MS diagnosis

This week we are going to discuss diagnosis of MS. It is extremely difficult to diagnose multiple sclerosis. An individual needs to meet many criteria and they may go years having the disease without the official diagnosis. Here are some tests that are used to diagnose the disease, when a patient tests positive for many of them, they might receive the diagnosis of MS.

MRI: Because an MRI is a particularly useful tool in detecting central nervous system damage and demyelenation, it is a powerful tool in helping to establish an MS diagnosis. However, approximately 5 percent of people with clinically definite MS (someone who tests (+) for enough tests to receive a diagnosis) do not initially show lesions on MRI at the time. If repeat MRIs continue to show no lesions, the diagnosis of MS should be questioned.

Spinal Tap: A small amount of cerebrospinal fluid (CSF) may be taken from the spinal column. The presence of oligoclonal bands (a certain type of antibody) is consistent with 90% of the population with MS. However, just because a personal has oligoclonal bands present does not necessarily mean they have MS!

Optical Coherence tomography: A relatively new diagnosis tool for MS is OCT. It is an imaging device that allows retinal structures (like the optic nerve) at the back of the eye to be viewed. OCT studies have shown that the retinal nerve fiber layer is different in people with MS than in people without MS.

 Blood Tests: There are still no blood test to diagnose MS, however blood tests are used in an MS patient to rule out other disorders. Lyme disease, HIV, rare genetic disorders, lupus, rheumatoid arthritis and scleroderma can all be ruled out using blood tests.

There basic rules that are applied when diagnosing MS are...

•  Rule out all other diagnosis AND
• Finding evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
• Find evidence that the damage occurred at two different points in time

Hence...MULTIPLE sclerosis

Diagnosis is essential for early treatment of MS. Permanent neurological damage can occur even in the early stages of the disease, so therefore early detection is crucial.

Diagnosis also gives people an answer to why they are feeling so much discomfort. Getting the diagnosis allows them to begin the adjustment process and relieves them of worries about other diseases such as cancer.

To get more information on MS read this article posted in the SAGE journal.
http://msj.sagepub.com/content/14/9/1157.full.pdf+html

Until next time!

Works:
http://msj.sagepub.com/content/14/9/1157.full.pdf+html
http://www.bbc.com/news/health-20836082
http://www.msfocus.org/diagnose-multiple-sclerosis.aspx
http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/basics/symptoms/CON-20026689
http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms

MS Etiology

I wanted to start this weeks blog with a video. While we can try to imagine what MS is like, I thought it might be helpful to hear a first hand account of what it is like from someone who lives with MS everyday.

 
Many of the debilitating side effects caused by MS (paralysis, blindness and numbness) is due to conduction block caused largely by demyelination and inflammation. Remember the analogy of the game, telephone? Conduction block is when the message can not be properly relayed down the line. You are probably wondering what causes this "demyelination" that we have been talking about for the last three weeks. This week we will discuss the etiology of MS.

Etiology /eti·ol·o·gy/ (e″te-ol?ah-je)

1. the science dealing with causes of disease.

2. the cause of a disease.

Immunologic:
The etiology of MS is still currently not completely understood. What we do know is that in MS, and abnormal immune mediated response occurs. This basically means that in an auto-immune response, the body doesn't recognize itself, but rather sees it as something that shouldn't be there and attacks itself. In the case of MS, the body attacks the coating around the nerve fibers called myelin. In recent years, researchers have finally been able to identify which immune cells are causing the attack, why they may attack and some of the receptors on the attacking cells that seem to be attacked the the myelin.

Environmental:
MS has been found more frequently in areas that are father from the equator. Because of this, etiologists are studying geography, demographics, gender and ethnic background to shed light onto potential risk factors. Studies have even shown that people who are born in an area with a high risk of MS who move to an area of lower risk under the age of 15, assume the new risk of the area they moved to. There is also evidence of Vitamin D (or lack of it!) contributing to a higher incidence of MS. Smoking (as with many diseases) may also contribute to the disease as well as contribute to a more rapid disease progression.

Genetic:
While MS is not hereditary (meaning passed through genes from parents to their offspring) , having a first degree (mom, dad, sister, or brother) relative who has MS does increase a person's risk of developing it themselves.There are theories that suggest that while MS itself is not hereditary, some may have a genetic predisposition to react to environmental agents.

Why we may not completely understand why a person may develop MS, we have disproved many theories. Here is a list of things that we know does not cause MS...

Living with a dog or other small pet: Some years ago, canine distemper a virus carried by dogs was proposed as a cause of MS, but research has since ruled this out (thankfully!). Be at ease knowing that there is no evidence to support that playing with your pooch has any influence on MS!

Having allergies: There is no evidence that MS is triggered by a reaction to a specific environmental allergen. Allergies are common in the general population and can occur in people with MS.

Exposure to heavy metals: While it is true that heavy metals may damage the nervous system, the damage is completely different than that which occurs during MS. There is no evidence that heavy metal exposure causes MS.

