Multiple Sclerosis: Frequently Asked Questions

1. What Is Multiple Sclerosis?

MS is an autoimmune disease, whereby the body's own immune system, which normally targets and destroys substances foreign to the body such as bacteria, mistakenly attacks normal tissues. In MS, the immune system attacks the brain and spinal cord (the central nervous system).

2. What Causes MS?

Doctors still don't understand what causes MS, but there are interesting data that suggest that genetics, a person's environment, and possibly even a virus may play a role.

Researchers believe that MS may be inherited (passed on from parents to children). First, second and third degree relatives of people with MS are at increased risk of developing the disease. Siblings of an affected person have a 2%-5% risk of developing MS.

Some scientists theorize that MS develops because a person is born with a genetic predisposition to react to some environmental agent, which, upon exposure, triggers an autoimmune response.

In addition, some studies have suggested that many viruses such as measles, herpes, and the flu viruses may be associated with MS. To date, however, this belief has not been proven.

3. What Are the Symptoms of MS?

The onset of MS may be dramatic or so mild that a person doesn't even notice any symptoms.

The most common early symptoms of MS include:

• Tingling
• Numbness
• Loss of balance
• Weakness in one or more limbs
• Blurred or double vision

Less common symptoms may include:

• Slurred speech
• Sudden onset of paralysis
• Lack of coordination
• Problems with thinking and processing information

As the disease progresses, other symptoms may include heat sensitivity, fatigue, changes in thinking or perception, and sexual disturbances.

4. Is Multiple Sclerosis Fatal, Contagious, or Hereditary?

MS is not considered a fatal, contagious or directly inherited disease, although there may be a familial predisposition of MS. Prevalence in families of individuals with MS is somewhat higher than in the general population.

5. Is There a Cure for MS?

Unfortunately, there is not a cure for multiple sclerosis, but there are many drugs that may slow down the progression of the disease. There are also many treatments available that can help a person with MS manage their symptoms and live a productive and fulfilling life.

6. Am I Going to End Up in a Wheelchair?

Most people with MS usually get around without assistance; however, there may be a time when you will need some type of assistance. Approximately 25% of people with MS will need a wheelchair. There may be a time when you would need to use some type of other walking aide like a cane or walker.

7. How Do I Decide Which Therapy Is Best for Me?

Choosing to begin therapy can be a difficult decision to make; learning about your treatment options and discussing them with your doctor is the first step in deciding what treatment to begin. Some other factors to consider are effectiveness, side effects, your current lifestyle, and how the therapy is given.

8. How Do People With MS Benefit From Deep Brain Stimulation?

The main purpose of deep brain stimulation in those with MS is to control tremor. In the case of multiple sclerosis, other problems such as loss of vision, sensation, or strength are not helped by deep brain stimulation.

9. What Alternative Therapies Are Recommended for MS?

• Positive Attitude. Having a positive outlook cannot cure MS, but it can lower your stress and help you feel better.
• Exercise. Exercises, such as tai chi and yoga can lower your stress, increase relaxation, and increase your energy, balance, and flexibility. As with any exercise program, check with your doctor before getting started.
• Diet. It is important for people with MS to follow a healthy, well-balanced diet. Ask your doctor what diet is right for you.

10. What Is Optic Neuritis?

Optic neuritis is the inflammation of the optic nerve, the nerve located in the back of the eye that transmits light and visual images to the brain and is responsible for vision. According to the National Multiple Sclerosis Society, 55% of people with MS will have an episode of optic neuritis. Frequently, it's the first symptom of the disease. Although having optic neuritis is very suggestive of MS, it does not mean that a person has or will get MS.

The symptoms of optic neuritis are the acute onset of any of the following:

• Pain in the eye
• Blurred vision
• Graying of vision
• Blindness in one eye

It's rare that both eyes are affected simultaneously. Loss of vision tends to worsen over the course of a few days before getting better. This usually takes about 4-12 weeks. Treatment may include intravenous and/or oral steroids to control the inflammation.

Bowel Problems Linked to Multiple Sclerosis

Types of Bowel Problems Affect People With MS

Constipation, bowel incontinence (loss of bowel control), and diarrhea are problems that affect people with MS.

1. Constipation

Constipation is characterized by infrequent bowel movements (usually fewer than two bowel movements per week), or by frequent straining to void fecal matter.

Constipation is very common among people with MS. In general, poor diet (including consuming less than 20 grams of fiber per day), lack of physical activity, and depression all affect the digestive system. Medications and supplements may also contribute to constipation.

With MS, constipation may be caused by an interruption of impulses to the brain that signal the need for a bowel movement. MS may also prevent pelvic floor muscles from relaxing. These muscles are used to help void fecal matter. Also, MS may block the natural increase in activity of the colon following meals.

2. Bowel Incontinence

Bowel incontinence is the loss of voluntary bowel control. A person suffering from bowel incontinence may not be able to reach the bathroom fast enough. The most common causes include long-term constipation, severe diarrhea, stress, hemorrhoids, nerve or muscle damage, and overuse of laxatives.

