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Too often, multiple sclerosis is thought of only as "the crippler of young adults." But in fact, 75 percent of all people with MS will never need a wheelchair. In Multiple Sclerosis, Dr. Louis J. Rosner and Shelley Ross explain that there genuinely is new hope, both for controlling the disease today and for curing it in the future. Multiple Sclerosis covers all the latest information on how to control the symptoms of the disease -- including thorough discussions of the roles of stress, diet, and pregnancy -- along with providing an analysis of the current treatments and of all the latest medical breakthroughs. Also covered are: * The diagnosis (including the revolutionary process of magnetic resonance imaging)
* The varying symptoms and courses of the disease
* The emotional problems that can come with MS and how to cope with them Whether you've just been diagnosed as having MS or you've lived with it for a while, or even if the person with MS is someone you know and love, you should know that misinformation is a far greater enemy than the disease. So though Multiple Sclerosis doesn't provide you with a cure, it can give you the best tool to beat MS -- the facts.
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Dr. Louis J. Rosner is a professor of clinical neurology at UCLA. He was formerly head of the UCLA Multiple Sclerosis Clinic.Excerpt. © Reprinted by permission. All rights reserved.:
MS -- What Is It, Who Gets It, and Why?
If ever a disease could be called fascinating, it would be multiple sclerosis. The volumes of available facts and figures give it an intriguing identity. We know, for example, that in the United States almost triple the number of MS cases are found above the thirty-seventh parallel (running from Santa Cruz, California, to Newport News, Virginia) as are found below it. In certain areas of the world, not a single case of MS has ever been reported. Certain races appear to be relatively immune. Some studies show that women from the upper echelons of society, aged twenty-five to thirty-five, form a noticeably high percentage of MS cases, a fact suggesting that MS is some kind of "elitist" disease. Why do all these facts consistently hold true? Scientists today are closing in on the answers to this and other perplexing questions.
We now know what MS is, who gets it, and when, where, and possibly why. Some aspects of the disease, however, such as its cause, still remain a mystery. In fact, a researcher once compared it to the old Indian legend in which a group of blind men encounter an elephant. They can each describe the part of the animal they have touched, but none of them can explain the total picture. This is the case with MS.
Still, scientists are closer than ever to describing the whole MS elephant. In January 1985 a team of researchers from Stanford University announced that they had wiped out a disease in mice that is similar to MS. We are truly on the threshold of discovery.
Among the general public, MS is one of the most misunderstood diseases. Just think of the public service slogan: MS, the Crippler of Young Adults. That's a pretty gloomy label for a disease where 75 percent of those who have it will never need a wheelchair. Whether you've just been diagnosed as having MS or you've lived with it a while -- or even if the MS patient is someone you happen to care for -- it's important to know that misinformation is a greater enemy than the disease itself. So, while we can't provide you with a cure in these pages, we can give you the best tools to beat MS -- the facts.
The MS story begins almost like a fairy tale, because once upon a time there was no MS -- not a case was known to medicine. Then, in the 1830s, two doctors in Europe began to write of a "new" disease, one never seen before. Jean Cruveilhier, professor of pathological anatomy in the Faculty of Medicine at the University of Paris, is credited with the first clinical report in 1835. During routine autopsies, he observed some "brown patches" in the central nervous system and described them to the medical community. Simultaneously, Robert Carswell was commissioned by the museum at University College in London to show a collection of sketches of the central nervous system that he had drawn as a young medical student. Among the two thousand color pictures he had drawn while observing autopsies were some that included unexplained "spots." In 1838, Carswell published an atlas of his drawings, along with written descriptions. In one chapter he wrote, "The anterior surface of the spinal cord presented a number of spots, from a quarter of an inch to half an inch in breadth."
Both Cruveilhier and Carswell only observed the effects of the disease during autopsies. A German doctor named Friedrich Theodor von Frerichs is given credit for the first diagnosis of the disease in a living subject. In 1849 he published a report more similar to the modern concept of MS. He wrote that it is more common in younger patients, that it is characterized by slow progression, that one side of the body is affected and then the other, and so on.
At about this time, too, reports of this disease started to appear outside medical literature. Perhaps the most famous historical case is recorded in the diary and letters of Sir Augustus Frederick d'Este (1794-1848), a grandson of George III of England and a cousin of Queen Victoria. In his published papers, he described his twenty-five years with recurring symptoms that included blurred vision, loss of balance, numbness in the limbs, and paralysis.
