and the IL7RA (idem for interleukin 7) genes. Mutations in these genes were already known to be associated with diabetes mellitus type 1 and other autoimmune conditions; the findings circumstantially support the notion that MS is an autoimmune disease.[49] DNA strand 1 differs from DNA strand 2 at a single base-pair location (a C/T polymorphism). ... For other uses, see Gene (disambiguation). ... The Interleukin-2 Receptor (IL-2R) is heterotrimeric protein expressed on the surface of certain immune cells, such as lymphocytes, that binds and responds to a cytokine called interleukin 2. ... In biochemistry, a receptor is a protein on the cell membrane or within the cytoplasm or cell nucleus that binds to a specific molecule (a ligand), such as a neurotransmitter, hormone, or other substance, and initiates the cellular response to the ligand. ... Interleukin-2 (IL-2) is an interleukin, a type of biological response modifier, a substance that can improve the bodys natural response to disease. ... Hematopoietic growth factor capable of stimulating the proliferation of lymphoid progenitors. ... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. ...


Studies of families with multiple cases of MS and research comparing proteins expressed in humans with MS to those of mice with EAE suggest that another area related to MS susceptibility may be located on chromosome 5. Other regions on chromosomes 2, 3, 7, 11, 17, 19, and X have also been identified as possibly containing genes involved in the development of MS.


These studies strengthen the theory that MS is the result of a number of factors rather than a single gene or other agent. Development of MS is likely to be influenced by the interactions of a number of genes, each of which (individually) has only a modest effect. Additional studies are needed to specifically pinpoint which genes are involved, determine their function, and learn how each gene's interactions with other genes and with the environment make an individual susceptible to MS.


Treatment

Main article: treatment of multiple sclerosis

Although there is no known cure for multiple sclerosis, several therapies have proven helpful. The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects, and many possible therapies are still under investigation. At the same time different alternative treatments are pursued by many patients, despite the paucity of supporting, comparable, replicated scientific study. Although there is no known cure for multiple sclerosis (MS), several therapies for multiple sclerosis have proven helpful. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... Alternative medicine has been described as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Alternative medicine practices are often based in belief systems not derived from modern science. ...


Management of acute attacks

During symptomatic attacks administration of high doses of intravenous corticosteroids, such as methylprednisolone,[50][51] is the routine therapy for acute relapses.The aim of this kind of treatment is to end the attack sooner and leave fewer lasting deficits in the patient. Although generally effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery.[52] Potential side effects include osteoporosis[53] and impaired memory, the latter being reversible[54] Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Methylprednisolone (molecular weight 374. ... A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ...


Disease modifying treatments

Disease-modifying treatments are expensive and most of these require frequent (up-to-daily) injections. Others require IV infusions at 1-3 month intervals.
Disease-modifying treatments are expensive and most of these require frequent (up-to-daily) injections. Others require IV infusions at 1-3 month intervals.

The earliest clinical presentation of relapsing-remitting MS (RRMS) is the clinically isolated syndrome (CIS). Several studies have shown that treatment with interferons during an initial attack can decrease the chance that a patient will develop MS.[55][56][23] Image File history File links Metadata Size of this preview: 800 × 600 pixelsFull resolution (1600 × 1200 pixels, file size: 1. ... Image File history File links Metadata Size of this preview: 800 × 600 pixelsFull resolution (1600 × 1200 pixels, file size: 1. ... Interferons (IFNs) are natural proteins produced by the cells of the immune system of most vertebrates in response to challenges by foreign agents such as viruses, bacteria, parasites and tumor cells. ...


As of 2007, six disease-modifying treatments have been approved by regulatory agencies of different countries for relapsing-remitting MS. Three are interferons: two formulations of interferon beta-1a (trade names Avonex and Rebif) and one of interferon beta-1b (U.S. trade name Betaseron, in Europe and Japan Betaferon). A fourth medication is glatiramer acetate (Copaxone). The fifth medication, mitoxantrone, is an immunosuppressant also used in cancer chemotherapy, is approved only in the USA and largely for SPMS. Finally, the sixth is natalizumab (marketed as Tysabri). All six medications are modestly effective at decreasing the number of attacks and slowing progression to disability, although they differ in their efficacy rate and studies of their long-term effects are still lacking.[57][58][59][60] Comparisons between immunomodulators (all but mitoxantrone) show that the most effective is natalizumab, both in terms of relapse rate reduction and halting disability progression[61]; it has also been shown to reduce the severity of MS[62]. Mitoxantrone may be the most effective of them all;[63] however, it is generally considered not as a long-term therapy as its use is limited by severe cardiotoxicity.[64] Interferons (IFNs) are natural proteins produced by the cells of the immune system of most vertebrates in response to challenges by foreign agents such as viruses, bacteria, parasites and tumor cells. ... Interferon beta-1a is a drug in the interferon family used to treat multiple sclerosis. ... Interferon beta-1b (marketed as Betaseron) is a drug in the interferon family used to treat multiple sclerosis. ... Glatiramer Acetate is the generic name for the drug Copaxone or Copolymer 1, developed by Teva Pharmaceuticals. ... Mitoxantrone belongs to the general group of medicines known as antineoplastics, specifically the anthracycline class. ... Immunosuppression is the medical suppression of the immune system. ... Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. ... Natalizumab is a drug co-marketed by Biogen Idec and Élan as Tysabri. ... Cardiotoxicity is the occurrence of heart muscle damage. ...


The interferons and glatiramer acetate are delivered by frequent injections, varying from once-per-day for glatiramer acetate to once-per-week (but intra-muscular) for Avonex. Natalizumab and mitoxantrone are given by IV infusion at monthly intervals. Natalizumab is a drug co-marketed by Biogen Idec and Élan as Tysabri. ... Mitoxantrone belongs to the general group of medicines known as antineoplastics, specifically the anthracycline class. ...