3. Diarrhea

Diarrhea is frequent, loose, or watery stools. It is sometimes the result of allergies or sensitivity to spicy foods or dairy products, contaminated water or food, a change in activity level, or viral, bacterial, and parasitic infections.

Diarrhea can also be the signal of another problem. If it becomes frequent or continual, see your doctor. In some cases, your doctor may recommend that you see a doctor who specializes in treating bowel problems (gastroenterologist).

How Can I Maintain Regular Bowel Movements?

• Increase your fluid intake. Try to drink 6-8 glasses of water daily. If you're having MS-related urinary problems it may be tempting to cut back on your fluid intake, but this makes constipation worse. Lack of water may harden the stool, making it more difficult to pass. And increased pressure from the stool on parts of the urinary system may actually increase bladder problems. Drink something hot as the first beverage in the morning, such as hot water or hot apple cider or drink ½ to 1 cup of prune juice in the morning to stimulate a bowel movement.
• Increase your fiber intake. Eating plenty of fresh fruits and vegetables and whole grain breads and cereals is the best way to increase the amount of fiber you eat. Add 2 to 4 tablespoons of unprocessed wheat bran to foods and drink plenty of liquids (liquids help bran to be effective). Try bran sprinkled over hot or cold cereal, casseroles or mixed with applesauce, pancake batter, pudding, muffin batter, milk shakes, or cookie dough. Your doctor may also recommend that you take a fiber supplement such as Metamucil.
• Try to maintain regularity. Establish a regular time for emptying the bowels. Plan trips to the bathroom immediately after meals since eating is a natural stimulus for having a bowl movement. Try to wait no more than 2-3 days between bowel movements.
• Exercise. Activity such as walking helps normalize bowel function.
• Use stool softeners. Only do this under the direction of your doctor.

How Do I Control Diarrhea?

• Drink 8 or more cups of liquids per day. Add 1 to 2 cups of liquids to the daily 8 cups for every episode of loose, watery stool you have to replace losses. Try water, lemonade or fruit-flavored drinks, fruit or vegetable juice, broth, milk, or cream soup.
• Talk with your doctor or dietitian about increasing or decreasing the amount of fiber you eat.
• Eat soft foods that contain large amounts of liquid, such as sherbet, yogurt, and pudding.
• Ask your doctor whether adjusting your medications might help relieve the diarrhea, but do not change your medications without first talking to your doctor.
• Don't take over-the-counter (nonprescription) drugs for diarrhea without talking to your doctor.

Multiple Sclerosis and Sleep problems

Sleep problems, or disorders, are conditions that prevent a person from getting restful sleep and as a result, cause daytime sleepiness. There are about 80 different types of sleep disorders and about 70 million Americans suffer from them. The inability to fall asleep or to stay asleep, called insomnia, is the most common sleep disorder.

Many people with multiple sclerosis complain of insomnia or broken sleep patterns, yet sleep problems are not a result of the disease itself. They occur because of secondary factors such as stress, spasticity, inactivity, or depression that people with MS often have.

People with MS often have trouble staying asleep because of spasticity, especially in the legs, and an increased need to go to the bathroom at night. Talk to your doctor about what is keeping you up at night; there may be medications he or she can prescribe to improve the problem.
How Can I Get a Good Night's Sleep?

One of the most important ways to ensure a good night's sleep is to create a consistent bedtime routine. Here are some tips to get you sleeping soundly.

*

Relax in the evening before going to bed. Try to not rehash the day's problems or worry about tomorrow's schedule.
* Go to bed when you're tired. Try to be consistent about the time you go to bed.
* Prepare yourself for bed by wearing comfortable nightclothes, adjust your bed pillows in a comfortable position, turn off the lights, adjust the temperature in your bedroom, and position yourself comfortably in your bed.
* If you do not fall asleep after 10-15 minutes -- get up! Do not lie in bed and watch the clock or count the cracks in the wall. Find something to do that is relaxing to you, such as putting together a puzzle, reading, or writing a letter to a friend. Rather than watching TV, which is a passive activity, do something active so that natural tiredness can build up. Remember your bed is only for sleeping. Any of the above activities should be done out of bed. Return to the bed only when you feel tired.

Also, try to adhere to the following suggestions.

* Do not nap during the day.
* Do not consume caffeine within 4-6 hours of bedtime
* Do not smoke or use nicotine products close to bedtime or during the night.
* Do not drink alcoholic beverages within 4-6 hours of bedtime.
* If running to the bathroom is keeping you up at night, reduce fluid intake in the evening. It is still important to drink the recommended amount of fluids during the day. Also go to the bathroom immediately before you go to bed.
* Do not go to bed hungry or soon after a heavy meal. If you are hungry, eat a light snack or drink a glass of warm milk.
* Exercise regularly, preferably during the day. Avoid vigorous exercise 3 hours before bedtime.
* Set your alarm to wake up at the same time every day, even on days when you're off work and on the weekends.