Multiple Sclerosis, or encephalomyelitis disseminate, is an inflammatory, autoimmune disease that 2-150 out of every 100,000 people are infected

with. It can cause problems with muscle control, strength, vision, balance, and thinking. Multiple Sclerosis, damages the fatty myelin sheaths around the nerve cells axons, which ultimately leads to de-myelination and scarring as well as a number of signs and symptoms. The disease has a characteristic affect on the Nerve cells and their ability to communicate with each other. Multiple Sclerosis is more common in women, and its onset usually occurs during young-adulthood, but can occur later in life. The Life-expectancy of a person diagnosed with MS is 5-10 years less than that of a normal person of their gender and health. Though the cause of MS is not entirely known, there is however a number of theories that combine a great number of different hypotheses as to what causes the disease. Epidemiological studies have given doctors some clues as to what the diseases cause is, but none of this evidence has been enough to produce a single, viable theory. Most theories differ in what they believe causes it, but all of them can agree that it is a combination of several different genetic, environmental, and infectious causes that all lead to diagnosis, or enhance ones risk of being diagnosed. Vascular problems have also been thought to be a cause of MS, but no research has proven definitive. Multiple genetics-related phenomena have been linked to MS, but the disease is nonetheless not considered to be a hereditary genetic disease. A much higher risk in contracting the disease is present in those who have a family member with the disease, with the average familial recurrence rate being about 20%. Monozygotic twins have the highest recurrence rate at 35%, while regular siblings have approximately a 5% recurrence rate.

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Several specific genes have been linked directly to a higher risk of contracting MS. Differences in the Human Leukocyte Antigen system, a group of genes in chromosome 6 of the human genome that serve as the Major Histocompatibility Complex (MHS) have been shown to increase the probability of diagnosis. The alleles DR15 and DQ6 of the MHS have also been shown to increase the probability. Conversely, HLA-C554 and HLA-DRB1*11 have been shown to decrease the probability of being diagnosed with MS. There are a number of environmental risk factors that can increase ones susceptibility to MS. These environmental risk factors can be of both infectious and non-infectious origin. Some of the environmental risk factors have even been geographical. There are more than likely many more environmental risk factors that scientists have simply not discovered yet. Many of these environmental risk factors are included in the theories that I mentioned earlier, but none have really proven completely definitive, and simply been linked with a higher risk of getting MS. MS is much more common in people who live further away from the equator, but many people far from the equator dont have MS, and many people near the equator do have MS, so this idea is not entirely accurate, but more of a just a trend highlighted by scientists. A lack of exposure to sunlight has also been shown to be a risk factor of MS. This is mainly due to the decrease in Vitamin D production from lack of sunlight, so really the main risk factor here is the lack of Vitamin D. Smoking has been shown to be an independent risk factor of Multiple Sclerosis, though it is not known entirely how the increase in risk is caused. Exposure to toxins and solvents at an occupational level has been proposed as a possible risk factor, but currently, no verdict has been reached on this, as research continues. As with the other possible environmental risk factors,

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Diet, as well as hormone intake have been investigated as possible risk factors, but not enough is known to clearly link them to a higher risk. Severe stress has also been proposed as a risk factor for MS. The infectious environmental causes of MS, just as the non-infectious, environmental causes are mostly theoretical, and no clear link has been shown between many of them, and higher risk factors for MS. Some hypotheses state that exposure to a number of infections during an early age can actually serve protective purposes against contracting MS, the reason being that MS is a result of infections from these disease later in life. Human Herpes virus, as well as Measles, Mumps, and Rubella have also been shown to be linked with MS. Another theory known as the Prevalence Theory states that that Multiple Sclerosis is contracted due to exposure to a certain pathogen that is much more common in areas that have high MS prevalence. The pathogen is more than likely a common one that causes in most individuals an asymptomatic persistent infection, but in people with high MS risk, after many years, the infection will begin to cause de-myelination and the onset of the disease. The process that Multiple Sclerosis affects is ones nerves, and their ability to communicate with one another. To understand how this process is affected, one must first understand the layout of nerves, as well as how nerve cell communication works. Nerve cells, also known as Neurons are highly specialized cells used to transmit messages (nerve impulses) through our bodies. Nerve cells differ structurally from most cells in the human body, but do share some common features. All Neurons have a cell body that contains the nucleus and is the metabolic center of the cell. The arm-like fibers that radiate from the cell body through the human body are also known as processes, or fibers, and can range from
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microscopic length, all the way up to 3-4 feet. Neuron Processes that conduct nerve impulses towards the cell body are known as Dendrites, while the processes that conduct nerve impulses away from the cell body are known as axons. Neurons may have hundreds of dendrites, but all neurons only have one axon. Each Axon Terminal is separated from the next neuron by a gap called the Synaptic Cleft, which is an important part of the Nerve Impulse event. Most long nerve fibers are covered in a fatty, whitish substance known as Myelin. Myelin has a waxy appearance, protects and insulates the nerve fibers, and increases the transmission rate of nerve fibers. Axons outside of the Central Nervous System (CNS) are myelinated by Schwann Cells. Schwann Cells are specialized supporting cells that wrap themselves tightly around the Axons in a sort of jelly-roll like fashion. When the wrapping process is done, the covering is then known as the Myelin Sheath. The Nerve Impulse event that is interrupted by Multiple Sclerosis is a very complex process, by which our body communicates feelings from the outside world to the inside of our body. Basically, a nerve impulse works like so. The membrane of the nervous fibers starts out with a positively charged exterior and a negatively charged interior. The chief extracellular ion is sodium (NA+), while the chief intracellular ion is potassium (K+). The membrane is relatively impermeable to both ions. This set of conditions is known as the resting membrane. A nervous stimulus then initiates a local depolarization, where the stimulus changes the permeability of a section of the membrane, and sodium ions diffuse into the cell quickly. This changes the polarity of the cell, with the inside now being more positive, and the outside being