Treatment of progressive MS is more difficult than relapsing-remitting MS. Mitoxantrone has shown positive effects in patients with a secondary progressive and progressive relapsing courses. It is moderately effective in reducing the progression of the disease and the frequency of relapses in patients in short-term follow-up.[60] On the other hand no treatment has been proven to modify the course of primary progressive MS.[65] Mitoxantrone belongs to the general group of medicines known as antineoplastics, specifically the anthracycline class. ...


As with any medical treatment, these treatments have several adverse effects. One of the most common is irritation at the injection site for glatiramer acetate and the Interferon treatments. Over time, a visible dent at the injection site due to the local destruction of fat tissue, known as lipoatrophy, may develop. Interferons also produce symptoms similar to influenza;[66] while some patients taking glatiramer experience a post-injection reaction manifested by flushing, chest tightness, heart palpitations, breathlessness, and anxiety, which usually lasts less than thirty minutes.[58]. More dangerous are liver damage of interferons and mitoxantrone,[67][68][69][70][71] the immunosuppressive effects and cardiac toxicity of the latter;[71] or the putative link between natalizumab and some cases of progressive multifocal leukoencephalopathy in patients who had taken it in combination with interferons.[72][73] Flu redirects here. ... Hepatotoxicity (from hepatic toxicity) implies chemical-driven liver damage. ... Cardiotoxicity is the occurrence of heart muscle damage. ... This article is about the viral disease. ...


Management of the effects of MS

Disease-modifying treatments only reduce the progression rate of the disease but do not stop it. As multiple sclerosis progresses, the symptomatology tends to increase. The disease is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Management of these deficits is therefore very important. Both drug therapy and neurorehabilitation have shown to ease the burden of some symptoms, even though neither influence disease progression.[74] As for any patient with neurologic deficits, a multidisciplinary approach is key to limiting and overcoming disability; however there are particular difficulties in specifying a ‘core team’ because people with MS may need help from almost any health profession or service at some point.[75] Similarly for each symptom there are different treatment options. Treatments should therefore be individualized depending both on the patient and the physician Look up disability in Wiktionary, the free dictionary. ... Interdisciplinary work is that which integrates concepts across different disciplines. ...


Therapies under investigation

Main article: therapies under investigation for multiple sclerosis

Scientists continue their extensive efforts to create new and better therapies for MS. There are a number of treatments under investigation that may improve function, curtail attacks, or limit the progression of the underlying disease. Many treatments already in clinical trials involve drugs that are used in other diseases or medications that have not been designed specifically for MS. There are also trials involving the combination of drugs that are already in use for multiple sclerosis. Finally, there are also many basic investigations that try to understand better the disease and in the future may help to find new treatments. Scientists continue their extensive efforts to create new and better therapies for multiple sclerosis. ...


Alternative treatments

Different alternative treatments are pursued by many patients, despite the paucity of supporting, comparable, replicated scientific study. Examples are dietary regimens,[76], herbal medicine, including the use of medical cannabis to help alleviate symptoms,[77][78] or hyperbaric oxygenation.[79] On the other hand the therapeutic practice of martial arts such as tai chi, relaxation disciplines such as yoga, or general exercise, seem to mitigate fatigue and improve quality of life.[80] The term Herbalism refers to folk and traditional medicinal practice based on the use of plants and plant extracts. ... A catalog page offering Cannabis sativa extract. ... Hyperbaric oxygen therapy (HBOT) is the medical use of oxygen at a higher than atmospheric pressure. ... A photoshopped, fictional portrayal of a martial arts therapist, depicted by the combined images of Sigmund Freud and Bruce Lee. ... Tai Chi Chuan or Taijiquan (from Chinese 太极拳 Tàijíquán, literally supreme ultimate fist), commonly known as Tai Chi or Taiji, is a nei chia (internal) Chinese martial art which is known for the claims of health and longevity benefits made by its practitioners and in some recent... For other uses such as Yoga postures, see Yoga (disambiguation) Statue of Shiva performing Yogic meditation Yoga (Sanskrit: योग Yoga, IPA: ) is a group of ancient spiritual practices originating in India. ...


Prognosis

The prognosis (the expected future course of the disease) for a person with multiple sclerosis depends on the subtype of the disease; the individual's sex, race, age, and initial symptoms; and the degree of disability the person experiences. The life expectancy of people with MS, at least for earlier years, is now nearly the same as that of unaffected people. This is due mainly to improved methods of limiting disability, such as physical therapy, occupational therapy and speech therapy, along with more successful treatment of common complications of disability, such as pneumonia and urinary tract infections.[81] Nevertheless half of the deaths in people with MS are directly related to the consequences of the disease, while 15% more are due to suicide.[82] Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... This article is about the measure of remaining life. ... Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ... Occupational therapy refers to the use of meaningful occupation to assist people who have difficulty in achieving healthy and balanced life; and to enable an inclusive society so that all people can participate to their potential in daily occupations of life. ... It has been suggested that Speech-Language Pathology, Speech pathology, Phoniatrics be merged into this article or section. ... This article is about human pneumonia. ... A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. ...

