HEALTH MATTERS: Early diagnosis key in MS

by Rene Gomez
Multiple sclerosis can be a difficult disease to diagnose, as its symptoms often mimic those associated with other health conditions. Yet early diagnosis and treatment are key to managing the chronic condition and slowing its progression.
   Fortunately, with advancements in MRI technology, doctors are now better able to diagnosis multiple sclerosis in its beginning stages, allowing patients to start treatment sooner and keep symptoms at bay.
   What is multiple sclerosis?
   Multiple sclerosis – or MS – is a disease of the central nervous system that interrupts the flow of information within in the brain and between the body and the brain.
   More specifically, MS is a result of the immune system attacking the protective insulation surrounding the nerve fibers of the central nervous system. When this insulation, called myelin, is damaged it can disrupt the nerve impulses traveling to and from the brain and spinal cord, resulting in a variety of symptoms.
   The Multiple Sclerosis Society estimates that MS affects more than 2.3 million people worldwide and finds that the disease is significantly more common in women than men.
   While MS can be diagnosed at any age, most people are diagnosed between the ages of 20 and 50.
   Signs and symptoms
   The signs and symptoms of MS vary greatly because the location and severity of the attack can be different every time. Moreover, symptoms can last for days, weeks, or months and then go into remission. In severe cases, symptoms become permanent.
   In general, the most common symptoms of MS include:
   * Impaired vision
   * Extreme fatigue
   * Problems with balance and walking
   * Numbness or pain and other sensory changes
   * Weakness in one or more limbs
   * Bladder and bowel symptoms such as constipation or frequent urination
   * Tremors
   * Problems with memory and concentration
   * Mood changes
       If you experience these or other troubling symptoms, talk with your doctor. He or she may recommend consulting a neurologist for further evaluation.
   How diagnosed
   Diagnosing MS is done by process of elimination and ruling out other conditions that could be causing symptoms. In order to make a diagnosis, a physician must:
   * Find evidence of damage in at least two separate areas of the central nervous system, which includes the brain, spinal cord and optic nerves, and
   * Find evidence that the damage occurred at least one month apart, and
   * Rule out all other possible diagnoses
       According to the National Multiple Sclerosis Society, MRI is the best imaging technology for detecting the presence of MS plaques or scarring in different parts of the central nervous system.
   At University Medical Center of Princeton at Plainsboro, doctors are using high-definition 3T (Tesla) MRI with intravenous contrast to detect lesions associated with MS at their earliest stages. This is some of the most advanced technology available, generating 3D images that enable doctors to make more accurate and faster diagnoses.
   In addition to MRI, doctors use other tests including visual evoked potentials and cerebrospinal fluid analysis to diagnose MS and rule out other conditions.
   Visual evoked potentials test the nervous system’s response to stimulation of the visual sensory pathway. When there is scarring along the pathway, response time is slower, evidence to help confirm a diagnosis of MS.
   Analysis of cerebrospinal fluid can detect certain immune system responses associated with MS, but they are not proof positive of MS as they can be associated with other diseases as well.
   Finally, while MS cannot be detected through a blood test, blood tests can be used to eliminate the possibility that another condition is causing the symptoms.
   How treated
   At this point in time, there is no cure for MS. Treatment is aimed at modifying the course of the disease by lessening the frequency and severity of attacks, reducing the accumulation of lesions in the brain and slowing the progression of symptoms.
   Medication is the first-line of treatment for MS and studies suggest that early treatment can lessen the degree of disability caused by the disease.
   A variety of medications that reduce flare-ups and slow the progression of MS are available and approved by the U.S. Food and Drug Administration. One of the newest and most effective medications is called natalizumab, commercially known as Tysabri.
   However, patients must be tested for the JC virus before taking this drug, which is administered intravenously. The virus lies dormant in the majority of people, but can be activated by taking natalizumab and lead to serious health risks.
   All medications have varying rates of efficacy and side effects. If you are diagnosed with MS, it is important to understand the risks and benefits associated with medication and to work with your doctor to come up with a therapy plan that is best for you.
   In addition to disease-modifying medication, other drugs may be prescribed to help relieve symptoms. Severe exacerbations are often treated with high-dose cortiscosteroids.
   Patients with MS also often benefit from rehabilitation and self-care techniques such as exercise, eating a healthy diet and managing stress.
   Multiple sclerosis can be an unpredictable and disabling condition, but with an early diagnosis and the right care and treatment the course of the disease can be slowed so patients can lead full and active lives.
   To find a neurologist with Princeton HealthCare System call (888) 742-7496 or visit
   Rene Gomez, M.D., F.A.A.N., is board certified in neurology and a fellow of the American Academy of Neurology. He is a member of the medical staff at University Medical Center of Princeton at Plainsboro.