Around the world isolated reports of this odd disease were cropping up, but it is the French neurologist lean-Martin Charcot who is credited with bringing the first clear-cut description of multiple sclerosis to the attention of the medical world. Charcot, the foremost authority on paralysis in Europe, attracted doctors from all parts of the continent to his dramatic lectures and presentations. Among his prominent students was the young Sigmund Freud, who traveled from Vienna to observe Charcot's treatment of patients with "hysterical" paralysis -- those paralyzed by emotional, not physical, problems. Charcot would actually get these patients to walk again by hypnotizing them, tricking them, or frightening them horribly. Freud, who became convinced that there were better ways to treat hysteria, ultimately went off on his own and pioneered psychoanalysis.
Still, what Charcot might have lacked in compassion he made up for in medical genius. In 1868 he identified a new disease that had previously been confused with paralysis. He was able to make his first observations of what would soon become known as multiple sclerosis right under his nose -- his own housekeeper had the disease.
On March 14, 1868, Charcot presented the clinical aspects of three cases to the French Biological Society. Soon after, he presented his own illustrations of the disease -- sketches that would appear in neurology textbooks for many generations to come. Most important, though, he was the first to correlate the "brown patches" discovered by Cruveilhier and Carswell with the symptoms of the disease he called sclérose en plaques, translated as "hardening in patches."
Because of Charcot's reputation and prominence, word of this new disease spread quickly, and the study of neurology would never be quite the same. Unfortunately, he only identified three symptoms of the disease -- the ones he observed in his maid -- and for years this led to very limited diagnosis around the world. In fact, until the 1950s the Japanese were thought to be immune to MS. They weren't immune at all; they had symptoms other than those in Charcot's literature, which was still respected as medical gospel.
The first American reports of MS began with a paper given on December 4, 1867, to the College of Physicians in Philadelphia, called "The Case of the Late Dr. C. W. Pennock." Dr. Pennock had been a physician trained both at the University of Pennsylvania and in Paris. Over a period of twenty-four years, he suffered progressive weakness and numbness in his limbs that left him unable to walk and ultimately to work. Dr. Pennock also noticed that warm weather made him feel weaker. His autopsy report mentioned "spots" that were discovered in the spinal cord. Although no name for the disease was ever given, it is apparent today that the case described was one of multiple sclerosis. It wasn't until 1878 that the term sclerosis appeared in American medical literature.
Our knowledge of MS is fairly new. As we look back now, the question is, Did MS appear out of the blue in the 1830s, or was it an older disease overlooked by doctors who made less acute observations? If it is a relatively new disease, it wouldn't be the first time in medical history a disease has suddenly appeared. Syphilis, for example, was unheard of before 1492, one of the more important dates we learn in elementary school. This is not a coincidence, since it was actually Christopher Columbus and his sailors who brought the disease to Europe. Syphilis was a very mild disease that was common among the women of Haiti. After Columbus's first voyage, he and his sailors returned to Europe via Haiti, where they contracted the disease. Unfortunately, Europeans had no immunity to syphilis, and it spread throughout the continent with very serious consequences.
In more recent times, too, brand-new diseases have appeared seemingly out of nowhere. The first case of Legionnaire's disease appeared in 1977, and the first case of AIDS (acquired immune deficiency syndrome) was diagnosed in the United States in 1980.
Why bother to trace the history of a disease at all? Quite often a little piece of information can help define the cause and lead to a cure or effective treatment. While medical debates still continue over the origin of MS, there is convincing evidence that MS was new on the scene in the 1830s.
WHAT WE KNOW ABOUT MS TODAY
Multiple sclerosis is a disease that strikes only the central nervous system, which consists of the brain and spinal cord. These organs control the movements and functions of the entire body. As the brain sends and receives signals, the spinal cord funnels them in and out, to and from different parts of the body through a network of nerves.
The nerves are surrounded by insulating matter called myelin -- a soft, white, fatty substance that forms a protective sheath for the nerves. The myelin sheath, which develops in the first ten years of life, insulates the nerve fibers and helps conduct signals through the body.
Multiple sclerosis is a disease where the myelin breaks down and is replaced by scar tissue. This demyelination can slow down or even block the flow of signals to and from the central nervous system to the rest of the body, impairing such functions as vision, strength, or coordination. One important characteristic of myelin, however, is that it can repair itself. This ability, called remyelination, is one of the reasons MS is usually associated with many attacks, or exacerbations, and recoveries, or remissions.