  • Individuals with progressive subtypes of MS, particularly the primary progressive subtype, have a more rapid decline in function. In the primary progressive subtype, supportive equipment (such as a wheelchair or standing frame) is often needed after six to seven years. However, when the initial disease course is the relapsing-remitting subtype, the average time until such equipment is needed is twenty years. This means that many individuals with MS will never need a wheelchair. There is also more cognitive impairment in the progressive forms than in the relapsing-remitting course.
  • The earlier in life MS occurs, the slower disability progresses. Individuals who are older than fifty when diagnosed are more likely to experience a chronic progressive course, with more rapid progression of disability. Those diagnosed before age 35 have the best prognosis. Females generally have a better prognosis than males. Although individuals of African descent tend to develop MS less frequently, they are often older at the time of onset and may have a worse prognosis.
  • Initial MS symptoms of visual loss or sensory problems, such as numbness or tingling, are markers for a relatively good prognosis, whereas difficulty walking and weakness are markers for a relatively poor prognosis. Better outcomes are also associated with the presence of only a single symptom at onset, the rapid development of initial symptoms, and the rapid regression of initial symptoms.
  • The degree of disability varies among individuals with MS. In general, one of three individuals will still be able to work after 15–20 years. Fifteen percent of people diagnosed with MS never have a second relapse, and these people have minimal or no disability after ten years.[83] The degree of disability after five years correlates well with the degree of disability after fifteen years. This means that two-thirds of people with MS with low disability after five years will not get much worse during the next ten years. It should be noted that most of these outcomes were observed before the use of medications such as interferon, which can delay disease progression for several years.
  • Apart from physical disability, cognitive impairment in MS occurs in approximately half of all patients. In its earlier stages, this impairment can include loss of short-term memory, depression and the pseudobulbar affect. As the disease progresess, the impairment can become more profound, ranging from loss of deductive reasoning to dementia.

Currently there are no clinically established laboratory investigations available that can predict prognosis or response to treatment. However, several promising approaches have been proposed. These include measurement of the two antibodies anti-myelin oligodendrocyte glycoprotein and anti-myelin basic protein, and measurement of TRAIL (TNF-related apoptosis-inducing ligand).[84] Wheelchair seating in a theater. ... A standing frame (also known as a stand, stander, standing technology, standing aid, standing device, standing box, tilt table) is assistive technology used by a child or adult who uses a wheelchair for mobility. ... Look up disability in Wiktionary, the free dictionary. ... Paresthesia (paraesthesia in British) is a sensation of tingling, pricking, or numbness of the skin with no apparent physical cause, more generally known as the feeling of pins and needles. ... Paresthesia (paraesthesia in British) is a sensation of tingling, pricking, or numbness of the skin with no apparent physical cause, more generally known as the feeling of pins and needles. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... Gait imbalance refers generally to difficulty in keeping ones balance when walking or standing, due to numbness in the patients lower legs and feet. ... Weakness is the inability to exert force with ones muscles to the degree that would be expected given the individuals general physical condition. ... Cognitive The scientific study of how people obtain, retrieve, store and manipulate information. ... On the Threshold of Eternity. ... Labile affect or Pseudobulbar affect refers to the pathological expression of laughter, crying, or smiling. ... For other uses, see Dementia (disambiguation). ... A medical laboratory or clinical laboratory is a laboratory where tests are done on biological specimens in order to get information about the health of a patient. ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... Myelin Oligodendrocyte Glycoprotein (MOG) is a glycoprotein believed to be important in the process of myelinization of nerves in the central nervous system (CNS). ... Myelin basic protein (MBP) is a protein believed to be important in the process of myelination of nerves in the central nervous system (CNS). ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ... A section of mouse liver showing an apoptotic cell indicated by an arrow Apoptosis (pronounced apo tō sis) is a process of suicide by a cell in a multicellular organism. ... In chemistry, a ligand is an atom, ion, or molecule (see also: functional group) that generally donates one or more of its electrons through a coordinate covalent bond to, or shares its electrons through a covalent bond with, one or more central atoms or ions (these ligands act as a...


Epidemiology

World map showing that risk (incidence) for MS increases with greater distance from the equator
World map showing that risk (incidence) for MS increases with greater distance from the equator

Epidemiology is, among other things, the study of prevalence and incidence of diseases, incidence being the percentage of cases reported each year and prevalence the total percentage of cases in the population. Prevalence is known to depend not only to incidence, but also to survival rate and migrations of affected people[85]. Image File history File linksMetadata MS_Risk. ... Image File history File linksMetadata MS_Risk. ... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ... In optics one considers angles of incidence. ... A disease is any abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected or those in contact with the person. ...


In northern Europe, continental North America, and Australasia, about one of every 1000 people suffers from multiple sclerosis, whereas in the Arabian peninsula, Asia, and continental South America, the frequency is much lower. In sub-Saharan Africa, MS is extremely rare. With important exceptions, there is a north-to-south gradient in the northern hemisphere and a south-to-north gradient in the southern hemisphere, with MS being much less common in people living near the equator.[86] Climate, diet, geomagnetism, toxins, sunlight exposure, genetic factors, and infectious diseases have all been discussed as possible reasons for these regional differences. Environmental factors during childhood may play an important role in the development of MS later in life. This idea is based on several studies of migrants showing that if migration occurs before the age of fifteen, the migrant acquires the new region's susceptibility to MS. If migration takes place after age fifteen, the migrant keeps the susceptibility of his home country.[87] However other works suggest that the age/geographical risk for developing multiple sclerosis spans a larger timescale than just the first 15 years of life.[88] For other uses, see Europe (disambiguation). ... North American redirects here. ... Australasia Australasia is a term variably used to describe a region of Oceania: Australia, New Zealand, and neighbouring islands in the Pacific Ocean. ... Arabia redirects here. ... For other uses, see Asia (disambiguation). ... South America South America is a continent crossed by the equator, with most of its area in the Southern Hemisphere. ... A political map showing national divisions in relation to the ecological break (Sub-Saharan Africa in green) A geographical map of Africa, showing the ecological break that defines the sub-Saharan area Sub-Saharan Africa is the term used to describe the area of the African continent which lies south... In nutrition, the diet is the sum of food consumed by a person or other organism. ... The cause of Earths magnetic field (the surface magnetic field) is not known for certain, but is possibly explained by dynamo theory. ... For other uses, see Toxin (disambiguation). ... Prism splitting light High Resolution Solar Spectrum Sunlight in the broad sense is the total spectrum of the electromagnetic radiation given off by the Sun. ... This false-colored electron micrograph shows a malaria sporozoite migrating through the midgut epithelia. ...