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more negative. If the stimulus is strong enough, the depolarization will actually cause a complete reversion of the membrane polarity, which in turn generates an action potential. This action potential is what we know as a nerve impulse. Depolarization in one patch will alter the permeability of the adjacent patches, causing their polarity to reverse as well. It is in this manner that the action potential propagates down the entire length of the nerve fiber, changing the polarity of sections of the fiber piece by piece. After the Action Potential has passed, Re-polarization then occurs, basically reversing the effects of the passing action potential. Potassium Ions then diffuse out of the cell, as the membrane permeability then changes back to normal, restoring the negative charge on the inside of the membrane and the positive charge on the outside of the membrane. The Re-polarization process occurs in the same direction that the depolarization process occurred in earlier. The ionic conditions are then restored by the actions of the sodium-potassium pump. The manner in which Multiple Sclerosis affects this process, as well as the nervous cells works basically by destroying the myelin sheaths and altering their structure. Basically, the sheaths around the nervous fibers are, over time, destroyed, and changed into hard coverings known as scleroses. The scleroses then prevent the nervous signal from transmitting, which in turn, takes away a persons ability to command their muscles. Over time, they become more and more disabled and are increasingly affected by attacks that bear some of the key symptoms of MS. Multiple Sclerosis can affect every person in different ways, but there are a number of different symptoms that affect most people. The symptoms for each person depend on what part of the brain and spinal cord is being affected. These symptoms occur in waves known as attacks. Each attack can function or occur differently.
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Attacks can last any amount of time, from days or weeks, all the way to months. Each period of attack is followed by a period of almost no or little symptoms. These periods are known as remissions, and can also last any amount of time. Some of the early warning signs that could show that one might possibly have MS are Muscle problems, sensory problems, visual problems, and balance problems. The muscle problems can include recurring weakness and fatigue, as well as stiffness. A victims limbs may begin to feel weighted and they will have trouble moving them. They may begin to drag their leg or legs when they walk, as they will have trouble lifting their feet off of the ground. They might have trouble gripping objects, or dropping things more often than they usually do due to this difficulty. The visual problems can include, but are not limited to both blurred and foggy vision. There is a possibility of pain in ones eyeballs, with this being much more likely if they are moving their eyeballs. Complete or partial blindness may occur as well as double vision, assuming one is not already blind. Optic Neuritis, a sudden loss of vision that is usually particularly painful is a common first symptom in many victims of MS. The sensory-related symptoms that often occur at the onset of MS can include a tingling feeling in the affected area, and possibly a sensation of needle-pricks on your skin. One might feel tightness in the chest, abdomen, or limbs, and feelings of electricity in the affected area. Another common sensation is a spinning sensation, when one is standing still. Victims of Multiple Sclerosis may have trouble standing up, as they are too dizzy and light-headed due to balance related nervous problems.

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These are only the symptoms that occur at the onset of the disease, as over time, the symptoms can worsen, and newer, worse symptoms can also appear. Tremors of pain can occur that move quickly through the body, causing pain in more than just the affected area. Problems controlling ones urination can also occur, and victims may need to make over-frequent bathroom trips to accommodate. Problems with swallowing can be a worsened symptom, and problems focusing mentally may also occur. Depression can be caused, and victims who already have depression may experience worsened depression. Mood swings are also a common worsened symptom of Multiple Sclerosis. Victims of MS can become very sensitive to the effects of heat. Their symptoms can actually be worsened by increased artificial or environmental heat, as well as hot showers or exercise. These worsened symptoms wont go away until the victim has a chance to lower their body temperature. Diagnosing MS can be a complex process, as so little is known about the disease as a whole. With the symptoms and possible causes covering such a broad range, its impossible after experiencing the symptoms in one attack to prove that it was caused by MS. There is always a possibility of the symptoms being similar to those of a Multiple Sclerosis attack, but actually being caused by an entirely unrelated ailment. As many as 10% of people who are diagnosed with MS are actually suffering from another disease, and during subsequent diagnoses, this confusion is resolved. Other conditions that may be mistaken for MS, or share the symptoms include, but are not limited to, blood vessel inflammation, strokes, deficiency in certain vitamins, lupus, or brain infections. Stress-related problems share the symptoms and can also lead to a misdiagnosis of MS.

