Multiple Sclerosis

Alternative Names: MS.

Multiple Sclerosis is an unpredictable disease of the nervous system which manifests itself primarily through disorders in mobility.  It is associated with a variety of other symptoms and complications.  The most important fact about multiple sclerosis is its unpredictability and its uncertainty.  There are very few certainties to be found anywhere in any aspect of this disease. Multiple sclerosis is a demyelinating disease of the white matter of the central nervous system.  Gray matter consists primarily of nerve cells.  Axons (nerve fibers) are the connections between the cell body and the muscles, sensory organs, and primary organs such as the heart.  These nerve cells are the communication system both within the central nervous system and between it and the rest of the body.  Axons are sheathed in myelin, a white substance (hence the term "white matter") that insulates them and speeds transmission of impulses along the cell fibers.  Electrical impulses move along the nerve fiber to the synapse (the connection point between cells) to the next nerve cell.

Incidence; Causes and Development

MS is the most common demyelinating disease of the central nervous system.  In the United States alone, there are at least 250,000 cases.  For reasons that remain unclear, it is more prevalent in northern temperate zones and affects noticeably more women than men.  The average age of onset is thirty years.

The lesions or plaques of multiple sclerosis are areas of tissue damage arising from inflammation, which occurs when white blood cells and fluid accumulate around blood vessels.  This inflammation causes destruction of myelin.  After the fragments are cleared away, a scar is formed in the area which is the lesion, or area of demyelinization.  These lesions impede conduction of signals by blocking or slowing communication, either completely or partially and from time to time.  The process can be thought of as similar to an electrical short circuit.  The symptoms of multiple sclerosis result from this loss in signal conduction.

Studies indicate that an environmental factor, perhaps exposure to a virus, when combined with a genetic predisposition to the disease, may well dictate occurrence of the disease.  MS is not a genetically transmitted disease; it may be an autoimmune disease, with some part of the body attacking itself.

Signs and Symptoms

Symptoms may appear very rapidly, within minutes or days, or very slowly, over a period of weeks.  They may be very transient and come and go rapidly.  New symptoms may accumulate; old symptoms may reappear and/or intensify.

Symptoms of MS vary enormously, both from patient to patient and, over time, in one patient.  There are three primary courses the disease may take:

• A benign course, involving a few early mild attacks followed by almost complete remission, leaving little or no disability (30% of cases)
• An exacerbating-remitting course with more early attacks with less complete remission resulting in some disability, followed by long periods of stability (40% of cases)
• A progressive course involving a slow and continuing progression of the disease with no remission (30% of cases).

Diagnosis and Tests

Diagnosis of MS is difficult.  A medical history and clinical examination must show at least two separate lesions that have occurred at more than one time.  Obviously, any other possible causes must be ruled out.  Because of the difficulty of diagnosis, the presence of MS is usually deemed to be either definite, probable, or possible.  There is no one specific diagnostic test that can either confirm or rule out its presence.

A neurological examination can indicate lesions through the presence or absence of various signs and reflexes.  Computerized tomographic (CT) scans will show some lesions.  Magnetic resonance imaging (MRI) usually reveals many more lesions than the CT scan, including some that may be subclinical.  An autopsy will usually show many more lesions than were suggested by either symptoms or signs.  These lesions are probably the result of subclinical attacks of the disease. 

Brain wave testing of responses to various forms of stimulation of the eyes, ears or other parts of the body may demonstrate delays in these responses and indicate lesions that are clinically silent (producing no symptoms) and can sometimes firm up a questionable diagnosis from probable to definite MS.  Testing of the cerebrospinal fluid for protein content, the number and type of white blood cells, and the amount of Ig6, a gamma globulin, can also support a diagnosis.  An old diagnostic technique is to see whether a person becomes worse after a hot bath.

Treatment and Prevention

There is no cure for multiple sclerosis.  Many promising modes of treatment are being developed and tested but most remain experimental.  An enormous amount of research is currently being done on the causes and processes of multiple sclerosis, and understanding of the disease continues to increase.

The Swank Diet
Dr. Roy Swank has provided convincing evidence that a diet low in saturated fats over a long period of time can slow down and in some cases stop the degenerative process in multiple sclerosis.  The Swank diet calls for:

1. No red meat for the first year of the diet (including the dark meat of turkey and chicken).  Following the first year, 3oz of red meat will be allowed per week
2. No dairy products containing 1% butterfat or more
3. No processed foods containing saturated fat
4. Saturated fat intake below 15gm (3 teaspoons) per day
5. Unsaturated fat intake at a minimum of 20gm (4 teaspoons) and a maximum of 50gm (10 teaspoons) per day
6. 1 teaspoon or 4 capsules of cod liver oil each day

The results of Dr. Swank's 34-year study from 1949-1984 are impressive.  Patients diagnosed as minimally disabled showed very little progression of the disease.  Only 5% of the diet group failed to survive the 34 years of the study while a remarkable 80% of those not following the diet failed to survive the same time period.  Moderately and severely disabled patients progressed much better subjectively and objectively than those that did not follow the diet.  The diet has been credited with preventing a worsening of the disease, greatly reducing fatigue, and dramatically reducing the death rate.

Prognosis

Some of those with an exacerbating-remitting course will eventually develop a slow progression involving fewer and less complete remissions with cumulative disabilities.  Very rarely, there is a rapidly progressive course leading to death.  MS itself is almost never the cause of death; death results from accompanying complications or infections.  Generally speaking, the life expectancy of those with MS is at least 75% of normal.

Exacerbations and remissions are difficult to define.  An exacerbation is an acute appearance of new symptoms or worsening of old symptoms which lasts at least 24 hours, while a remission is a total or more often partial clearing of symptoms and signs which lasts more than 24 hours.

Exacerbations - episodes of new disease activity - are not easy to diagnose with certainty.  New symptoms may result from old, not new, areas of disease that were previously silent.  Conversely, recurrence of old symptoms is not a sure indication of lack of exacerbation.  Over time, the disease process may result in the formation of new plaques or the enlargement of existing ones.  Exacerbations can be caused by heat, physical trauma, extreme fatigue, psychological stress, infections, or any other kind of stress.  While all of these factors have been associated with exacerbations, there is little empirical data to support these associations.

There does seem to be a direct correlation between the degree of remission from an exacerbation and its duration.  For example, 85% will usually improve spontaneously from an exacerbation that lasts one week, but only 7% will improve after an exacerbation lasting one to two years.  Over time, a series of exacerbations and remissions may result in a gradual accumulation of irreversible changes and disability.

There are factors that may be predictive of the course of the disease.  An earlier age at onset may mean a more benign course.  If, at onset, symptoms are sensory, the course of the disease may be less severe, while motor symptoms (weakness or poor coordination) at onset may be predictive of greater disability.  Again, as with everything to do with this disease, variation is extreme and the course and progression of the disease is unpredictable.