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Multiple Sclerosis Definition. This is a condition characterized by the inflammation and then gradual degeneration of myelin sheaths in the spinal cord and brain. Demographics. Multiple sclerosis (MS) strikes both men and women, but women get it at least twice as often. Two out of three cases are identified between the ages of 20 and 40. The average age of onset overall is 33. It is practically unknown for MS to be first diagnosed during childhood, or after the age of 60. Statistically, MS favors people from latitudes far away from the equator, both North and South, but no one really knows whether this is an environmental or genetic tendency. There are about 350,000 cases of MS in the United States, and about 8,800 new cases are diagnosed every year. Etiology. The word sclerosis means hardened scar or plaque. In MS there often are several different areas in the central nervous system (CNS) that show these plaques where myelin should be. As the myelin is replaced, the electrical impulses that should be tying the whole system together literally short-circuit. This results in motor and sensory paralysis, instead of coordinated movement and feeling. The signs and symptoms of the disease, like so many disorders of the CNS, depend entirely on where and how much of the nerve tissue has been impaired. This is
one of those mysterious conditions that can defy any effort to pin Causes. This is one of those mysterious conditions that can defy any effort to pin it down to a single distinct cause. One theory involves an unidentified virus, which may lead to an autoimmune reaction against myelin. The human herpesvirus type 6 (HHV-6) has recently been implicated in MS and other demyelinating diseases but has not been named as a definitive cause. MS does not seem to be directly hereditary, although there may be an inherited vulnerability to other MS triggers. People who have a close relative with MS have only a 2 to 5 percent chance of developing the disease themselves.
Signs and Symptoms. This disease is sometimes called "The Great Imitator" because its initial symptoms can look like anything, depending on what area of nerve tissue has been affected. The earliest symptoms (which are almost never identified as such) generally include temporary tingling or weakness in isolated areas in the extremities, especially after exercise or a hot bath. Other early indicators include eye pain (optic neuritis is considered by some to be a reliable precursor of MS), fatigue and Lhermitte's sign--electrical sensations running down the spine when the neck is in flexion. Later symptoms include clumsiness, spasticity, blurred speech and/or vision, problems with light and color perception, and loss of bladder control. There may be facial pain, vertigo, tremors, memory loss and difficulties in concentration. Many MS patients also experience digestive disturbances that vary greatly from day to day. The order in which MS symptoms appear can vary widely, which is one reason this condition is so difficult to diagnose. Most MS patients who are diagnosed at a relatively young age experience periods of diminished function that may last days or weeks, followed by longer periods of remission, during which function is partially or totally restored. New plaques are forming on the myelin sheaths during these episodes of degeneration. Many people have only one attack and experience a complete recovery in their lifetime. Persons who show no symptoms until later in life often have a steadily progressive situation with no periods of remission. Diagnosis. There is as yet no definitive test to diagnose MS. The disease is identified through a description of symptoms, a family health history, a spinal tap to look for raised antibody levels and myelin fragments, and MRIs that can reveal CNS lesions. (The lesions shown in MRIs may be from sources other than MS, however, so they are not considered a definitive diagnosis.) Nerve conduction tests to measure the speed of electrical impulses through nerves also may be conducted. There are several conditions that can produce MS-like symptoms. Part of a thorough diagnosis is ruling out the following:
Treatment. Different cases of MS respond to vastly different kinds of approaches, ranging from vitamin therapy to hyperbaric oxygen chambers. Therefore, it is quite possible that one day it will be discovered that MS is not a single disease at all, but rather a group of several distinct problems that produce similar symptoms, but which must be treated differently. Treatment for MS usually takes a two-pronged approach: symptom abatement and inflammation control. Medicines that will modify disease activity (i.e., control the frequency and severity of attacks) are also used. Symptom control is generally aimed at the most debilitating aspects of MS. Medication to combat fatigue works well for some patients, but is poorly tolerated by others. Other medications can help with bladder control, constipation, tremors, facial pain and spasticity. Perhaps the most important symptom or complication of MS to treat is the depression that often accompanies any degenerative disease. Steroids are sometimes prescribed to limit inflammation during acute MS episodes. These can reduce symptoms in the short run, but have not been shown to have long-lasting benefits, and their side effects can be severe. Therefore, they are usually used only as a temporary measure. Some of the most exciting research happening in MS treatment is in drugs that can improve the efficiency of electrical transmission, even through damaged neurons. While still in the experimental stages, these medicines may soon become