MS occurs mainly in Caucasians. It is twentyfold lower in the Inuit people of Canada than in other Canadians living in the same region. It is also rare in the Native American tribes of North America, Australian Aborigines and the Māori of New Zealand. Scotland appears to have the highest rate of MS in the world.[89] The reasons for this are unknown. These few examples point out that either genetic background or lifestyle and cultural factors play an important role in the development of MS. For the peoples actually from the Caucasus, see Peoples of the Caucasus. ... For other uses, see Inuit (disambiguation). ... This article is about the people indigenous to the United States. ... North American redirects here. ... Australian Aborigines are the main indigenous people of Australia. ... This article is about the Māori people of New Zealand. ... This article is about the country. ...


As observed in many autoimmune disorders, MS is more common in females than males; the mean sex ratio is about two females for every male. In children (who rarely develop MS) the sex ratio may reach three females for each male. In people over age fifty, MS affects males and females equally. Onset of symptoms usually occurs between fifteen and forty years of age, rarely before age fifteen or after age sixty. This article is about the mathematical concept. ...


As previously discussed, there is a genetic component to MS. On average one of every 25 siblings of individuals with MS will also develop MS. Almost half of the identical twins of MS-affected individuals will develop MS, but only one of twenty fraternal twins. If one parent is affected by MS, each child has a risk of only about one in forty of developing MS later in life.[90] Fraternal twin boys in the tub The term twin most notably refers to two individuals (or one of two individuals) who have shared the same uterus (womb) and usually, but not necessarily, born on the same day. ...


Finally, it is important to remark that advances in the study of related diseases have shown that some cases formerly considered MS are not MS at all. In fact, all the studies before 2004 can be affected by the impossibility to distinguish MS and Devic's disease (NMO) reliably before this date. The error can be important in some areas, and is considered to be 30% in Japan.[91] Devics disease, also known as Devics syndrome, neuromyelitis optica (NMO), or optic-spinal MS, is an autoimmune, inflammatory disorder in which a persons own immune system attacks myelin of the neurons of the optic nerves and spinal cord. ...


History

The French neurologist Jean-Martin Charcot (1825–93) was the first person to recognize multiple sclerosis as a distinct, separate disease in 1868. Summarizing previous reports and adding his own important clinical and pathological observations, Charcot called the disease sclerose en plaques. The three signs of MS now known as Charcot's triad are dysarthria (problems with speech), ataxia (problems with coordination), and tremor. Charcot also observed cognition changes in MS since he described his patients as having a "marked enfeeblement of the memory" and "with conceptions that formed slowly".[92] Neurology is the branch of medicine that deals with the nervous system and disorders affecting it. ... Categories: People stubs | French physicians | 1825 births | 1893 deaths | History of medicine ... This article is about the medical term. ... There are two sets of Charcots triads, both of which are sets of clinical signs relating to quite separate diseases. ... Look up dysarthria in Wiktionary, the free dictionary. ... For other uses, see Ataxia (disambiguation). ... For the film see Tremors (film). ...


Prior to Charcot, Robert Hooper (1773–1835), a British pathologist and practicing physician, Robert Carswell (1793–1857), a British professor of pathology, and Jean Cruveilhier (1791–1873), a French professor of pathologic anatomy, had described and illustrated many of the disease's clinical details. For other uses, see Doctor. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... Jean Cruveilhier (born 1791 in Limoges, France; died 1874 in Jussac) was a French anatomist. ... Human heart and lungs, from an older edition of Grays Anatomy. ...


After this, several people, such as Eugène Devic (1858–1930), Jozsef Balo (1895–1979), Paul Ferdinand Schilder (1886–1940), and Otto Marburg (1874–1948) found special cases of the disease that some authors consider different diseases and now are called the borderline forms of multiple sclerosis. Eugène Devic (1858-1930) was a French neurologist who was a native of La Cavalerie, a village in the department of Aveyron. ... Austrian doctor and researcher. ... Dr. Otto Marburg (1874-1948), was born in Vienna, Austria. ... This article or section is in need of attention from an expert on the subject. ...


There are several historical accounts of people who probably had MS. Saint Lidwina of Schiedam (1380–1433), a Dutch nun, may be one of the first identifiable MS patients. From the age of sixteen until her death at age 53, she suffered intermittent pain, weakness of the legs, and vision loss—symptoms typical of MS. Almost a hundred years before there is a story from Iceland of a young woman called Halla. This girl suddenly lost her vision and capacity to talk; but after praying to the saints recovered them seven days after.[93] Augustus Frederick d'Este (1794–1848), an illegitimate grandson of King George III of Great Britain, almost certainly suffered from MS. D'Este left a detailed diary describing his 22 years living with the disease. He began his diary in 1822 and it had its last entry in 1846 (only to remain unknown until 1948). His symptoms began at age 28 with a sudden transient visual loss after the funeral of a friend. During the course of his disease he developed weakness of the legs, clumsiness of the hands, numbness, dizziness, bladder disturbances, and erectile dysfunction. In 1844, he began to use a wheelchair. Despite his illness, he kept an optimistic view of life.[94] Another early account of MS was kept by the British diarist W. N. P. Barbellion, who maintained a detailed log of his diagnosis and struggle with MS. His diary was published in 1919 as The Journal of a Disappointed Man. Saint Lidwina (April 18, 1380 – April 14, 1433) was a Dutch saint. ... Nickname: Location of Schiedam within The Netherlands. ... For other uses, see Nun (disambiguation). ... Augustus Frederick dEste (1794-1848) was the son of Prince Augustus Frederick, Duke of Sussex and Lady Augusta Murray and the grandson of King George III. His parents marriage was in contravention of the Royal Marriages Act 1772, which meant the Augustus dEste was legally considered illegitimate. ... George III redirects here. ... Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. ... Wheelchair seating in a theater. ... W(ilhelm) N(ero) P(ilate) Barbellion was the nom-de-plume of Bruce Frederick Cummings (September 7, 1889 - October 22, 1919), an English diarist who was responsible for what is usually considered one of the greatest diaries of all time, The Journal of a Disappointed Man. ...


