FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

MULTIPLE SCLEROSIS DOESN'T USUALLY SHORTEN LIFE

Question: Several months ago my cousin started complaining that her legs and body felt really weak and that she fatigued quite quickly. She now says she's tired all the time and cannot get enough rest. This illness has also caused slurred speech and twisted her mouth. At first we thought she had a stroke or Bell's Palsy. She went to a family doctor and then a specialist who diagnosed her condition as multiple sclerosis. That brings up my question: How many different types of multiple sclerosis are there, and are all of them life threatening?

Answer: Multiple sclerosis, commonly referred to simply by the initials "MS," is a disease of the brain. In MS one or more areas of the brain are damaged in a way that interferes with the normal function of the brain cells. Disease in regions that control movement of the mouth cause your cousin's twisted mouth and garbled speech. Damage in other areas can cause weakness, confusion, and other symptoms.

We don't yet understand the exact nature of the damage that MS causes, but we do know that this illness is the number one disabling illness of young adults. About 300,000 people in the United States have this disease, and the majority of them are Caucasian. Female sufferers also outnumber males by 2 to 1. This illness has a strong tendency to run in families. For instance, MS strikes one out of every 1,000 persons in the general population, but if your mother, father or sibling has had the disease, your chances are 35 out of 1,000. Even more striking, if an identical twin has the illness, you have a 50 percent chance of getting it 500 out of a 1,000.

What we refer to as "types" of multiple sclerosis are probably really no more than a tacit recognition of the variety of ways our bodies can respond to the unknown cause or causes of this disease. To give you some idea of the range of variations possible, I'll give you a small dose of statistics: After the first symptoms appear, 90 percent of MS sufferers experience a remission. Some 20 percent have only two or three episodes of relapse and remission and are then free of symptoms. The remaining majority continue the cycle of relapse and remission, but after five years or more of this "on again, off again" pattern, there is a 60 percent chance that the disease will become progressive without futher remissions.

There is also a very uncommon type of MS that is progressive from its onset and often results in death within a few years. For the majority of those with the disease, however, life expectancy is barely affected at all. Even when longevity isn't significantly altered by MS, the quality of life usually is. Twenty years after the onset of the disease, 50 percent will have significant disability. Half of these individuals will be able to walk without the aid of a cane or crutch, while the other half are less fortunate.

Question: What is the treatment for MS?

Answer: A relatively new medication, beta interferon, can help those with the "relapsing-remitting" variety of MS. This medication reduces the frequency and severity of attacks. Prednisone can also be helpful, especially if started early in an attack. There are other medications that are also of some benefit for the uncommon progressive MS. Unfortunately, none of these therapies are successful for all patients, and none can cure the disease. Medical researchers are still working toward that goal.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.