Feb 2, 2002
Philippine Daily Inquirer
BY RAFAEL R. CASTILLO, M.D
MULTIPLE sclerosis (MS) started ringing a bell in many people's consciousness when a popular movie actress was reported to be suffering from the disease. Because of the lack of sufficient knowledge about it, varied questions-like is it like a cancer or is she going to become progressively weak-popped into their minds. Some reports in the lay media pictured it as a terminal disease, others said that it was similar to brain cancer. This is quite a distance from what MS truly is.
Here in the Philippines, MS, described as a scarring of the nerves in various sites, is a rare disease affecting only a small fraction of our population. Statistics show that MS occurs in only one out of 10,000 people who are born in a tropical climate. Multiple sclerosis infrequently occurs in people who grow up in countries near the equator, like the Philippines. Local doctors however see such cases from time to time.
Disease of young adults
Women are more likely to develop MS than men. The disease occurs 50 percent more frequently in women than in men. Multiple sclerosis is also known to be a disease of young adults with the mean age of onset at 29-33 years.
Marie L. is afflicted with MS and she assures everyone that it is neither a cancer nor a terminal disease. And definitely, there's still life after MS. Marie, now 33, has been diagnosed with the disease two years ago. She was working as a sales manager in an insurance company when she noticed that sometimes she seemed to be having trouble with her vision. Sometimes, her vision would suddenly blur and there would be pain in one eye. At first she thought it was just an error of refraction so she had an eyeglass fitted by an optometrist in a nearby mall.
However, the eyeglasses made little difference. Aside from her vision problems, Marie also kept on complaining about numbness and tingling in her arms, legs and face. What frightened her most was when she started experiencing difficulty moving her arms and legs. Oftentimes, she felt dizzy and weak. Marie then became more worried when these symptoms started taking its toll on her job and married life.
As a sales manager, part of Marie's job included giving seminars to prospective sales agents and conducting client calls. However, because of the weakness and her impaired vision, Marie found it hard to perform these tasks as efficiently as she had done before. She also experienced mental lapses. Sometimes, while speaking in front of prospective insurance agents, she would suddenly stop because she forgot the titles of the different insurance plan categories offered by their company. This lessened her credibility and convincing power.
Marie and her husband started to be concerned about Marie's condition and they had no idea what she had. They sought their family physician's help who referred them to a brain and nerve specialist (neurologist).
After studying Marie's history and doing laboratory tests including magnetic resonance imaging (MRI) to evaluate her nervous system, the doctor was quite convinced about the diagnosis of multiple sclerosis.
MS is a chronic disease of the central nervous system. It is considered an autoimmune disease, meaning that the body is reacting to and damaging its own tissues. In MS, it causes damage to the myelin sheath, which is the protective covering of the nerves.
Imagine that your nerves are like electric wires. Much like the insulation around the electric wire, the nerves are also protected with many layers of insulation called the myelin sheath. The myelin sheath permits electrical impulses to be conducted along the nerve fiber with speed and accuracy. When myelin is damaged, nerves don't conduct impulses properly.
Though rarely fatal, MS is often progressive. Most people with MS are diagnosed between the ages of 20 and 40 but the unpredictable physical and emotional effects can be life long. The progress, severity and specific symptoms of MS differ from person to person, which means that several patients with MS may not share the same symptoms and pattern of the disease.
The symptoms depend on the location where the sheath is damaged or where the nerve scars develop. For example, when a scar is located in the part of the brain controlling the left leg, the person will have left leg symptoms.
In Marie's case, optic neuritis, the inflammation of the nerves in her eye, was the first symptom of MS. Some experts believe this condition may actually be a form of multiple sclerosis even if the complete syndrome doesn't evolve. Vision, usually in one eye, becomes unclear or doubled, and there may be a shimmering effect. Pain and nystagmus-involuntary jerking or movement of the eye-may also occur.
Other early symptoms of MS include fatigue, heaviness or clumsiness in the arms and legs, tingling sensations, and poor coordination. Another indication of MS is a reaction known as Llermitte's sign, whereby bending the neck produces an electrical sensation that runs down the back and into the legs. As the disease develops over months or even years, other symptoms may include spasticity, imbalance, tremors, incontinence, constipation, sexual dysfunction, hearing loss, vertigo, facial pain, memory loss, and difficulty in concentrating and problem solving.
"But doc, I have always been conscious about my health. I have no vice, so how could it be that I have this disease?" Marie asked her doctor.
"The cause of multiple sclerosis is not yet known, but thousands of researchers all over the world are meticulously putting the pieces of this complicated puzzle together. Basically, there are four theories that try to explain the cause of multiple sclerosis: immunologic, viral, environmental and genetic," the doctor started to explain.
Many of the characteristics of MS suggest an autoimmune disease whereby the body attacks its own cells and tissues, which in the case of MS is myelin. Researchers do not know what triggers the immune system to attack myelin, but it is thought to be a combination of several factors.
Another theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly instigate the autoimmune process.
The virus has not yet been identified but it is probable that there is no one MS virus, but that a common virus, such as measles or herpes, may act as a trigger for MS. This trigger activates white blood cells in the bloodstream, which enter the brain by making vulnerable the brain's defense mechanisms. Once inside the brain these cells activate other elements of the immune system in such a way that they attack and destroy myelin.
Aside from being considered an autoimmune disease, MS is also believed to be caused by various environmental factors. Migration patterns and epidemiological studies have shown that people who are born in an area of the world with a lower risk of MS and move to an area with a high risk acquire the risk of their new home, if the move occurs prior to adolescence. Such data suggest that exposure to some environmental agent encountered before puberty may predispose a person to develop MS later.
Genetics may also play a role in the development of MS. There appears to be some genetic susceptibility to the disease although it is not an inherited disease, nor is it genetically transmitted. This explains the fact that there is a slightly higher risk of MS in families where it has already occurred.
Since all these theories may be involved in the development of MS, some neurologists put together these pieces to explain the whole puzzle. They theorize that MS develops when a person is born with a genetic predisposition to react to some environmental agent, which, upon exposure to such agent, triggers an autoimmune response.
A relationship between stress and the onset of MS or its relapses is considered possible. During times of stress, more energy is required to think, solve problem, and handle daily life. For example, one's ability to be patient with family members often wanes after a tough day. At stressful or demanding times, symptoms may be experienced more strongly, because the energy to deal with them and get on with life has been drained.
To ease Marie's stress a little bit, her doctor assured her that today, there are medications that slow down the rate of relapses and reduce the amount of damage brought about by the disease. Although none of them can cure MS, these drugs slow down the onset of disability and help prevent life-threatening complications for many users.
Marie can't help but feel depressed as she realizes that her future is filled with a lot of uncertainties. Only God knows what is in store for her as she struggles with her disease. However, she also realizes that if she learns to help herself and regain her positive outlook in life, she will be in a better position to adjust more easily with the problems and changes that are yet to come.
Her doctor keeps on reminding Marie
that a patient's attitude can significantly influence the course of his
or her illness. People with many different chronic illnesses have demonstrated
that when they are actively involved in the world around them- especially
in their own health care-their outlook improves. Consequently, they are
able to live a fulfilling and productive life, and barring complications,
they sometimes even surpass the average life span. The future does not
look that bleak in patients with MS. And certainly, they can still look
forward to a meaningful life.
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