Multiple Sclerosis

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9780136046950: Multiple Sclerosis

The most trusted book on multiple sclerosis, updated and revised with the latest research in combating the disease.

Once known as the “crippler of young adults,” now more than seventy-five percent of MS patients will never need a wheelchair. In Multiple Sclerosis, Dr. Louis J. Rosner and Shelley Ross explain that there genuinely is new hope, more than ever before, both for controlling the disease today and curing it tomorrow.

Updated with the latest research and terminology, this revised edition gets to the bottom of every treatment option from the tried-and-true to today's cutting-edge and experimental therapies. Its trusted advice covers every step of living with MS, what you need to know, and what you need to ask. Dr. Louis Rosner and Shelley Ross explain what the disease is, who gets it and why, and what people with MS can do to continue living happy and healthy lives. Whether you or your loved one has just been diagnosed with MS or has lived with it for a while, Multiple Sclerosis gives you the information you need to live well with the disease, including:

-The diagnosis: how to understand and identify MS as early as possible
-The varying symptoms and courses of the disease: how to recognize and treat them
-The emotional struggles that come with MS: where to turn for support
-The most current medical research and therapies available to MS patients: how to know if they are right for you

For decades, this trusted handbook has helped those with MS and their families and friends to treat and understand their disease. Research brings us closer to a cure every day, but until that day comes, patients have, in this book, the very best tool for beating MS—the facts.

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About the Author:

Louis J. Rosner, M.D., is a retired professor of clinical neurology at UCLA. He was formerly head of the UCLA Multiple Sclerosis Clinic.

Excerpt. Reprinted by permission. All rights reserved.:

1

MS -- What Is It, Who Gets It, and Why

If ever a disease could be called fascinating, it would be multiple sclerosis. The volumes of available facts and figures give it an intriguing identity. We know, for example, that in the United States almost triple the number of MS cases are found above the thirty-seventh parallel (running from Santa Cruz, California, to Newport News, Virginia) as are found below it. In certain areas of the world, not a single case of MS has ever been reported. Certain races appear to be relatively immune. Some studies show that women from the upper echelons of society, aged twenty-five to thirty-five, form a noticeably high percentage of MS cases, a fact suggesting that MS is some kind of "elitist" disease. Why do all these facts consistently hold true? Scientists today are closing in on the answers to this and other perplexing questions.

We now know what MS is, who gets it, and when, where, and possibly why. Some aspects of the disease, however, such as its cause, still remain a mystery. In fact, a researcher once compared it to the old Indian legend in which a group of blind men encounter an elephant. They can each describe the part of the animal they have touched, but none of them can explain the total picture. This is the case with MS.

Still, scientists are closer than ever to describing the whole MS elephant. In January 1985 a team of researchers from Stanford University announced that they had wiped out a disease in mice that is similar to MS. We are truly on the threshold of discovery.

Among the general public, MS is one of the most misunderstood diseases. Just think of the public service slogan: MS, the Crippler of Young Adults. That's a pretty gloomy label for a disease where 75 percent of those who have it will never need a wheelchair. Whether you've just been diagnosed as having MS or you've lived with it a while -- or even if the MS patient is someone you happen to care for -- it's important to know that misinformation is a greater enemy than the disease itself. So, while we can't provide you with a cure in these pages, we can give you the best tools to beat MS -- the facts.

THE HISTORY

The MS story begins almost like a fairy tale, because once upon a time there was no MS -- not a case was known to medicine. Then, in the 1830s, two doctors in Europe began to write of a "new" disease, one never seen before. Jean Cruveilhier, professor of pathological anatomy in the Faculty of Medicine at the University of Paris, is credited with the first clinical report in 1835. During routine autopsies, he observed some "brown patches" in the central nervous system and described them to the medical community. Simultaneously, Robert Carswell was commissioned by the museum at University College in London to show a collection of sketches of the central nervous system that he had drawn as a young medical student. Among the two thousand color pictures he had drawn while observing autopsies were some that included unexplained "spots." In 1838, Carswell published an atlas of his drawings, along with written descriptions. In one chapter he wrote, "The anterior surface of the spinal cord presented a number of spots, from a quarter of an inch to half an inch in breadth."

Both Cruveilhier and Carswell only observed the effects of the disease during autopsies. A German doctor named Friedrich Theodor von Frerichs is given credit for the first diagnosis of the disease in a living subject. In 1849 he published a report more similar to the modern concept of MS. He wrote that it is more common in younger patients, that it is characterized by slow progression, that one side of the body is affected and then the other, and so on.

At about this time, too, reports of this disease started to appear outside medical literature. Perhaps the most famous historical case is recorded in the diary and letters of Sir Augustus Frederick d'Este (1794-1848), a grandson of George III of England and a cousin of Queen Victoria. In his published papers, he described his twenty-five years with recurring symptoms that included blurred vision, loss of balance, numbness in the limbs, and paralysis.

