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The diseases of the brain and spinal cord in which myelin sheath or white matter is affected are known as demyelinating diseases. The cells of the human nervous system are anatomically and physiologically divided into grey matter and white matter. The white matter can be compared to the electrical wires that perform the important function of transporting the sensations or commands originating from gray matter cells to other parts of the nervous system. The electrical wires have an outer cover for insulation. Similarly, the white matter has a myelin sheath for insulation. The diseases damaging the myelin coating of the white matter are known as demyelinating diseases. The most important, strange and painful demyelinating disease is called multiple sclerosis. In simple language some type of allergy or disturbance in metabolism of brain, damages the white matter. This is called as demyelination and gliosis. In this disease specific symptoms are seen in the brain, spinal cord and mainly the sensory nerves of the eyes.
· This disease is twice more common in females than in males.
· It is generally seen in age group of 15 to 50 years. Generally it is not found in children and elderlypeople.
· This disease is more prevalent in Scotland, North Europe and America. It is seen prominently in the countries that are away from the equator, thus the proportion of this disease is comparatively less in India.
Like many other brain diseases, the causes of this disease are also awkward and still not properly understood. In a few cases it seems to be hereditary, but in other cases the reasons may not be hereditary.
This disease may occur due to some virus, environmental factors or irregularities in lifestyle and food habits.
1. Paralysis of one or more parts of the body: in 35% cases.
2. Loss of vision or diplopia: in 36% cases
3. Loss of sensation in some parts of the body (in 37% cases) or abnormal sensations like pricking of needles (in 26% cases).
4. Loss of balance, vertigo, problems of bowel and bladder movements.
5. Loss of memory and seizures.
6. Tremors of limbs, pain, and problems in sexual life, mental disorders ranging from insanity to depression may be seen.
Multiple sclerosis may start with one or more of the above symptoms and it may....
· either be cured completely, recover and recur again (relapsing variety) or
· gradually go on increasing in intensity after a mild beginning (chronic progressive variety) or
· Initially relapsing disease may become permanent after a few years.
It is important to contact a physician/neurologist immediately, if the patient is suffering from above mentioned symptoms, especially the ones related to eyesight, paralysis or equilibrium.
Diagnosis mainly requires some specific blood tests and Magnetic Resonance Imaging (MRI). Besides this C.S.F. (lumbar puncture) examination is also important. The C.S.F. test shows increase in cell count, increase in protein levels, specifically gammaglobulin. Oligoclonal band (1gG) is seen with increase in the myelin basic protein level. V.E.P, S.S.E.P, B.E.R.A tests are helpful in confirmation of diagnosis.
Thus, physical examination and above-mentioned tests can help in accurate diagnosis.
A few years ago, this disease was considered incurable; but modern medical science has partially succeeded in-the treatment of this disease.
· When the attack of the disease occurs steroids should be started, especially injections of methyl prednisolone or injections of A.C.T.H. followed by oral prednisolone.
· When the disease increases gradually and becomes permanent, methotrexate, azathioprine etc. are used. Mitoxanthrone (Novantrone) is currently being investingated for secondary progressive MS. cases.
· In order to prevent an attack, beta interferon 1a (Avonex), beta interferon lb (Beta seron), Copaxone are used. These medicines are called ABC medicines and are the basic drugs for this disease but are very expensive and are to be taken under the guidance of a specialist.
· Gamma-globulin therapy is rather costly but has proved to be effective in certain cases.
· In this disease the patient may suffer from severe pain, tremors and stiffness of limbs, bowel and bladder problems, weakness, lethargy, problems in sexual life and mental depression which should be treated symptomatically.
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