No one knows what actually causes MS, but we do know that it is an acquired disease -- you are not born with it. Multiple sclerosis is also an exogenous disease, meaning that it is contracted from the outside. And fortunately, it is not contagious. American researchers have shown that the rate of increased prevalence among husbands and wives is only 1 percent. In England, the prevalence of MS among husbands and wives is less than among the general population, occurring at a rate of 4.9 per 10,000 compared with 5.0 per 10,000.
Multiple sclerosis is often confused with other diseases, most commonly muscular dystrophy (MD) and arteriosclerosis. Multiple sclerosis is not related to either. Muscular dystrophy is a disease of the muscles; arteriosclerosis is a disease that causes hardening of the arteries and blood circulation problems. Because MS is confined to the central nervous system, it has been confused with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. Amyotrophic lateral sclerosis is a disease of the nervous system, but it is very different from MS; it has no effect on the myelin sheath but destroys the motor neurons in the central nervous system that directly control muscles.
WHO GETS MS?
The focus of much MS research has been in the area of epidemiology -- the study of diseases in terms of their geographic and ethnic occurrence, with analysis of all factors including environment and heredity. The epidemiology of MS is nothing less than intriguing.
Since World War II more than 250 prevalence studies of multiple sclerosis have been conducted. As seen in much of the medical literature, many of the studies conflict. According to the National MS Society, the number of reported cases of MS in the United States is approximately 250,000. The actual number of Americans with MS, however, may be closer to 500,000. Because many patients with minor symptoms never consult a doctor about them, they often ascribe the condition to stress, nerves, and other self-diagnosed causes. Additionally, with recent technological advances, the number of MS cases may climb even higher. New diagnostic tools are showing that many people have "silent" MS: They have MS lesions throughout their central nervous systems, but they never have a single manifestation of the disease.
There is no question that multiple sclerosis has a specific age of onset when symptoms first appear. MS rarely strikes before age ten or after age fifty, and symptoms generally appear between ages twenty and forty. Statistically, the average age of onset is twenty-eight, and the average age of diagnosis is thirty-three. (The average age of onset is slightly lower for women than men.)
Interestingly, the richest countries, with the highest standards of sanitation, have the highest incidence of MS. The poorest countries, with lower standards of hygiene, have the lowest percentage of MS cases. Two large and carefully conducted American studies, along with another from England, have shown that MS has a predilection for the socially privileged. The evidence suggests that people in less sanitary communities may develop some sort of immunity to MS early in life. Although other studies from Ireland, Israel, the Canadian city of Winnipeg, and the Orkney Islands off northern Scotland do not support these findings, MS has maintained its reputation as a disease of the middle and upper classes.
Worldwide research shows that MS has a definite geographical distribution. It has been long established that MS is more prominent in colder regions and very rare in subtropical and tropical areas -- the farther away from the equator, the higher the incidence of MS. In the United States, the farther north, the more MS. And, in fact, if a line were drawn straight along the thirty-seventh parallel, the incidence above the line,would be almost twice that below it: Canada has twice the MS incidence of the United States.
Around the world, high-density areas of MS (30 cases per 100,000) include northern Europe into the USSR, Canada, the northern United States, New Zealand, and southeastern Australia. Medium-density areas (between 5 and 29 cases per 100,000) include nothernmost Scandinavia, the central USSR, southern Europe, the southern United States, and much of Australia. Low-density areas (fewer than 5 cases per 100,000) include all of Asia and the tropics.
Most evidence suggests that exposure to MS occurs before age eighteen, followed by a latency period (before symptoms appear) of twenty-one years. This has been most clearly documented in migration studies conducted in Israel and South Africa.
In Israel scientists recorded every single case of MS -- the age of onset, where each patient came from, at what age he or she immigrated, and the latency period. They found that MS was unknown among native-born Sabras and immigrants from North Africa and Yemen but high among immigrants from western, northern, and eastern Europe. In fact, the MS frequency among immigrants matched the incidence rates in their native countries.
The MS surveys in South Africa were equally revealing. There the native-born blacks and whites were found to have a very low incidence of MS (only 3 cases per 100,000), while the immigrants, mostly from the United Kingdom and the Netherlands, had a high incidence (50 cases per 100,000). However, studies also showed ...
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