Disease course

Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.

Small increases in body temperature can temporarily worsen signs and symptoms of MS, but these aren’t considered disease relapses.

About 60 to 70 percent of people with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, known as secondary-progressive MS.

The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS.

Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses. This is known as primary-progressive MS.

Causes

The cause of multiple sclerosis is unknown. It’s considered an autoimmune disease in which the body’s immune system attacks its own tissues. In the case of MS, this immune system malfunction destroys myelin (the fatty substance that coats and protects nerve fibers in the brain and spinal cord).

Myelin can be compared to the insulation coating on electrical wires. When the protective myelin is damaged and nerve fiber is exposed, the messages that travel along that nerve may be slowed or blocked. The nerve may also become damaged itself.

It isn’t clear why MS develops in some people and not others. A combination of genetics and environmental factors appears to be responsible.

Risk factors

These factors may increase your risk of developing multiple sclerosis:

• Age. MS can occur at any age, but most commonly affects people between the ages of 15 and 60.
• Sex. Women are about twice as likely as men are to develop MS.
• Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
• Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
• Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.
• Climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe.
• Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.
• Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.

Complications

People with multiple sclerosis also may develop:

• Muscle stiffness or spasms
• Paralysis, typically in the legs
• Problems with bladder, bowel or sexual function
• Mental changes, such as forgetfulness or mood swings
• Depression
• Epilepsy

Rx:

“Multiple sclerosis (MS) happens when your immune system attacks myelin, the sheath around your nerve cells. Without this outer shell, your nerves become damaged and cause communication problems between your brain and the rest of your body.

MS is a chronic, or long-lasting, disease that can affect your brain, spinal cord, and the optic nerves in your eyes. It can cause problems with vision, balance, muscle control, and other basic body functions. 

The effects of MS vary from person to person. Some people have mild symptoms and don’t need treatment, while others have trouble getting around and doing daily tasks.”

WebMD (https://www.webmd.com/multiple-sclerosis/what-is-multiple-sclerosis)

To understand Multiple Sclerosis (MS) lets understand first it attacks the nervous system at the what we call the myelin shealth.  The myelin sheath does this first the Myelin is a fatty white substance that surrounds the axon of some nerve cells, forming an electrically insulating layer. It is essential for the proper functioning of the nervous system. It is an outgrowth of a type of glial cell. The production of the myelin sheath is called myelination or myelinogenesis.  The myelin sheath is a multi-layered membrane, unique to the nervous system, that functions as an insulator to greatly increase the efficiency of axonal impulse conduction.

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).

In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged.

There’s no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.

Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. They may include:

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• Prolonged double vision
• Tingling or pain in parts of your body
• Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
• Tremor, lack of coordination or unsteady gait
• Slurred speech
• Fatigue
• Dizziness
• Problems with bowel and bladder function

When to see a doctor

See a doctor if you experience any of the above symptoms for unknown reasons.

“Our nervous system is divided in two components: the central nervous system (CNS), which includes the brain and spinal cord, and the peripheral nervous system (PNS), which encompasses nerves outside the brain and spinal cord. These two components cooperate at all times to ensure our lively functions: we are nothing without our nervous system!

Unlike the brain and the spinal cord of the central nervous system that are protected by the vertebrae and the skull, the nerves and cells of the peripheral nervous system are not enclosed by bones, and therefore are more susceptible to trauma.

If we consider the entire nervous system as an electric grid, the central nervous system would represent the powerhouse, whereas the peripheral nervous system would represent long cables that connect the powerhouse to the outlying cities (limbs, glands and organs) to bring them electricity and send information back about their status.”

University of Queensland (https://qbi.uq.edu.au/brain/brain-anatomy/peripheral-nervous-system)

What are the parts of the nervous system?

The nervous system has two main parts:

1 – Central nervous system (CNS): Your brain and spinal cord make up your CNS. Your brain reads signals from your nerves to regulate how you think, move and feel.

2 – Peripheral nervous system (PNS): Your PNS is made up of a network of nerves. The nerves branch out from your spinal cord. This system relays information from your brain and spinal cord to your organs, arms, legs, fingers and toes.

Your peripheral nervous system (PNS) is that part of your nervous system that lies outside your brain and spinal cord. It plays key role in both sending information from different areas of your body back to your brain, as well as carrying out commands from your brain to various parts of your body.

Some of those signals, like the ones to your heart and gut, are automatic. Others, like the ones that control movement, are under your control.

What’s the difference between the peripheral and central nervous systems?

Your nervous system consists of two main parts: your central nervous system and your peripheral nervous system.

Your central nervous system includes two organs, your brain and spinal cord.

Your peripheral nervous system is everything else and includes nerves that travel from your spinal cord and brain to supply your face and the rest of your body. The term “peripheral” is from the Greek word that means around or outside the center.

There are two parts to your peripheral nervous system:

• The somatic nervous system guides your voluntary movements.

Your somatic nervous system is a subdivision of your peripheral nervous system, which is all of your nervous system except your brain and spinal cord. Your somatic nervous system allows you to move and control muscles throughout your body. It also feeds information from four of your senses — smell, sound, taste and touch — into your brain.

• The autonomic nervous system regulates the activities you do without thinking about them (involuntary movements).

