Multiple Sclerosis
by Candace Parson
Disability Specialist
Multiple sclerosis (MS) is a progressive demyelinating neurological and immune system disorder that affects the myelin sheath of the brain and spinal cord. The myelin sheath is the protective layer that covers the nerves in the brain and spinal cord and enables electrical impulses to be conducted along the nerve fiber with speed and accuracy. When the myelin sheath is damaged the nerves are unable to conduct the electrical impulses normally. In MS the body’s immune system attacks the myelin sheath in error causing inflammation and damage to the myelin sheath as well as the nerve fibers themselves. This damage may appear on imaging studies as multiple areas of scarring (sclerosis) which can cause slowing or even blockage of nerve signals affecting muscle coordination, strength, sensation, and vision.
There is no one specific test that can be used to use to diagnose MS. Rather, the diagnosis of MS is made using a combination of evidence of damage in at least two separate areas of the central nervous system (CNS) which includes the brain, spinal cord, and optic nerves, plus evidence that this damage to the CNS occurred at least one month apart. All other possible diagnoses must be ruled out. In addition to a complete medical history and detailed neurologic exam, an MRI, visual evoked potentials for those individuals with visual deficiency, and cerebrospinal fluid analysis are generally used to establish the diagnosis of MS. The visual evoked potential tests are generally considered the most useful test for confirming the diagnosis of MS. A normal MRI does not rule out MS. Blood tests are helpful in ruling out other conditions which cause symptoms similar to those of MS.
Symptoms of multiple sclerosis vary from person to person and can change over time in the same person. Some common symptoms include muscle weakness, fatigue, loss of balance, decreased coordination, blurred or hazy vision, double vision, eye pain, hearing loss, muscle spasms, problems walking, and tremors. Bowel and bladder symptoms include constipation, stool leakage, difficulty with urination, and incontinence. Cognitive symptoms include decreased attention span, poor judgment, memory loss, and difficulty solving problems. Depression may be present. Other symptoms that can occur include slurred speech, trouble chewing and swallowing, and facial pain. Patients sometimes describe tingling, crawling or burning feelings in the arms and legs.
In persons with MS the disease process takes one of four courses to a mild, moderate, or severe degree. The most common course is relapsing-remitting MS (85% of all MS cases) in which individuals have clearly defined attacks with worsening of their neurologic symptoms followed by partial or complete periods of recovery during which there is no progression of the disease. Persons with primary-progressive MS (10%) experience slowly worsening neurologic function from the beginning with no distinct periods of remission. The third course is progressive-relapsing MS (5%). Individuals with this form of the disease have steadily worsening disease from the beginning, but also have clear attacks with worsening neurologic function during the course of the disease. Unfortunately, these individuals do not experience periods of remission. Lastly, there are persons who develop secondary-progressive MS. These people have had an initial period of relapsing-remitting MS and then enter a phase of steady worsening of the disease. About 50% of people with relapsing-remitting MS develop this form of the disease within 10 years.
There is no cure for MS; however, a number of medications have been developed to modify the disease course and improve function of people living with MS. A healthy well-balanced diet and exercise are recommended.
Multiple Sclerosis is evaluated by Social Security under Listing 11.09.