Cultural references

  • The German propaganda film Ich klage an (1941) by Wolfgang Liebeneiner had the main character suffering from MS and wishing herself to be killed because she had become unable to do so by herself.
  • In the 1986 film Duet for One, Julie Andrews plays a concert violinist who must sacrifice her career when she is diagnosed with MS.
  • In the American television series The West Wing, the fictional United States President, Jed Bartlet, has the relapsing-remitting subtype of MS. In the episode "He Shall, from Time To Time..." it is erroneously stated that with his MS "…a fever could be life threatening."
  • Another American TV series, Extreme Makeover: Home Edition, aired a two-part episode on February 12, 2006 that featured a new home for Carol Crawford-Smith of Blacksburg, Virginia, a former principal dancer with the Dance Theatre of Harlem who was diagnosed with MS in 2000. Ty Pennington and his team not only built her a new home, but also renovated her Blacksburg dance studio, "The Center of Dance."
  • In the 2006 film Dreamland the character Callista suffers from Multiple Sclerosis.
  • British cellist Jacqueline du Pré died with MS in 1987 when she was 42. After a long struggle with the disease, she was robbed of her capacity to perform as she progressively lost sensitivity in her fingers, hearing, and muscle coordination. This decline was portrayed in the 1998 film, Hilary and Jackie. The aforementioned play Duet for One was inspired by du Pre's life.
  • The character of Susan Kinski in the Australian soap Neighbours was diagnosed with MS in episodes broadcast in Australia during November 2007.
  • The Billy Talent song How It Goes is about Aaron Solowoniuk, the band's drummer, who has MS.
  • The novel Eleanor Rigby by Douglas Coupland features a character named Jeremy, the long-lost son of main character Liz Dunn, who has MS and experiences many of the disease's severe effects.

Image File history File links Broom_icon. ... The Why We Fight Series depicts the Nazi propaganda machine. ... Wolfgang Liebeneiner (October 6, 1905 - November 28, 1987) was a German actor and film and theater director. ... Duet for One (1986) is a film based on an award-winning British play about a world-famous concert violinist named Stephanie Anderson who is suddenly struck with multiple sclerosis. ... Dame Julie Elizabeth Andrews, DBE (born Julia Elizabeth Wells[1] on 1 October 1935[2]) is an award-winning English actress, singer, author and cultural icon. ... “The West Wing” redirects here. ... For the signatory of the Declaration of Independence, see Josiah Bartlett. ... He Shall, From Time To Time. ... Extreme Makeover: Home Edition is an ABC reality television series that began broadcasting in 2003 in which a familys house, including all rooms, exterior and landscaping, is made over by a team of builders and designers in seven days. ... is the 43rd day of the year in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... Blacksburgs location within Virgina Virginias location within the United States Coordinates: Country United States State Virginia County Montgomery Founded 1798 Government  - Mayor Ron Rordam Area  - Town  19. ... Dance Theatre of Harlem is a ballet company founded in Harlem, New York City, USA in 1969 by Arthur Mitchell and Karel Shook. ... Tygert Burton Ty Pennington (born October 19, 1965 in Atlanta, Georgia) is a carpenter and TV personality. ... Dreamland is an American Drama film that was released on December 19, 2006. ... This article is about the stringed musical instrument. ... Jacqueline Mary du Pré, O.B.E. (January 26, 1945 – October 19, 1987), was a British cellist, today acknowledged as one of the greatest exponents of the instrument. ... Hilary and Jackie is a 1998 movie directed by Anand Tucker and written by acclaimed British screenwriter Frank Cottrell Boyce, starring Emily Watson and Rachel Griffiths as the sisters Jacqueline du Pré and Hilary du Pré. The movie is based on Hilary du Pres book about her sister Jacqueline. ... Susan Wendy Kinski (née Smith, formerly Kennedy) is a fictional character in the Australian soap opera Neighbours, played by Jackie Woodburne. ... This article is about an Australian soap opera. ... Billy Talent is a Canadian alternative band formed in 1993 in Mississauga, Ontario. ... Billy Talent is the second full-length album of Canadian band Billy Talent, after their first, Watoosh!, was released under their old name of Pezz in 1998. ... Aaron Solowoniuk (pronounced Solo-von-yuk), born November 21, 1974, is the drummer for the Canadian band Billy Talent. ... Eleanor Rigby is a 2004 novel by Douglas Coupland, about a plain, fat and lonely 42-year-old woman. ... Douglas Coupland (born December 30, 1961) is a major Canadian fiction writer as well as a playwright and visual artist. ...

See also

The MS Challenge Walk is a walk-a-thon to raise money for Multiple Sclerosis, a chronic disease that affects the central nervous system. ... 2004 MS Bike Tour from Houston to Austin MS Bike Tour or MS 150 refers to any of a series of charity bicycle rides organized by the National Multiple Sclerosis Society in various locations around the United States and Canada. ... List of different Multiple Sclerosis Organizations in different countries around the world This list is incomplete; you can help by expanding it. ...

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A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... is the 91st day of the year (92nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 244th day of the year (245th in leap years) in the Gregorian calendar. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... is the 91st day of the year (92nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 244th day of the year (245th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... The Lancet is a British medical journal, published weekly by the Lancet Publishing Group. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... is the 225th day of the year (226th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 274th day of the year (275th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

Further reading

  • The patient's journey: multiple sclerosis Langgartner M, Langgartner I, Drlicek M. The patient's journey: multiple sclerosis. BMJ. 2005 Apr 16;330(7496):885-8. PMID 15831874.

The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ...

