By Ed Lash
In my last few columns, I discussed some basics of self-help. Now let’s pause and ask an even more basic question: What exactly is multiple sclerosis (MS) anyway?
MS is an inflammatory disease of the central nervous system (CNS), which is composed of the brain and spinal cord. MS is characterized by the occurrence of random patches of inflammation in the CNS, along with the loss of insulation (called myelin) that surrounds CNS nerve fibers. These patches, or “plaques,” occur sporadically; the number of plaques, their exact location, and the frequency of new plaques vary widely from person to person. When these plaques begin to heal, they often form scars.
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The name “multiple sclerosis” refers to the multiple scars that develop in the CNS as a result of the disease. The quantity or extent of plaques is not necessarily an indication of the severity of symptoms, since autopsies and MRI scans have shown significant areas of plaque in people with few, or no, symptoms.
Some symptoms of MS are due to inflammation and some from the resultant scar tissue, called demyelination. Inflammation is the immune system’s response to a perceived threat; it occurs as white blood cells accumulate at a specific location. “Soldiers” in the immune system’s “army,” white blood cells are specialists with regard to the functions they perform before and after an “enemy”-normally an invader from outside the body-is confronted. Since white blood cells are relatively large, wherever they accumulate, they cause swelling and pressure, or a “squeeze” on nerve cells in that part of the CNS. Depending on which nerve cells are being squeezed, the part of the body associated with them will be affected either in function or sensation. When the immune system dissipates or reduces this inflammation (with or without medication), pressure on the nerve cells is reduced and symptoms improve. The damage, or scarring, which may have resulted from this inflammatory process, can, it is hoped, begin to heal.
Who gets MS? MS occurs throughout the entire world and in all races, although in some populations the rate of incidence is much lower than in others. It is relatively rare among American Indians, Japanese and other Asian peoples, and virtually absent (though not totally) among the Inuit and the Roma. MS is most common in middle- to upper-class Caucasians, especially those of northern European ancestry. Although not a hereditary disease, evidence indicates a genetic predisposition. An environmental factor appears to be involved since people born and raised in the temperate zone show a greater incidence of MS regardless of where they may live as young adults or later. This seems to indicate that such environmental factors as locations of birth and early growing years are more important than lineage in determining risk.
MS occurs more frequently in women than in men by at least a 2:1 ratio. MS is not contagious and the probability of getting MS if you are the spouse of a person with MS is the same as for the general population, 0.1%. The probability of getting MS if you have a sibling with MS is 2%, and it’s much greater for identical twins. If you are a child of a parent with MS, it’s 1%. Approximately 15% of people with MS have a relative with MS.
There are still insufficient clues as to the cause or cure of MS. Until all the evidence is in, MS will remain one of the great unsolved mysteries in modern medicine.
Note: Self-help is not intended to replace medical treatment. It should be used together with the help of appropriate professionals in a team effort.
Ed Lash is a United Spinal member who lives in Trumbull, Connecticut. This essay is adapted from his book, MULTIPLE SCLEROSIS, Self-help . . . A Patient’s View (Vantage Press 2001), which is available for $16 ($13.95 plus $2.05 for S&H) by e-mail from edlash.ms.selfhelp@juno.com, or by phone at 203-445-0118.
