September 19, 2019 at 11:34 pm #349
What is Multiple Sclerosis?
A recently completed study found that there are approximately one million (1,000,000) people in the United States with some for of Multiple Sclerosis. There are about 2.3 million people worldwide suffering from MS. There are approximately 200 cases per day, or about 73,000 people annually, diagnosed in the US.
Multiple Sclerosis is autoimmune disease. It is classified as an autoimmune disease because the immune system attacks the myelin, the fatty covering of the nerve cells, of the central nervous system (CNS), as if it is a foreign invader in the body. The CNS consists of the brain and spinal cord in the body. The reasons for the attack on the myelin are unclear. The myelin that covers the nerves in the body are made of lipids (fatty substances) and proteins. The rest of the nerves in the body are considered peripheral nervous system (PNS). CNS myelin is produced by special cells called oligodendrocytes. PNS myelin is produced by Schwann cells.It is not known why the difference stops MS from attacking the PNS and allows it to attack the CNS.
How is MS diagnosed?
When the body attacks the brain or spinal cord it causes areas called “lesions” that can be detected by using a test called an MRI for Magnetic Resonance Imaging. While a computerized tomography (CT) scan, usually referred to as a “cat scan” can detect larger lesions the MRI is the test most often used because of its higher resolution.
It should be pointed out that brain lesions are not the definitive marker for MS but only one part of the puzzle. There are other conditions that can cause a lesion such as:
- Brain aneurysm
- Hydrocephalus (a congenital brain abnormality)
- Traumatic brain injury
There is no known cause for MS and no one test that can detect it. There are usually a battery of tests in addition to the MRI or CT that are designed to rule out any other causes for the lesions. Other tests may include nerve tests that test the nerve response to light and sound, and testing how the nerves of the arms and legs conduct signals.
Another test that is often used is the spinal tap, or lumber puncture, usually referred to as an LP. In this test the doctors are looking for oligoclonal bands, or o-bands. If the CSF doesn’t have these proteins, though, the patient may still have multiple sclerosis. 5% to 10% of people with the condition never show signs in their spinal fluid. There are other diseases that can cause o-bands to appear in CSF such as:
- Lyme disease
- Neuromyelitis optica (Devic’s disease
- Systemic lupus erythematosus
An LP by itself can’t confirm or rule out a diagnosis of multiple sclerosis. It must be part of the total picture of testing for the disease. There are usually many blood tests also including tests for other diseases that can mimic MS such as Lyme Disease. Most doctors will try to rule out everything else before giving a diagnosis of Multiple Sclerosis.
MS is a very large puzzle. It helps to find a Neurologist that has experience in diagnosing and treating MS. This can be the most important — and most difficult — piece of the puzzle for most people.
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