External links

  • Multiple sclerosis at the Open Directory Project
  • Database for analysis and comparison of global data on the epidemiology of MS
  • NIH listing of clinical trials related to MS
  • Abstract index of the Cochrane Library

The Open Directory Project (ODP), also known as dmoz (from , its original domain name), is a multilingual open content directory of World Wide Web links owned by Netscape that is constructed and maintained by a community of volunteer editors. ... The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration. ... Multiple sclerosis can cause a variety of symptoms, including changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty to move; difficulties with coordination and balance; problems in speech (Dysarthria) or swallowing (Dysphagia), visual problems (Nystagmus, optic neuritis, or diplopia), fatigue and acute or chronic pain syndromes, bladder and... For other uses, see Ataxia (disambiguation). ... On the Threshold of Eternity. ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... Look up dysarthria in Wiktionary, the free dictionary. ... Dysphagia () is a medical term defined as difficulty swallowing. ... Exhaustion redirects here. ... The tone or style of this article or section may not be appropriate for Wikipedia. ... Thought to be unique to sufferers of multiple sclerosis[1], neurological fatigue is a feeling of overwhelming lassitude or tiredness that can occur at any time of the day, for any duration and does not necessarily reccur in a recognisable pattern for any given patient. ... Nystagmus is involuntary eye movement that can be part of the vestibulo-ocular reflex (VOR), with the eyes moving first in the direction of the lesioned side (slow phase) followed by a quick correction (fast phase) to the opposite side or away from the lesioned side. ... Optic neuritis, sometimes called retrobulbar neuritis, is the inflammation of the optic nerve that may cause a complete or partial loss of vision. ... Look up Pain in Wiktionary, the free dictionary. ... The McDonald criteria are diagnostic criteria for multiple sclerosis. ... The Kurtzke Expanded Disability Status Scale (EDSS) is a method of quantifying disability in multiple sclerosis. ... Multiple sclerosis is a disease in which the myelin (a fatty substance which covers the axons of nerve cells, important for proper nerve conduction) degenerates. ... Experimental autoimmune encephalomyelitis (EAE) is an animal model of brain inflammation. ... Although there is no known cure for multiple sclerosis (MS), several therapies for multiple sclerosis have proven helpful. ... Interferons (IFNs) are natural proteins produced by the cells of the immune system of most vertebrates in response to challenges by foreign agents such as viruses, bacteria, parasites and tumor cells. ... Glatiramer Acetate is the generic name for the drug Copaxone or Copolymer 1, developed by Teva Pharmaceuticals. ... Mitoxantrone belongs to the general group of medicines known as antineoplastics, specifically the anthracycline class. ... Natalizumab is a drug co-marketed by Biogen Idec and Élan as Tysabri. ... Scientists continue their extensive efforts to create new and better therapies for multiple sclerosis. ... This article or section is in need of attention from an expert on the subject. ... Acute disseminated encephalomyelitis (ADEM) is an immune mediated disease of brain. ... Balo concentric sclerosis is one of the borderline foms of multiple sclerosis. ... Devics disease, also known as Devics syndrome, neuromyelitis optica (NMO), or optic-spinal MS, is an autoimmune, inflammatory disorder in which a persons own immune system attacks myelin of the neurons of the optic nerves and spinal cord. ... Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ... Marburg multiple sclerosis, also known as malignant, acute or fulminant multiple sclerosis, is one of the multiple sclerosis borderline diseases, which is a collection of diseases clasified by some as MS and by others as different diseases. ... Schilder disease or diffuse myelinoclastic sclerosis is a a very infrequent neurodegenerative disease that presents clinically as pseudotumoural demyelinating lesions, what difficults its diagnosis. ... . ... List of different Multiple Sclerosis Organizations in different countries around the world This list is incomplete; you can help by expanding it. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... The nervous system is a highly specialized network whose principal components are nerves called neurons. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... A diagram showing the CNS: 1. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Arachnoiditis describes a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. ... Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. ... Myelitis is a human disease involving swelling of the spinal cord, which disrupts central nervous system functions linking brain and limbs. ... Encephalomyelitis is a general term for inflammation of the brain and spinal cord, describing a number of disorders: acute disseminated encephalomyelitis or postinfectious encephalomyelitis, a demyelinating disease of the brain and spinal cord, possibly triggered by vaccination or viral infection; encephalomyelitis disseminata, a synonym for multiple sclerosis; equine encephalomyelitis, a... Acute disseminated encephalomyelitis (ADEM) is an immune mediated disease of brain. ... Tropical spastic paraparesis (TSP) is an infection of the spinal cord by Human T-lymphotropic virus resulting in paraparesis or weakness of the legs. ... Atrophy is the partial or complete wasting away of a part of the body. ... Spinocerebellar ataxia (SCA) is a genetic disease with multiple types, each of which could be considered a disease in its own right. ... Friedreichs ataxia is a rare autosomal recessive disorder caused by a mutation in Gene X25 that codes for frataxin, located on chromosome 9. ... Ataxia-telangiectasia (AT) (Boder-Sedgwick syndrome or Louis-Bar syndrome) is a primary immunodeficiency disorder that occurs in an estimated incidence of 1 in 40,000 to 1 in 300,000 births (Lederman, 2000). ... Hereditary spastic paraplegia (HSP), also called familial spastic paraparesis (FSP), refers to a group of inherited disorders that are characterized by progressive weakness and stiffness of the legs. ... Spinal Muscular Atrophy (SMA) is a term applied to a number of different disorders, all having in common a genetic cause and the manifestation of weakness due to loss of the motor neurons of the spinal cord and brainstem. ... Werdnig-Hoffman disease (or Infantile spinal muscular atrophy, type I) is an autosomal recessive muscular disease. ... Kugelberg-Welander disease (or juvenile spinal muscular atrophy, type III) is an autosomal recessive muscular disease. ... Fazio Londe Syndrome is an inherited motor neuron disease found in children and young adults. ... The motor neurone diseases (MND) are a group of progressive neurological disorders that destroy motor neurones, the cells that control voluntary muscle activity such as speaking, walking, breathing, and swallowing. ... Amyotrophic Lateral Sclerosis (ALS, sometimes called Lou Gehrigs Disease, or Maladie de Charcot) is a progressive, usually fatal, neurodegenerative disease caused by the degeneration of motor neurons, the nerve cells in the central nervous system that control voluntary muscle movement. ... Progressive muscular atrophy (PMA) is a rare subtype of Motor neurone disease (MND) which affects only the lower motor neurones. ... Progressive bulbar palsy is a form of motor neuron disease characterized by dysfunction of the muscles controlled by the cranial nerves of the lower brain stem (the bulb) -- specifically, the glossopharyngeal nerve (IX), vagus nerve (X), and hypoglossal nerve (XII). ... Pseudobulbar palsy is a form of motor neuron disease which can be associated with paralysis. ... Primary lateral sclerosis (PLS) is a rare neuromuscular disease characterized by progressive muscle weakness in the voluntary muscles. ... In human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. ... Neuroleptic malignant syndrome (NMS) is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. ... This disease is believed to have been caused by a viral illness, stimulating degeneration of the nerve cells in the substantia nigra, leading to clinical parkinsonism. ... PKAN: Pantothenate Kinase-Associated Neurodegeneration Symptoms Pantothenate kinase-associated neurodegeneration (PKAN) is one of many forms of neurodegeneration, or brain deterioration . ... Progressive supranuclear palsy (PSP) (or the Steele-Richardson-Olszewski syndrome, after the Canadian physicians who described it in 1963 ) is a rare degenerative disorder involving the gradual deterioration and death of selected areas of the brain. ... Striatonigral degeneration refers to a form of multiple system atrophy involving the loss of connections between two areas of the brain, the striatum and the substantia nigra, which work together to ensure smooth movement and maintain balance. ... Dystonia is a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. ... Dyskinesia refers to an impairment of voluntary movement. ... Torticollis, or wry neck, is a condition in which the head is tilted toward one side, and the chin is elevated and turned toward the