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A proper diagnosis of MS is carried out by first having a doctor examine yoyr medical history, and then having a neurological scan done on your brain to test certain functions of your brain and spinal cord. A large part of a proper diagnosis is the skill of the doctor in his or her abilities to ask the correct questions to find out important information and properly assess the signs of a malfunctioning brain and/or spinal cord. Additional specialized tests that can be done in order to assist with a diagnosis of MS, but are not necessary for a proper diagnosis are specialized imaging techniques such as MRIs, spinal taps, or lumbar punctures. Evoked potential tests can also be used as well as lab analyses of blood samples. Brain Lesions are another prominent sign of MS, and two or more lesions on ones brain are important criteria that can lead to a diagnosis of Multiple Sclerosis. The criteria that doctors usually look for when considering a Multiple Sclerosis diagnosis are signs that indicate a disease of the brain or spinal cord, physical evidence of a disease of the brain or spinal cord that come up on a doctors exam, two or more attacks that last at least twenty-four hours, and occur at least a month apart, and no other explanation for the symptoms other than a Multiple Sclerosis diagnosis. MRIs are generally acknowledged as being the most efficient test to view the changes in the brain and spinal cord that are caused by Multiple Sclerosis. The sharp image created by an MRI allows Neurologists to take a clear look at the scarred tissue in the deep of the brain and on the spinal cord that is a characteristic symptom of Multiple Sclerosis. MRIs cannot be the only system used for a diagnosis as brain spots can also be caused by a number of other conditions. Approximately 5% of all patients who are believed/confirmed to have Multiple Sclerosis when

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other criteria are taken into account are actually proven not to have Multiple Sclerosis when checked for brain lesions via an MRI. Other tests given to prospective Multiple Sclerosis diagnosees are electrical tests of ones nervous paths, also referred to as Evoked Potentials, are useful when confirming a diagnosis on the basis of other criteria, as they can help doctors to realize whether or not the disease has altered the visual, auditory, or sensory pathways. Evoked Potentials are done by putting wires on ones scalp and testing the brain by watching ones electrical responses to certain stimuli, like watching a video, listening to sounds, or getting electrical shock in the limbs. Blood Tests are useful if a doctor wants to eliminate possible outside conditions that could be mistaken for Multiple Sclerosis. There are several treatments that have been shown to slow the progress of Multiple Sclerosis, however there is no cure for the disease. Most of these treatments are known as disease modifying drugs. There are currently seven disease modifying drugs on the market. These include Avonex (interferon beta-1a), Betaseron (interferon beta 1b), Copaxone (glatiramer acetate), Novantrone (mitoxantrone), Rebif (interferon beta-1b), Tysabri (natalizumab), and Glenya (fingolimod). The disease-modifying drugs work by suppressing the activity of the human bodys immune system. These drugs prove that Multiple Sclerosis is at least somewhat caused by abnormalities in the immune system, that causes the body to attack its own Myelin Sheaths, however once again, as stated earlier, none of the causes are definitive, and MS is believed to be a mixture of a number of causes. The Disease Modifying drugs do not cure Multiple Sclerosis, but they do lower the frequency as well as the severity of the episodes, and can slow (but not

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prevent) the development of new lesions on the brain. They also slow the progression of the disease as a whole, which can help to lower or lessen the effects of possible future disabilities caused by Multiple Sclerosis. There are a number of side-effects associated with these drugs, and they are all different as the active chemical ingredient in each treatment is different. When a patient wants to consider going on one of these drugs, which is highly recommended immediately after diagnosis are potential side-effects, benefits, frequency, method of delivery, personal concerns, as well as lifestyle. Multiple Sclerosis is a somewhat unknown, however still very dangerous disease that can be dealt with for the most part under good circumstances. Doctors currently know some information about the disease, however much is still not known about its cause, as well as the effects on the body. What is known is that it is an autoimmune disease that affects the manner in which the brain communicates with the other parts of the body, due to a conversion of the myelin sheaths around the nervous pathways. Though there is currently no cure for the disease, doctors are currently researching and marketing new techniques to assist those who have unfortunately been diagnosed. There is hope for people who have been diagnosed, and hopefully a cure can be found eventually.

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Works Cited New England Journal of Medicine. 10 March 2012 <http://www.nejm.org/doi/full/10.1056/NEJMoa1100648>. New York Times. New York Times Health. 10 March 2012 <http://health.nytimes.com/health/guides/disease/multiple-sclerosis/overview.html>. Webmd. 10 March 2012 <http://www.webmd.com/multiple-sclerosis/guide/recognizingmultiple-sclerosis>.

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