Aspartame:  No scientific evidence supports the claims that aspartame, an artificial sweetener used in many diet soft drinks and other foods causes MS. Kick back and enjoy your diet coke

That is all for now... until next week!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1692682/
http://www.nationalmssociety.org/What-is-MS/What-Causes-MS
https://www.youtube.com/watch?v=lpDhCOO1EII

The Whys & Wherefores of MS

Epidemiology: The incidence, distribution and possible control of diseases and other factors relating to health

MS is thought to affect more than 2.3 million people worldwide. While gender, genetics, age and geography have all been ruled contributing factors of MS, epidemiological studies have proven difficult. Because of the complexity of the disease, MS can be difficult to diagnose. The incidence (or the number of new cases in a given period in a given population) has been proved virtually impossible to estimate. Epidemiologists instead focus on prevalence (the number of people with MS at a particular point in time, in a particular place) of MS. Here are some of the main points regarding the prevalance...

http://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic

• Although more people today are currently being diagnosed with the disease, this may be because of an increase in testing, awareness and a greater access to medical care. There is not definitive evidence that proves the rate of MS increasing in the population. 
• MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is more common in Caucasians of northern European ancestry
• Most are diagnosed between the ages of 20-50 years of age
• MS is 2 to 3 times more prevalent in women than in men
• MS is the leading cause of non-traumatic disability in young adults
• In general, MS is more common in areas farthest from the equator

 

 http://www.medicine.ox.ac.uk/bandolier/booth/neurol/msgeog.html

As you can see in the above images that prevalence rates are higher in places closer to the poles compared to places closer to the equator. This may be due to lack of sunlight and vitamin D found in the regions furthest from the equator. While this fits the hypothesis that a higher exposure to sunlight decreases the incidence of MS, studies of not definitively found this to be true yet.

While we know some of the factors contributing to the prevalence of disease, MS is still widely misunderstood as to why, who and when people develop the disease. Possibly because of this, there is still no treatment for MS.

Works:
http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS
http://multiplesclerosis.net/what-is-ms/statistics/

What is Multiple Sclerosis?

Multiple Sclerosis, commonly referred to as MS, is an immune-mediated neurological condition characterized by the demyelination of nerve fibers of the brain and spinal cord. MS is confusing and complex...so let me break it down. Our central and peripheral nervous system consists of our brain, spinal cord, sensory neurons, ganglia (clusters of neurons) and nerves that connect to one another and to the central nervous system. Think communication! Remember the game telephone? The one where a person creates a phrase and whispers it into the ear of the person next to them. They cannot repeat the phrase (and this phrase can be complex) so the second player needs to listen carefully. The second player then whispers the phrase to the third player, which whispers it to the fourth. The goal of this game is to have the last player repeat the initial message that the first player sent down the line.

Now lets get back to MS. This idea can demonstrate the disease process. The first phrase is the message that the initial neuron in the CNS (brain & spinal cord) is trying to send out. The whispers represent the message traveling down the axon (nerve fiber) of the neuron. This is where things can get tricky. In MS, the myelin sheath (the cover that surrounds many nerve cells and helps to increase the speed by which information travels along the nerve) degenerates or breaks down, so these messages may have a hard time reaching their target. This breakdown occurs because the immune system mistakenly attacks the meylin (this is why it is considered an immune-mediated process). 

Because these messages are used to communicate all over the body, MS can complicate a number of functions, from muscle movement to balance to vision to skin sensations to mood to problems with bladder function.

Digest this information and re-cap with the following video. Next time we will focus on why people may acquire this disease, who is most at risk, complications of the disease and treatments.

References:
http://www.nationalmssociety.org/What-is-MS

How to Play Telephone

By James Holloway, eHow Contributor

- last updated November 12, 2014

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The tension of the game can make it even harder for players to remember phrases.

Most of us think that we understand and remember everything we hear, but when we're tested we find out that the truth is very different. The classic party game Telephone brings this to light, often with hilarious results. In addition to producing laughs, Telephone can help children or people learning English develop their active listening skills.

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1. Getting Started

   • To play Telephone, you'll need a group of players. More is better, but a group of more than 10 players can make the game too long. If you have a large group, consider splitting your players into teams. Choose a phrase for the team to use or let them select one themselves. Phrases should be complicated, with plenty of detail and unfamiliar words -- for instance, try using a phrase such as "Mahogany tables don't look good painted fuchsia." The phrase should never be a familiar expression; these are too easy to remember. Only one player should know what the phrase is.

   Starting the Whispers

   • The player who created or received the phrase starts the game by whispering it into the ear of another player. She cannot repeat the phrase, so the second player needs to listen carefully. The second player then whispers the phrase to the third player, who whispers it to the fourth, and so on until the last player.

Read more : http://www.ehow.com/how_2044551_play-telephone.html

The player who created or received the phrase starts the game by whispering it into the ear of another player. She cannot repeat the phrase, so the second player needs to listen carefully. The second player then whispers the phrase to the third player, who whispers it to the fourth, and so on until the last player.

Read more : http://www.ehow.com/how_2044551_play-telephone.html

player who created or received the phrase starts the game by whispering it into the ear of another player. She cannot repeat the phrase, so the second player needs to listen carefully. The second player then whispers the phrase to the third player, who whispers it to the fourth, and so on until the last player

Read more : http://www.ehow.com/how_2044551_play-telephone.html

player who created or received the phrase starts the game by whispering it into the ear of another player. She cannot repeat the phrase, so the second player needs to listen carefully. The second player then whispers the phrase to the third player, who whispers it to the fourth, and so on until the last player

Read more : http://www.ehow.com/how_2044551_play-telephone.html