opposite side. ... Meiges syndrome is a type of dystonia, also known as oral facial dystonia or hemifacial spasm, the main symptoms of which involve involuntary blinking and chin thrusting. ... A blepharospasm (from blepharo (eyelid) and spasm (uncontrolled muscle contraction)) is any abnormal tic or twitch of the eyelid. ... This article or section does not cite its references or sources. ... Myoclonus is brief, involuntary twitching of a muscle or a group of muscles. ... Lafora disease is a hereditary disease characterised by the presence of inclusion bodies, known as Lafora bodies, within the cells of neurons, heart, liver, muscle, and skin. ... // Chorea sancti viti (Latin for St. ... Choreoathetosis is a combination of chorea and athetosis. ... Restless legs syndrome (RLS, Wittmaack-Ekboms syndrome, or sometimes, but inaccurately, referred to as Nocturnal myoclonus) is a condition that is characterized by an irresistible urge to move ones legs (occasionally arms or torso). ... Stiff person syndrome (SPS) (or occasionally, stiff-man syndrome) is a rare neurologic disorder of unknown etiology. ... A demyelinating disease is any disease of the nervous system in which the myelin sheath of neurons is damaged. ... Pick’s disease, also known as Pick disease and PiD, is a rare fronto-temporal neurodegenerative disease. ... Alpers disease, also called progressive infantile poliodystrophy, is a progressive degenerative disease of the central nervous system that occurs in infants and children. ... Dementia with Lewy bodies is the second most frequent cause of hospitalization for dementia, after Alzheimers disease. ... Leighs disease, a form of Leigh syndrome, also known as Subacute Necrotizing Encephalomyelopathy (SNEM), is a rare neurometabolic disorder that affects the central nervous system. ... Devics disease, also known as Devics syndrome, neuromyelitis optica (NMO), or optic-spinal MS, is an autoimmune, inflammatory disorder in which a persons own immune system attacks myelin of the neurons of the optic nerves and spinal cord. ... Central pontine myelinolysis is a neurologic disease caused by severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area termed the pons. ... Transverse myelitis is a neurological disorder caused by a loss of the myelin encasing the spinal cord, also known as demyelination. ... This article is about epileptic seizures. ... Focal seizures (also called partial seizures) are seizures which are characterized by: preserved consciousness in simple focal seizures impaired consciousness (dream-like) in complex focal seizures experience of unusual feelings or sensations sudden and inexplainable feelings of joy, anger, sadness, or nausea altered sense of hearing, smelling, tasting, seeing, or... Simple partial seizures are seizures which affect only a small region of the brain, often the temporal lobes and/or hippocampi. ... A complex partial seizure is an epileptic attack that involves a greater degree of impairment or alteration of consciousness/awareness and memory than a simple partial seizure. ... Generalised epilepsy is a form of epilepsy, a chronic neurological condition characterized by recurrent seizures, which are a result of abnormal activity in both sides of the brain. ... Tonic-clonic seizures (also known as Grand Mal Seizures, though this term is now discouraged and rarely used in a clinical setting) are a type of generalised seizure affecting the whole brain. ... Absence seizures are one of several kinds of seizures. ... Atonic seizures (also called drop seizures, drop attacks, or akinetic seizures), are a minor type of seizure. ... Benign familial neonatal convulsions (BFNC) is a rare autosomal dominant inherited form of epilepsy. ... Lennox-Gastaut syndrome (LGS), also known as Lennox syndrome, is a difficult to treat form of childhood-onset epilepsy, that most often appears between the second and sixth year of life and is characterized by frequent seizures and different seizure types and is often accompanied by mental retardation and behavior... West syndrome, otherwise known as infantile spasms, is an uncommon to rare and serious form of epilepsy in infants. ... Epilepsia partialis continua is a rare type of recurrent motor epileptic seizures that are focal (hands and face), and recur every few seconds or minutes for extended periods (days or years). ... Complex Partial Status Epilepticus (CPSE) is one of the non-convulsive forms of Status epilepticus, a rare form of epilepsy defined by its recurrent nature. ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Familial hemiplegic migraine (FHM) is an autosomal dominant classical migraine subtype that typically includes hemiparesis (weakness of half the body) during the aura phase. ... Cluster headaches are rare, extremely painful and debilitating headaches that occur in groups or clusters. ... A vascular headache is a headache where blood vessel swelling or disturbance is causing the pain. ... Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988, are the most common type of primary headaches. ... A transient ischemic attack (TIA, often colloquially referred to as mini stroke) is caused by the temporary disturbance of blood supply to a restricted area of the brain, resulting in brief neurologic dysfunction that usually persists for less than 24 hours. ... Amaurosis fugax is a type of transient ischaemic attack (TIA). ... Transient global amnesia (TGA), is an anxiety-producing temporary loss of short-term memory. ... Cerebrovascular disease is damage to the blood vessels in the brain, resulting in a stroke. ... Middle cerebral artery syndrome is a condition where the blood supply from the middle cerebral artery is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel. ... Anterior cerebral artery syndrome is a condition where the blood supply from the anterior cerebral artery is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel. ... Posterior cerebral artery syndrome is a condition where the blood supply from the posterior cerebral artery is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel. ... Fovilles syndrome is caused by the blockage of the perforating branches of the basilar artery in the region of the brainstem known as the pons. ... Millard-Gubler syndrome is a syndrome of unilateral softening of the brain tissue arising from obstruction of the blood vessels of the pons, involving the sixth and seventh cranial nerves and fibers of the corticospinal tract, and is associated with paralysis of the abducens (including diplopia, internal strabismus, and loss... Lateral medullary syndrome (also called Wallenbergs syndrome) is a disease in which the patient has difficulty with swallowing or speaking or both owing to one or more patches of dead tissue (known as an infarct) caused by interrupted blood supply to parts of the brain. ... Webers Syndrome (superior alternating hemiplegia) is characterized by the presence of an oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. ... There are very few or no other articles that link to this one. ... This article is about the sleeping disorder. ... Hypersomnia, also known as excessive daytime sleepiness (EDS), is excessive amount of sleepiness. ... Sleep apnea, sleep apnoea or sleep apnœa is a sleep disorder characterized by pauses in breathing during sleep. ... Ondines Curse, Congenital Central Hypoventilation Syndrome or primary alveolar hypoventilation, is a respiratory disorder that is fatal if untreated. ... For other uses, see Narcolepsy (disambiguation). ... Cataplexy is a medical condition which often affects people who have narcolepsy, a disorder whose principal signs are EDS (Excessive Daytime Sleepiness), sleep attacks, and disturbed nighttime sleep. ... Kleine-Levin Syndrome, or KLS, is a rare sleep disorder characterized by episodes of near-constant sleep and altered behavior. ... Circadian rhythm sleep disorders are a family of sleep disorders affecting the timing of sleep. ... Delayed sleep-phase syndrome (DSPS) is a chronic disorder of sleep timing. ... Advanced sleep phase syndrome (ASPS) is a sleep disorder in which patients feel very sleepy early in the evening (e. ... Normal pressure hydrocephalus (NPH) is a chronic type of communicating hydrocephalus whereby the increase in intracranial pressure (ICP) due to accumulation of cerebrospinal fluid (CSF) becomes stable and that the formation of CSF equilibrates with absorption. ... Idiopathic intracranial hypertension (IIH), sometimes called benign intracranial hypertension (BIH) or pseudotumor cerebri (PTC) is a neurological disorder that is characterized by increased intracranial pressure (ICP), in the absence of a tumor or other intracranial pathology. ... Encephalopathy literally means disease of the brain. ... Herniation, a deadly side effect of very high intracranial pressure, occurs when the brain shifts across structures within the skull. ... Cerebral edema (cerebral oedema in British English) is an excess accumulation of water in the intra- and/or extracellular spaces of the brain. ... Reyes syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver. ... An uncollapsed syrinx (before surgery). ... Syringobulbia is a medical condition when syrinxes, or fluid filled cavities, affect the brainstem. ... Spinal cord compression develops when the spinal cord is compressed by a tumor, abscess or other lesion. ...


