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Multiple Sclerosis Ms

 

Multiple Sclerosis Introduction

Multiple sclerosis (MS) is a debilitating disease of the central nervous system. It involves progressive destruction of the nerve fibers, targeting the myelin sheaths of the brain and spinal cord. Once this layer is destroyed, the signal cannot be passed along the nerve and a given function is then compromised. Multiple sclerosis causes a wide range of neurological symptoms, paralleled with remissions and exacerbations.

The cause of multiple sclerosis is not fully understood. Suspected causality is multifactorial, with an autoimmune abnormality being most prevalent. Other suspected etiologies include viral infection, dietary causes, and oxidative damage to lipids in the cell membrane. [1]

Multiple sclerosis affects women slightly more than men. The average age of occurrence is between 20 and 40 years. Incidence is linked to the geographical area a person inhabits the first 15 years of their life; being more prevalent in temperate climates (those of higher latitudes) than the tropics. [2]

Multiple Sclerosis Symptoms

Multiple sclerosis can present with single or multiple signs and symptoms of CNS damage. The symptoms may come and go throughout the individual’s lifetime. The course of Multiple Sclerosis can be varied. In some, it can remain in remission for life, while in others, slowly progresses with exacerbations. Still, in a unique few, MS will progress quickly, and lead to a complete loss of physiological functioning. The main areas impacted by Multiple Sclerosis are the motor, visual, sensory, cognitive, vestibular, and genitourinary systems. [3]

  • Motor symptoms are the most frequent first presenting signs. The patient may complain of weakness in a limb, feeling of heaviness, leg or foot drop, stiffness, loss of grip or tendency to drop things, and clumsiness. [4] Deep tendon reflexes will be increased, especially of the knee and ankle. T remor will be present, the gait may be abnormal. Paralysis may also occur in more severe cases, or late in the course of the disease. [5]
  • Visual disturbances are the second most common presenting sign or symptom. Patients may notice blurred vision, foggy vision, and double vision, pain in the eye, or even blindness. [6] Patients can also present with nystagmus, inflammation of the optic nerve, or papilledema. [7]
  • Sensory deficits that can occur include a numbness and tingling in the arms and legs. Patients may complain of a ‘dead limb’ feeling, muscle tightness, or a sensation as if a band is tied around a body part. They may also sense electrical shocks in different areas.
  • Multiple Sclerosis can also affect the vestibular system, causing light-headedness, vertigo, and nausea and vomiting. Incontinence, loss of bladder sensation, and loss of sexual function, can also be presenting symptoms when the genitourinary system is affected. [8]

Aside from all the physical symptoms, the mental pain of the individual is also affected. Patients may develop apathy, lack of judgment, and poor decision making. They may become emotionally irrational, laughing or crying for inappropriate reasons. Many suffering from Multiple Sclerosis may also suffer depressive episodes/depression. [9]

Multiple Sclerosis Statistics

  • Currently it is estimated that 350,000 - 500,000 people in the US have multiple sclerosis.
  • There are approximately 8,000 new cases diagnosed each year.
  • 20% of the cases will be benign, 30% intermittent, 40% slow progressive, and 10-20% steady progressive.
  • 40% of patients will have no disruption in their activities of daily living.
  • The average lifespan of a person with Multiple Sclerosis is 75% that of a person without Multiple Sclerosis.
  • 75% of sufferers will never need a wheelchair.
  • Multiple Sclerosis rarely causes death. [10]

Multiple Sclerosis Treatment

Because of the variable course of Multiple Sclerosis, treatment can be difficult. Conventional therapy is focused on preventing relapse and maintaining the remission of disease. The two drug therapies of choice are corticosteroids and immunomodulating drugs. Symptomatic treatment is also available during exacerbations and are used in the treatment of pain, fatigue, muscle spasms, and bladder control problems. [11]

The goal of alternative treatment is the same as conventional; to avoid relapse and maintain remission. Nutritional approaches are, many times, effective in treating the symptoms of Multiple Sclerosis. The approach that alternative treatment makes is quite different than conventional methods. Alternative medicine attempts to treat the cause, or remove agents that may be contributing to the disease.

Supplements helpful for Multiple Sclerosis

Acetyl-L-carnitine

Acetyl-L-carnitine is involved in energy metabolism inside the cell. It is a transport molecule for the production of ATP in mitochondria. One study compared acetyl-l-carnitine to amantadine for fatigue symptoms often experienced in Multiple Sclerosis sufferers. Results found that acetyl-l-carnitine was more effective and better tolerated than amantadine. [12]

Essential fatty acids

Essential fatty acids are an integral part of any cell membrane. They are anti-inflammatory in nature, and may help prevent lipid peroxidation. EFAs are also theorized to be immune modulating, and may decrease the autoimmune reactivity in multiple sclerosis. They have been studied for the treatment of multiple sclerosis and are recommended as a normal aspect of the diet in individuals with Multiple Sclerosis.