Your autonomic nervous system is a network of nerves throughout your body that control unconscious processes. These are things that happen without you thinking about them, such as breathing and your heart beating. Your autonomic nervous system is always active, even when you’re asleep, and it’s key to your continued survival.

Your autonomic nervous system is a part of your overall nervous system that controls the automatic functions of your body that you need to survive. These are processes you don’t think about and that your brain manages while you’re awake or asleep.

What does the nervous system look like?

Nerve cells (neurons) are the basis of your nervous system. There are 100 billion neurons in your brain. These cells connect throughout your entire body.

Imagine your nervous system as a tree. Your central nervous system is the trunk of the tree that contains your brain and spinal cord. The tree branches are your peripheral nervous system (nerves). The branches extend from the truck (brain and spinal cord) to reach all parts of your body.

Signs and symptoms of nervous system conditions vary by type but may include:

• Movement and coordination changes.
• Memory loss.
• Pain, numbness or a pins and needles feeling.
• Behavioral and mood changes.
• Difficulty with thinking and reasoning.
• Seizures.

Some conditions, like a stroke, are medical emergencies that need treatment quickly. If you notice the following symptoms, contact 911 or your local emergency services number:

• Muscle weakness or paralysis in one side of your body.
• Sudden vision loss.
• Slurred speech.
• Confusion.

“The nervous system is the major controlling, regulatory, and communicating system in the body. It is the center of all mental activity including thought, learning, and memory. Together with the endocrine system, the nervous system is responsible for regulating and maintaining homeostasis. Through its receptors, the nervous system keeps us in touch with our environment, both external and internal.

Like other systems in the body, the nervous system is composed of organs, principally the brain, spinal cord, nerves, and ganglia. These, in turn, consist of various tissues, including nerve, blood, and connective tissue. Together these carry out the complex activities of the nervous system.”

National Cancer Institute (https://training.seer.cancer.gov/anatomy/nervous/)

Your nervous system is your body’s command center. It’s made up of your brain, spinal cord and nerves. Your nervous system works by sending messages, or electrical signals, between your brain and all the other parts of your body. These signals tell you to breathe, move, speak and see, for example. Your nervous system keeps track of what’s going on inside and outside of your body and decides how to respond to any situation you’re in.

Your nervous system regulates complicated processes like thoughts and memory. It also plays an essential role in the things your body does without thinking, like blushing, sweating and blinking.

Your nervous system’s main function is to send messages from various parts of your body to your brain, and from your brain back out to your body to tell your body what to do. These messages regulate your:

• Thoughts, memory, learning and feelings.
• Movements (balance and coordination).
• Senses (how your brain interprets what you see, hear, taste, touch and feel).
• Wound healing.
• Sleep.
• Heartbeat and breathing patterns.
• Response to stressful situations, including sweat production.
• Digestion.
• Body processes, such as puberty and aging.

How does the nervous system work?

Your nervous system uses nerve cells called neurons to send signals, or messages, all over your body. These electrical signals travel among your brain, skin, organs, glands and muscles.

The messages help you move your limbs and feel sensations, like pain. Your eyes, ears, tongue, nose and the nerves all over your body take in information about your environment. Then, nerves carry that data to and from your brain.

There are different types of neurons. Each type of neuron has a different job:

• Motor neurons take signals from your brain and spinal cord to your muscles. They help you move. They also assist with breathing, swallowing and speaking.
• Sensory neurons take information from your senses (what you see, touch, taste, etc.) to your brain.
• Interneurons communicate between motor and sensory neurons. These neurons regulate your movement in response to sensory information (like moving away from a hot surface) and play a role in how you learn, think and remember.

“Endometriosis is derived from the word “endometrium,” which is the tissue that lines the uterus. Patients with endometriosis have endometrial-type tissue outside of the uterus.

Endometriosis Risk Factors:

Research shows that there are some things that put a person at higher risk of developing endometriosis, including having:

• A mother, sister or daughter who has endometriosis
• An abnormal uterus, which is diagnosed by a doctor
• Early menstruation (before age 11)
• Shorter menstrual periods (less than 27 days on average)
• Heavy menstrual periods lasting more than seven days

Some things that can lower the risk of endometriosis include:

• Pregnancy and breastfeeding
• Having your first period after age 14
• Eating fruits, especially citrus fruits

Endometriosis prevention:

Endometriosis is an idiopathic condition, meaning there is no known cause. There are also no specific ways to prevent endometriosis. However, being aware of the symptoms and whether you could be at higher risk can help you know when to discuss it with a doctor.

Endometriosis Stages:

Doctors classify endometriosis from stage 1 to stage 4. The stages are based on where endometrial tissue occurs in the body, how far it has spread and how much tissue is in those areas.

Having a more advanced stage of endometriosis does not always mean you will have more severe symptoms or more pain. Some women with stage 4 endometriosis have few or no symptoms, while those with stage 1 can have severe symptoms.

“Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally.

It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility.

There is currently no known cure for endometriosis and treatment is usually aimed at controlling symptoms.

Access to early diagnosis and effective treatment of endometriosis is important, but is limited in many settings, including in low- and middle-income countries.”

World Health Organization WHO (https://www.who.int/news-room/fact-sheets/detail/endometriosis)