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Andrew M. 'Andy' Ramirez

Multiple Sclerosis Info

Welcome to Andy's Multiple Sclerosis Information Page. Andy was diagnosed with MS in April of 1990 by a Neurologist after an MRI scan. On this page you will find info detailing MS, what it is, symptoms, types and its treatment. It is my hope you enjoy the info contained on this page and can learn something from it.

MS Overview

Multiple sclerosis (MS) is a chronic disease of the central nervous system that generally strikes between the ages of 20 and 40. Because its varied symptoms manifest slowly-and often overlap with other conditions-MS is one of the most difficult diseases to diagnose and understand. With the possibility of relapse or remission always right around the corner, unpredictability is perhaps the most consistent characteristic. During the 1990s, dubbed the "Decade of the Brain," researchers discovered many new aspects of the disease, now thought to be caused by improper immune reactions. In addition, new drugs were approved which show promise for altering the course of the disease. Such exciting advances are fostering a more aggressive treatment approach and lending hope to the fight to end MS's debilitating effects.

What Is MS?

Multiple sclerosis (MS) is literally a "disease of many scars."

The scars - or scleroses - form on nerve fibers in the brain, spinal cord, and optic nerves, which are the basic components of the central nervous system (CNS). Also known as plaques, these scars are the result of lesions that destroy the protective material that surrounds the nerve fibers. This material is called the myelin sheath.

Much like the insulation on an electrical wire, an intact myelin sheath keeps nerve impulses traveling rapidly and accurately along the nerve fiber. These impulses are essential to normal movement and sensation throughout the body.

MS lesions eat away at the myelin sheath, eventually healing into hardened scar tissue. This process is called demyelination.

The scar tissue "short circuits" or interferes with the proper transmission of nerve impulses to various systems in the body. The result is a broad array of motor and sensory disabilities.

If the sheath can regenerate itself - known as remyelination -- normal nerve function may return. If not, the nerve will eventually die, and the disability will be permanent.

As the extent of nerve damage increases, the level of disability can grow progressively worse over time.

Researchers believe the damaging lesions are caused by an autoimmune reaction, where the body's defense system mistakenly attacks its own tissue. What triggers this abnormal immune response is presently unknown, although viral infection and/or environmental factors are suspect. Genetics may also play a role in susceptibility to the disorder.

The immune system's assault causes inflammation of CNS tissues. The inflamed nerves then develop the destructive lesions that adversely affect a variety of functions, depending upon the location and extent of the lesion damage.

These functions include:
Balance and Coordination, Bladder/bowel control, Pain, Sensation, Sexual function, Speech, Stamina, Strength,Thought process, and Vision

MS Symptoms

Clinical attacks are called flare ups, exacerbations or relapses. They are characterized by one or more of a constellation of symptoms. In most MS cases, these attacks occur sporadically during the early years of the disease and are usually followed by recovery - either complete or incomplete. Clinical relapses are separated by periods of remission where no new problems are noted. The frequency of the attacks and nature of symptoms can vary widely.

Some MS symptoms are medically manageable or can be reduced by rehabilitative therapy. Report all symptoms as completely as possible so that your doctor can determine the optimal management strategies for you.

Symptoms of a flare up may involve:

Balance and coordination - Dizziness, unsteadiness, stumbling, falling, and difficulty making muscle groups work together, especially in the limbs. While a person may have reasonable control of each arm and leg, getting them to perform in a coordinated manner can be problematic. This type of discoordination is known as ataxia. When this condition affects walking, it is called gait ataxia.

Muscle stiffness combined with uncontrollable muscle contractions can cause a painful condition called spasticity. Shaking of the hands, known as tremor, may limit the ability to write legibly, eat, or accomplish tasks requiring dexterity without assistance.

Bladder/bowel control - Increased urinary urgency and/or frequency, incontinence, hesitancy, constipation. These symptoms can cause extreme anxiety as a person experiences the need to urinate abnormally often. It may become difficult to keep from evacuating the bladder spontaneously, causing a person to "wet" himself or herself. Or a sufferer may feel the need to urinate or defecate but cannot.

Pain - Sharp, intense, sometimes burning, localized pain. Common locations include the face - a condition known as trigeminal neuralgia -- and in or behind the eyes. Although the pain seems to come from a specific part of the body, there is generally no actual damage at the perceived site.

Pain may also be the result of compensating physical adjustments due to diminished function. For example, if strength in the lower body is adversely affected, increased use of the upper body may produce muscle or joint discomfort.

Fatigue - An unusually deep and persistent tiredness that will not subside regardless of rest. Half of all MS patients report that fatigue is their worst problem. In some cases, the flu-like exhaustion of chronic fatigue may interfere with patients' ability to work or complete daytime activites. Fortunately for those individuals, there are now treatments available which can help to restore wakefulness and raise energy levels. Although fatigue usually accompanies a relapse, it does not indicate a relapse when it occurs in isolation.

Sensation - Tingling, numbness, or other peculiar feelings in the arms, legs, trunk, or face. These strange sensations are known as dysesthesia.

Speech - A slowing of the speech pattern, slurring of words, and/or rhythmic disruptions in the cadence of speech known as dysarthria. This latter symptom can make speech sound disjointed and labored. These dysfunctions are caused by discoordination of the tongue, lips, palate and vocal cords when controlling impulses from the cerebellum are interrupted.

