WHERE ARE THE PLAQUES MOSTLY FOUND?

Plaques in multiple sclerosis mostly occur in the spine, periventricular white matter, and the cerebral aqueduct. Periventricular white matter refers to white matter that is immediately to the side of the two lateral (side) ventricles of the brain. White matter is a group of white nerve fibers that conduct nerve impulses quickly. White matter is mostly made of myelin, the substance that gets destroyed in MS. White matter is important for muscle movements.

Ventricles are openings in the brain that provide a pathway for cerebrospinal fluid. Cerebrospinal fluid is the cushiony fluid that protects the brain and spine from trauma. The lateral ventricles are two curved openings (shaped like a horseshoe) located deep within the top section of the brain.

The cerebral aqueduct is a narrow opening in the brain that connects the third ventricle with the fourth ventricle, allowing cerebrospinal fluid to flow between these two areas. The cerebral aqueduct drains cerebrospinal fluid from the third ventricle to the fourth ventricle.

The third ventricle is a narrow, four-sided, irregularly shaped opening in the middle of the brain. The fourth ventricle is a wide, flat open space located in the back bottom part of the brain. The lateral ventricles, third ventricle, fourth ventricle, and cerebral aqueduct are pictured below:

In MS, plaques can also occur in the cerebrum (the top section of the brain), cerebellum, and brainstem. The cerebellum is an area in the lower back part of the brain that is important for movement. The brainstem is an area in the lower part of the brain that connects it with the spinal cord. The brainstem plays a crucial role in many functions that are crucial for life to continue.

WHAT ARE THE SIGNS AND SYMPTOMS OF MULTIPLE SCLEROSIS?

Thee signs and symptoms of MS vary considerably depending on the person and the severity of the condition. The severity of the condition is largely determined by the size of the plaques and where they are located in the brain or spine. The signs and symptoms are due to the destruction of myelin (see above).

Abnormal sensations (called paresthesias) in the legs or hands, or on one side of the face, is often the first sign of MS. Other early signs of MS include weakness, dizziness, loss of vision, double vision, and nystagmus. Nystagmus is rhythmic involuntary jerking or swinging movements of the eyes.

Later signs of MS include bladder abnormalities, mood changes, abnormal reflexes, and ataxia (uncoordinated walking). Other symptoms of MS include impaired eye movements, impaired color vision, eye pain, loss of taste, increased muscle tone, loss of position sense, loss of vibration sense, tingling, dysarthria (a type speech articulation difficulty), and feelings of burning, warmth, and cold. If the neck is flexed, it can sometimes feel like an electric shock is shooting down the spine to the feet.

About 90% of people with MS go through periods of increased symptom severity (known as relapses or exacerbations) and decreases/absences of symptoms (remissions). However, 10% of people keep getting worse without the symptoms going away for any period of time. Those whose symptoms get worse without any remission of symptoms typically have more cognitive (thinking) problems than those with the relapse-remitting form of the disease. The time period between exacerbations and remissions decreases as the disease progresses. Since MS gets worse over time, it is called a progressive disorder.

WHO IS LIKELY TO GET MULTPLE SCLEROSIS?

MS occurs mostly in young adults and typically begins slowly. Approximately 1 in 5000 people get this condition and women are more likely to get it than men. People who live in colder climates are five times more likely to develop MS than people who live in warmer climates. If a parent has multiple sclerosis the child of that parent is 20 times more likely to develop MS. If a brother or sister has multiple sclerosis, a sibling is 12 times more likely to develop MS.

HOW IS MULTIPLE SCLEROSIS DIAGNOSED?

There is no single definitive test to diagnose multiple sclerosis. Rather, the physician needs to take multiple factors into account when making the diagnosis. One crucial factor is to exclude that the patient's problems are not due to the many other disorders of tha brain and/or spine that can cause similar signs and symptoms. Another factor is to consider the patient's age, since MS usually starts in early adulthood.

When the physician suspects multiple sclerosis, he/she may perform a lumbar puncture (also known as a spinal tap) to look for increased levels of protein in the cerebrospinal fluid. A lumbar puncture is a procedure in which a needle is inserted into a space inside the spinal canal for the purpose of removing some of the cerebrospinal fluid. The spinal canal is the space between the spinal cord and the bony structure that surrounds it.

The doctor may also want to look at images on the patients brain and/or spine with a CT scan or MRI. CT (computerized tomography) scanning is an advanced imaging technique that uses x-rays and computer technology to produce more clear and detailed pictures than a traditional x-ray. MRI (Magnetic Resonance Imaging) scans produce extremely detailed pictures of the inside of the body by using very powerful magnets and computer technology.

HOW IS MULTIPLE SCLEROSIS TREATED?

Unfortunately, there is no cure for MS. However, corticosteroids are often used to help control some of the suddenly occurring signs and symptoms. Corticosteroids are a group of drugs that act similarly to a natural chemical in the body known as corticosteroid hormone. Corticosteroid hormones control the body's use of nutrients and the amount of water and salts in the urine (pee). Other medications can be prescribed to treat other specific signs and symptoms, such as medications to control depression and medications to help better control urine output.

Physical therapy is sometimes used to treat MS because it can help strengthen muscles. A physical therapist can provide a patient with various aids that can help him/her remain independent and move around easier.

WHAT ELSE IS MULTIPLE SCLEROSIS CALLED?

MS is also known as focal sclerosis, insular sclerosis, and disseminated sclerosis.

HOW CAN I GET MORE INFORMATION ON MULTIPLE SCLEROSIS?

If you would like to learn more about multiple sclerosis, please go to MSactivesource.com and the National Multiple Sclerosis Society, both of which are great websites that provides news, information, and support for all people touched by this disease.

WHAT IS THE ORIGIN OF THE TERM, MULTIPLE SCLEROSIS?

Multiple sclerosis comes from the Latin word "multi" meaning "many," the Latin word "plus" meaning "fold," and the Greek word "sklerosis" meaning "hardness." Put the terms together and you have "many fold hardness." So multiple sclerosis refers to multiple hardenings in the brain and spine.