  Results from FactBites:
 
multiple sclerosis (8457 words)
While the typical clinical course of multiple sclerosis is characterized by relapsing and progressive disability, there have been examples of subclinical cases of MS where the diagnosis is confirmed only by the presence of large confluent, demyelinating plaques found only upon autopsy.
In his article, "The Pathogenesis of Multiple Sclerosis", Dr. Charles Poser states that multiple sclerosis is in fact an acquired "trait" characterized by "a permanent state of hyper-active or intensified immunocompetent responsiveness of capability" resulting from exposure to a viral antigen (either through primary infection or vaccination) in a genetically susceptible individual.
However, it is important to recognize that the increased antibody titers in patients with multiple sclerosis compared to controls may be evidence that the immune system becomes compromised in multiple sclerosis, not that that particular virus is involved in the etiology and/or pathogenesis of the disease.
Multiple Sclerosis (1524 words)
Multiple sclerosis (MS) is a chronic disease that affects the fatty substance called myelin that surrounds the nerves in the brain and the spinal cord (central nervous system).
The Multiple Sclerosis Genetic Group (MSGG) is a collaborative effort between the Center for Human Genetics at Duke University Medical Center, Vanderbilt University Medical Center, the University of California at San Francisco and UC Berkeley.
The Multiple Sclerosis Genetics Group is collecting this important environmental information on their patients in order to examine gene/environmental interactions.
  More results at FactBites »

 
 

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