One study observed that supplementation with fish oil in newly diagnosed MS patient’s. There was an improved clinical outcome over a 2 year follow up period with those who supplemented with fish oil, as compared to patients who had no inclusion of these oils. [13] Another clinical study looked at linoleic acid supplementation in patients with Multiple Sclerosis. It showed that linoleic acid treatment reduced the severity of relapse and prolonged the time period in between exacerbations. [14]

Vitamin B12

Vitamin B12 is required for optimal formation of the myelin sheaths around delicate nerve fibers. It is also involved in many autoimmune mechanisms. Vitamin B12 is deficient in patients with multiple sclerosis. The deficiency of Vitamin B12 in Multiple Sclerosis is related to age of onset, with younger patients having the greatest deficits. [15]

Supplementation with Vitamin B12 caused an improvement in the auditory and visual systems of patients with Multiple Sclerosis in study. The improvement was by as much as 30%, and was effective in patients with the more severe chronic progressive form of Multiple Sclerosis. Motor function, however, did not improve. [16]

Antioxidants

Antioxidant treatment is indicated in multiple sclerosis. The destruction of myelin is thought to be mediated by certain oxidative stressors. Free radicals or reactive oxygen species cause oxidative stress. Lipid peroxidation is also a result of increased oxidative stress. Antioxidants may reduce the risk of developing Multiple Sclerosis if taken early in life of higher risk individuals. Treatment may prevent propagation of the disease and improve outcome. [17]

One study examined the effects of antioxidant supplementation on the levels of glutathione peroxidase, the most potent antioxidant enzyme in the brain. It was found that the initial levels of this antioxidant enzyme were low in patients with Multiple Sclerosis, as were the antioxidant co-factors selenium, vitamin C and vitamin E. After supplementation, levels of both glutathione peroxidase and antioxidants were raised. [18] Another study examined the effects of Vitamin E supplementation on lipid peroxidation in Multiple Sclerosis patients. Vitamin E was found to reduce lipid peroxidation caused by oxidative stress in patients with MS. [19]

References

[1] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Multiple sclerosis; pp: 1474-1476.

[2] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone, New York; pp: 344-351.

[3] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone, New York; pp: 344-351.

[4] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone, New York; pp: 344-351.

[5] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Multiple sclerosis; pp: 1474-1476.

[6] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone, New York; pp: 344-351.

[7] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Multiple sclerosis; pp: 1474-1476.

[8] Pizzorno J, Murray M, and Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone, New York; pp: 344-351.

[9] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Multiple sclerosis; pp: 1474-1476.

[10] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml The Multiple Sclerosis Foundation. November 2004.

[11] Beers M and Berkow R. The Merck Manual; 17th Ed. 1999. Multiple sclerosis; pp: 1474-1476.

[12] Tomassini V et al. Comparison of the effects of acetyl-l-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomized, double blind, crossover trial. J Neurol Sci. 2004 Mar 15; 218(1-2): 103-108.

[13] Nordvik I, Myhr KM, Nyland H, Bjerve KS. Effect of dietary advice and n-3 supplementation in newly diagnosed multiple sclerosis patients. Acta Neurol Scand. 2000 Sep; 102(3): 193-200.

[14] Dworkin RH, Bates D, Millar JH, Paty DW. Linoleic acid and multiple sclerosis: a reanalysis of three double blind trials. Neurology. 1984 Nov; 34(11): 1441-1445.

[15] Sandyk R, Awerbuch GI. Vitamin B12 and its relationship to age of onset in multiple sclerosis. Int J Neurosci. 1993 Jul-Aug; 71(1-4): 93-99.

[16] Kira J, Tobimatsu S, Goto I. Vitamin B12 metabolism and massive dose methyl Vitamin B12 therapy in Japanese patients with multiple sclerosis. Intern Med. 1994 Feb; 33(2): 82-86.

[17] Gilgun-Sherki Y, Melamed E, Offen D. The role of oxidative stress in the pathogenesis of multiple sclerosis: the need for effective antioxidant therapy. J Neurol. 2004 Mar; 251(3): 261-268.

[18] Mai J, Sorenson PS, Hansen JC. High dose antioxidant supplementation to multiple sclerosis patients. Effect on glutathione peroxidase, clinical safety, and absorption of selenium.

[19] Butterfield DA et al. Vitamin E and neurodegenerative disorders associated with oxidative stress. Nutr Neurosci. 2002 Sep; 5(4): 229-239.