Sexual function - Inability to become sexually aroused and climax. Interrupted nerve impulses may short circuit the physical mechanisms of sexual desire, adversely affecting erectile function in males, vaginal sensation and lubrication in females, and the ability to achieve orgasm in both sexes.

Thought process - Confusion, anxiety, and depression. Inflammation of brain nerves can cause a variety of troubling cognitive effects. Sufferers may not feel mentally sharp or in complete control of their faculties. Frightening physical symptoms, loss of function, and the prospect of deteriorating quality of life may also lead to situationally triggered mental conditions.

Vision - Blurred or double vision. Most often the optic neuritis attacks affect only one eye at a time. Normal vision is usually restored within a few weeks. Demyelination of the optic nerve usually diminishes the ability to distinguish between colors.

Types of MS

In general, the clinical status of the MS patient is characterized as relapsing, in which flare-ups occur at some intervals then subside, or progressive, in which measurable clinical neurological deterioration occurs over time. There are five general categories of MS based upon the disease's clinical behavior, and patients may transition between these categories.

Benign MS Although there is not an agreed-upon definition of benign MS, it is the mildest form of relapsing MS. Relapses are not severe, and are associated with minimal residual disability. Because many patients initially exhibiting benign MS will transition to another category of MS, and because it is not presently possible to predict which patients these will be, benign MS is a diagnosis that only can be made retrospectively, after years of observation demonstrate an unchanged clinical course.

Relapsing-remitting MS (RRMS) Unpredictable relapses occur during which new symptoms appear or existing symptoms become more severe. The episodes can last for varying periods of time, and there is partial or total recovery. The disease may appear to be clinically stable in between relapses.

According to the National Multiple Sclerosis Society, approximately 70-75% of people living with MS initially experience the relapsing-remitting form. To be designated as an RRMS relapse, the exacerbation must last for more that 24 hours, and two relapses must be spaced at least a month apart.

RRMS relapse rates range from 1.5-12 times per year. Research indicates that most untreated patients recover within six weeks of an acute relapse.1 Pregnant women generally experience a reduction in relapses but become more susceptible to attack in the three to five months following delivery.

Secondary progressive MS (SPMS) This is the major progressive form of MS, and it initially appears as relapsing-remitting MS. The relapsing patient transitions into a progressive, slowly worsening stage marked by continued, worsening neurologic deficits. An observation period of six months or greater of this transition indicates a diagnosis of SPMS. In established SPMS, relapses typically diminish in frequency and then stop, but progressive neurologic decline continues. Up to 90% of relapsing patients become SPMS patients.

Primary progressive MS (PPMS) This form is characterized by continual worsening from onset, without relapses. In late stages of disease, loss of function can become severely disabling.

Progressive Relapsing MS (PRMS) In this form, there is worsening from the onset of the disease, with the subsequent appearance of relapses. Unlike RRMS, there is no correlating pattern of disability associated with the relapses and remissions.

Prognosis for MS Patients


According to the National Multiple Sclerosis Society, MS patients have 95% of the normal human life expectancy. In addition, most patients never need a wheelchair and remain functional even after 20 years of being diagnosed.

Beyond that, the clinical course of MS is very difficult to predict. The severity of the disease varies drastically from individual to individual.In many ways, the type of MS you have reflects the pattern the disease has demonstrated in the past. Even knowing your type cannot necessarily help you anticipate the rate of relapse and disease advancement. As a result, researchers are currently looking for more precise indicators of future disease activity.

The past decade--dubbed "Decade of the Brain" due to the explosion of neurological knowledge--has witnessed the exciting arrival of disease-modifying agents, or immunomodulators. As research accumulates, we will be able to better evaluate how long these drugs can affect the disease course. With the MS community now fully endorsing early intervention, the goal is to preserve the patient's lifestyle while scientists continue to search for a cure.

Treating MS

Unfortunately, there is no cure yet for MS. Treatment for the disease differs according to stage or type.

The primary key to effective treatment is early diagnosis and immediate therapy initiation upon diagnosis. Research indicates that MS develops long before clinical evidence and symptoms are apparent. As a result, some doctors now recommend that treatment be started as soon as nerve damage is suspected rather than confirmed. This more aggressive approach may actually affect the disease course.

Current treatment goals include:
Retarding the disease's progress
Preserving neurological and body function
Reducing the number of exacerbations and relapses
Alleviating or easing symptoms

The advent of disease-modifying agents called immunomodulators in 1993 gave doctors a new and promising method for altering the disease process. By reducing the frequency of flare-ups, these injectable drugs help to keep the disease's most debilitating effects at bay. Studies to date show significant reduction in relapses and disability as measured by EDSS. Ideally, such pharmaceutical advancements may provide the ability to potentially ward off the worsening of relapsing-remitting MS (RRMS).

Because the initial symptoms of MS may be subtle and sporadic, some people choose to do nothing, hoping that the illness will not return. Ignoring the disease, however, may allow for irreversible damage to the central nervous system and accelerated symptoms.

The above above info courtesy Montel Williams and MS Society. For more information visit the National MS Society at www.nationalmssociety.org

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