Around the world isolated reports of this odd disease were cropping up, but it is the French neurologist Jean-Martin Charcot who is credited with bringing the first clear-cut description of multiple sclerosis to the attention of the medical world. Charcot, the foremost authority on paralysis in Europe, attracted doctors from all parts of the continent to his dramatic lectures and presentations. Among his prominent students was the young Sigmund Freud, who traveled from Vienna to observe Charcot's treatment of patients with "hysterical" paralysis -- those paralyzed by emotional, not physical, problems. Charcot would actually get these patients to walk again by hypnotizing them, tricking them, or frightening them horribly. Freud, who became convinced that there were better ways to treat hysteria, ultimately went off on his own and pioneered psychoanalysis.

Still, what Charcot might have lacked in compassion he made up for in medical genius. In 1868 he identified a new disease that had previously been confused with paralysis. He was able to make his first observations of what would soon become known as multiple sclerosis right under his nose -- his own housekeeper had the disease.

On March 14, 1868, Charcot presented the clinical aspects of three cases to the French Biological Society. Soon after, he presented his own illustrations of the disease -- sketches that would appear in neurology textbooks for many generations to come. Most important, though, he was the first to correlate the "brown patches" discovered by Cruveilhier and Carswell with the symptoms of the disease he called sclérose en plaques, translated as "hardening in patches."

Because of Charcot's reputation and prominence, word of this new disease spread quickly, and the study of neurology would never be quite the same. Unfortunately, he only identified three symptoms of the disease -- the ones he observed in his maid -- and for years this led to very limited diagnosis around the world. In fact, until the 1950s the Japanese were thought to be immune to MS. They weren't immune at all; they had symptoms other than those in Charcot's literature, which was still respected as medical gospel.

The first American reports of MS began with a paper given on December 4, 1867, to the College of Physicians in Philadelphia, called "The Case of the Late Dr. C. W. Pennock." Dr. Pennock had been a physician trained both at the University of Pennsylvania and in Paris. Over a period of twenty-four years, he suffered progressive weakness and numbness in his limbs that left him unable to walk and ultimately to work. Dr. Pennock also noticed that warm weather made him feel weaker. His autopsy report mentioned "spots" that were discovered in the spinal cord. Although no name for the disease was ever given, it is apparent today that the case described was one of multiple sclerosis. It wasn't until 1878 that the term sclerosis appeared in American medical literature.

Our knowledge of MS is fairly new. As we look back now, the question is, Did MS appear out of the blue in the 1830s, or was it an older disease overlooked by doctors who made less acute observations? If it is a relatively new disease, it wouldn't be the first time in medical history a disease has suddenly appeared. Syphilis, for example, was unheard of before 1492, one of the more important dates we learn in elementary school. This is not a coincidence, since it was actually Christopher Columbus and his sailors who brought the disease to Europe. Syphilis was a very mild disease that was common among the women of Haiti. After Columbus's first voyage, he and his sailors returned to Europe via Haiti, where they contracted the disease. Unfortunately, Europeans had no immunity to syphilis, and it spread throughout the continent with very serious consequences.

In more recent times, too, brand-new diseases have appeared seemingly out of nowhere. The first case of Legionnaire's disease appeared in 1977, and the first case of AIDS (acquired immune deficiency syndrome) was diagnosed in the United States in 1980.

Why bother to trace the history of a disease at all? Quite often a little piece of information can help define the cause and lead to a cure or effective treatment. While medical debates still continue over the origin of MS, there is convincing evidence that MS was new on the scene in the 1830s.

WHAT WE KNOW ABOUT MS TODAY

Multiple sclerosis is a disease that strikes only the central nervous system, which consists of the brain and spinal cord. These organs control the movements and functions of the entire body. As the brain sends and receives signals, the spinal cord funnels them in and out, to and from different parts of the body through a network of nerves.

The nerves are surrounded by insulating matter called myelin -- a soft, white, fatty substance that forms a protective sheath for the nerves. The myelin sheath, which develops in the first ten years of life, insulates the nerve fibers and helps conduct signals through the body.

Multiple sclerosis is a disease where the myelin breaks down and is replaced by scar tissue. This demyelination can slow down or even block the flow of signals to and from the central nervous system to the rest of the body, impairing such functions as vision, strength, or coordination. One important characteristic of myelin, however, is that it can repair itself. This ability, called remyelination, is one of the reasons MS is usually associated with many attacks, or exacerbations, and recoveries, or remissions.

No one knows what actually causes MS, but we do know that it is an acquired disease -- you are not born with it. Multiple sclerosis is also an exogenous disease, meaning that it is contracted from the outside. And fortunately, it is not contagious. American researchers have shown that the rate of increased prevalence among husbands and wives is only 1 percent. In...

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