Condition Care Guide
What is multiple sclerosis?
Multiple sclerosis (MS) is among the most baffling of all diseases. Very little is known about what causes it or what factors influence its progression and outcome.
The condition begins with localized inflammatory damage to the myelin sheaths that surround nerve fibers as a result of an attack by the immune system. Although MS is considered an autoimmune disease, it is not clear what prompts the immune system to attack the nerve sheaths.
MS is two to three times more common in women compared to men and while it affects all ethnic groups, it is most common among Caucasians (particularly those of northern European ancestry). The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age. Risks are higher among those who have a close relative with MS.
The disease becomes more common the further from the equator you live. This suggests that vitamin D, which the body synthesizes in response to direct sunlight, may play a protective role, but definitive research has not established a link.
MS can take several different forms:
- Relaxing, remitting MS: symptoms come and go.
- Primary-progressive MS: symptoms worsen steadily.
- Secondary-progressive MS: a mixture of relaxing/remitting and primary-progressive MS.
- Progressive-relapsing: a rare form which worsens steadily (progressive-relapsing MS).
What are the symptoms?
Because the location and severity of each attack can be different, MS symptoms can vary greatly. Attacks (relapses) can last for days, weeks, or months and may alternate with remissions when symptoms ease up or disappear for varying periods of time. Muscle symptoms include loss of balance, muscle spasms, numbness in any area of the body, problems with moving the arms or legs, with walking, coordination and making small movements. Tremor in one or more of the arms or legs is another symptom. Fatigue is common and usually is worse in the afternoon.
MS can affect the bowel and bladder causing constipation and stool leakage, difficulty urinating, a frequent need or strong urge to urinate, and incontinence. When the disease affects the eyes, patients may develop double vision, eye discomfort, uncontrollable rapid eye movements and vision loss (usually in one eye at a time). MS patients also can experience numbness, tingling or pain in the face, painful muscle spasms, tingling, crawling or burning sensations in the arms and legs.
If the brain is affected, MS can lead to decreased attention span, poor judgment, memory loss, difficulty reasoning and solving problems, depression, dizziness and balance problems and hearing loss. Some patients develop speech and swallowing problems and some encounter sexual symptoms such as lack of vaginal lubrication in women and erectile dysfunction in men.
MS symptoms can be triggered or worsened by fever, hot baths, sun exposure and stress.
What are the causes of multiple sclerosis?
No one knows for sure what causes MS, why there are so many different forms of the disease or why some people have transient symptoms that never return, while others experience cycles of relapses and remission. Researchers have been investigating the possibility of a viral trigger. Potentially related to this theory is the fact that MS is more common in northern latitudes versus near the equator, therefore vitamin D levels due to solar exposure and the vitamin's role in immune system support could be at play.
How is multiple sclerosis diagnosed?
Because there is no one confirmatory test, and symptoms can mimic those of many other nervous system disorders, the only way to diagnose MS is by ruling out other possible causes.
A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. It may reveal decreased ability to move a part of the body, decreased or abnormal sensation or other loss of nervous system functions.
An eye examination may show abnormal pupil responses, changes in the visual fields or eye movements, decreased visual acuity or rapid eye movements triggered when the eye moves.
Other tests that may be recommended:
- Lumbar puncture (spinal tap): This is done to test cerebrospinal fluid for elevated levels of IgG antibodies, as well as a group of inflammation-related proteins called oligoclonal bands and proteins that are the breakdown products of myelin.
- MRI of the brain and spine: to look for inflammation related changes in the blood-brain barrier.
- Evoked potential tests: These are nerve function studies that can reveal evidence of scarring along nerve pathways that doesn't show up in neurological exams.
- Visual evoke potential tests: To identify impaired transmission along optic nerve pathways; these tests are considered key to an MS diagnosis.
What is the conventional treatment for multiple sclerosis?
Drugs called beta interferons, including Avonex, Betaseron, or Rebif, glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri), have become the standard treatment for MS patients, especially those with the remitting variety. While these drugs can slow progression of the disease, they are expensive and can lead to unpleasant side effects. Reliably effective medical treatment is still not available for most patients.
In addition to beta interferons, the following medications may be prescribed to slow the progression of MS:
- Fingolimod (Gilenya): A new class of medication believed to act by retaining some white blood cells in the lymph nodes, preventing them from passing into the central nervous system. Following reports of deaths among some patients taking Glineya, the FDA updated its prescribing rules to require heart-function tests and monitoring before the drug is taken.
- Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may be prescribed if other drugs are not working well.
Steroids may be used to decrease the severity of attacks and other specific drugs may be prescribed to reduce muscle spasms, urinary problems, mood or behavior symptoms, and fatigue.
In addition to drug treatment, physicians may recommend some of the following measures as necessary:
- Physical therapy, speech therapy, occupational therapy, and support groups.
- Assistive devices (wheelchairs, bed lifts, shower chairs, walkers, and wall bars).
- A planned exercise program early in the course of the disorder.
- A healthy lifestyle, with good nutrition along with regular periods rest and relaxation.
- Avoiding fatigue, stress, temperature extremes, and exposures that could lead to illness.
- Changes in food and drink consistency for those who have problems with swallowing.
- Safety measures at home designed to prevent falls.
- Consultations with social workers or other counseling services plus assistance from such services as Meals-on-Wheels.
What therapies does Dr. Weil recommend for multiple sclerosis?
Dr. Weil says that he likes to work with MS patients because of the variability of the disease and its potential to go into remission, as well as its responsiveness to stress reduction, mind/body treatments and changes in lifestyle. He recommends trying the following dietary approaches to see what proves most helpful:
- Decrease protein toward 10 percent of daily caloric intake. Replace animal protein as much as possible with plant protein.
- Eliminate milk and milk products, substituting other calcium sources.
- Eat organically grown fruits and vegetables as much as possible as well as organic products made from wheat and soy.
- Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils, and all foods (such as deep-fried foods) that might contain trans-fatty acids. Use extra-virgin olive oil as your main source of dietary fat.
- Increase intake of omega-3 fatty acids from wild-caught fish such as salmon and halibut, walnuts, or flax and hemp seeds.
- Eat more fruits and vegetables.
- Eat ginger and turmeric regularly.
Dr. Weil also recommends trying the following supplements:
- For constipation: probiotics and psyllium or use the Ayurvedic herbal bowel regulator, triphala.
- A quality antioxidant and daily multivitamin formula and a B-50 complex vitamin, along with a multi-mineral supplement daily.
- Soy lecithin granules: take five grams daily (store this in the refrigerator).
- Coenzyme Q10 (CoQ10): take 30 milligrams two or three times a day.
Other lifestyle measures:
- Do some kind of light aerobic exercise on a regular basis. Choose something you enjoy but do not push yourself to the point of exhaustion.
- Explore visualization, meditation, and hypnotherapy in order to redirect your mental energies in positive directions.
- Experiment with traditional Chinese medicine and Ayurvedic medicine with qualified practitioners.