the standard treatment for MS patients. Prognosis. Even though not much is understood about the cause of this disease, there are a lot of statistics about how it affects the populations of people who have it. For instance, about one-third of the people diagnosed with this disease have no lasting debilitation. Seventy percent of people diagnosed with MS are fully functional five years after diagnosis. Half of them are still working 10 years after diagnosis, and 66 percent are fully ambulatory 25 years after diagnosis. That's all on the bright side. The dark side illustrates that about one-fifth, or 20 percent, of all cases don't experience the typical relapse-remission cycle. Instead, they suffer a slow, steady degeneration. These patients usually have a late onset of the disease, and they experience the most extreme form of it. MS is not a terminal disease in itself. People who have MS generally have a life span of about six years shorter than average. People who die prematurely from this disease are usually immobile, and they fall prey to an opportunistic disease, such as a kidney infection, urinary tract infection or pneumonia. Massage? This disease usually has acute and subacute periods; massage is indicated in the subacute stages. But care must be taken not to overstimulate the client, which can result in painful and uncontrolled muscle spasms. Symptoms also may be exacerbated by heat. Every client with MS will present his or her symptoms and problems differently. If sensation is present, massage can be useful as an agent against stress (which seems to trigger relapses), depression and spasticity, and it will help to maintain the health and mobility of the tissues. In areas where sensation is not present, nonmechanical types of work (i.e., very light effleurage and energy work) may keep some of the neurons firing. Case History: Multiple Sclerosis Tricia is a 36-year-old mother of five children. Eighteen months ago she moved into a new house, and her youngest child started school. For the first time in 15 years she was looking forward to having some time to herself. One morning, after returning from a vacation, there was a pain that felt like a stone bruise in Tricia's left heel. She assumed it was from too much walking while she'd been on vacation. Two weeks later she noticed a lack of sensation in her foot that traveled up her leg to her knee. Her right leg also began to have symptoms. She felt numbness and tingling in her left hand. Tricia couldn't put her heels down because there would be a sharp tingling "funny bone" feeling. Sometimes it was so hard to walk that she had to crawl on her belly to get from room to room in her house. Tricia was anxious about her condition, but put off going to a doctor. She eventually went to her OB for her headaches. He prescribed migraine medication, but it didn't help her. She then saw a neurologist who examined her and watched her walk. After consulting with another physician, he told Tricia he suspected multiple sclerosis, and asked her to return for a spinal tap. Tricia's condition was first treated with steroids administered intravenously. The next day she was excited to find she could walk normally, but by the end of that morning she was already beginning to feel tired. Her condition deteriorated in spite of the steroids. By the end of the week she was bedridden. Diagnostic tests didn't yield any clear-cut evidence. An MRI showed tiny spots in her brain, but nothing conclusive. The spinal taps all came back negative. Nonetheless, her degeneration was so profound that her doctors were ready to diagnose her with chronic progressive MS, which meant she could be dead in a matter of weeks. At this point, Tricia decided she would be happier at home, so she checked out of the hospital against medical advice. She received physical therapy at a local clinic. At first they had her sit in a warm pool with jets of water after she exercised, which made her feel even more drained and tired. When they adjusted that part of the treatment, she did better. Today Tricia still doesn't have much sensation below her knees. She never knows if she'll be able to stand when she awakens. "It takes all the courage I can muster just to stand up in the morning," she says. She has extreme headaches that begin on the lower half of one side of her face and go up into her ear. Occasionally, she can't eat at all. She has episodes of dizziness and double vision. She's not on steroids now, but takes an antidepressant for the headaches. Her greatest fear, even more than being in a wheelchair, is of losing bladder or bowel control, or going blind. Tricia's doctor says her prognosis is good. She's had a year and a half without any exacerbations and seems to be in remission. On the other hand, her headaches are worse; they are more painful and happen more often. ••• Adapted from A Massage Therapist's Guide to Pathology by Ruth Werner and Ben E. Benjamin, published by Lippincott, Williams and Wilkins, Baltimore, Maryland. ••• Figure 1: Reprinted with permission from Sobbota. Atlas der Anatomie des Menschen, ed. by H. Ferner and J. Staubesand, Urban & Schwarzenberg. As seen in Clemente, CD. Anatomy: A Regional Atlas of the Human Body. 3rd ed., Munchen, Germany: Urban & Schwarzenberg, 1987: Figures 404 and 406 ••• Ben E. Benjamin, Ph.D. in sports medicine and education, is the founder and president of the Muscular Therapy Institute in Cambridge, Massachusetts. In private practice for more than 35 years, he is the author of dozens of articles. Ruth Werner, teacher and massage therapist, has taught every aspect of the massage therapy curriculum at the Brian Utting School of Massage in Seattle, Washington. |
