Term Paper on "Multiple Sclerosis Etiology Multiple Sclerosis, Some Researchers"

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Multiple Sclerosis Etiology

Multiple sclerosis, some researchers argue, constitutes "a disease of unknown etiology," which reportedly implies a single causal organism triggers MS. Numerous infectious agents suspected as possible etiological agents include: "the corona, measles, Epstein-Barr, herpes simplex type 6, and canine distemper viruses, the human T-cell lymphotrophic virus (HTLV)-I, an 'MS-associated agent' and, most recently, Chlamydia." (Poser 12) No one has been able to confirm any these infectious agents, however, this contention continues even though competent investigators routinely utilize sophisticated techniques to conduct exhaustive searches. (Poser 12) Numerous steps leading to the development process of MS remain invisible and unidentified. The contemporary consensus regarding MS. Albeit, posits it likely evolves from a genetically susceptible subject, of the immune system's activation by various viral agents, consequently initiating a pathogenetic surge ultimately contributing the myelin sheath and axon being destroyed. (Poser 12) Multiple sclerosis (MS) constitutes the current, most common neurological illness in North America and Europe. MS, Doughty reports, affects approximately 2.5 million individuals worldwide. At times, the complex, daunting aspects of MS contribute to challenging individuals, with MS, mentally, physically personally, socially, and vocationally. Accompanying challenges continually confront individuals with MS with critical crossroads in life and require relevant rationale choices be made by them and/or those who work with and care for this particular population. Population and the geographic location both reportedly influence the frequency of MS. Current r

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esearch reflects that white persons of northern European descent who live in temperate climates are more frequently diagnosed with MS, an observation suggesting genetic, as well as, environmental factors may influence the frequency of MS. Anderson et al., cited by Wilson and Islam, estimates approximately 250,000-350,000 cases of MS were diagnosed in 1990, the incidences of MS (noting total population of approximately 250 million) equates to a prevalence of approximately 1 case per 1000 population. This amounts to half the prevalence of MS in northern Europe, which equates to two cases per 1000 population. Wilson and Islam define MS as: "an inflammatory demyelinating condition of the central nervous system (CNS) traditionally deemed autoimmune in nature. White matter tracts are affected, including those of the cerebral hemispheres, infratentorium, and spinal cord."

The locality where MS lesions or plaques may develop in CNS white matter may vary. Clinical presentations of MS may also be dissimilar. Frequently, the ongoing lesion formation in MS fosters physical disability and, in some cases, leads to cognitive decline. MS characteristics include its unpredictable nature, the time delay between the onset of symptoms and the confirmed MS diagnosis, as well as, the physiological and psychological symptomatology (collective symptoms MS) ranges potentially present in an individual with MS. As common in a number of other autoimmune conditions, the MS patient's immune system attack its host, likely due to exposure to a molecular sequence mimicking the host tissue's molecular sequence. Wilson and Islam explain that even though the immune trigger has not yet been identified, the targets are known to be myelinated CNS tracts. In inflamed areas, the blood-brain barrier breaks down, accompanied by perivascular lymphocytic and monocytic infiltration. "Focal destruction of myelin ensues, with axonal damage, gliosis, and the formation of sclerotic plaques. Gradually, cumulative damage results in significant loss of white matter and a reduction in total brain volume." (Wilson and Islam)

MRI Images

The following figures compare MRI images of a "normal" brain with one of a person with MS.

Point-resolved spectroscopic study performed in MS patient reflects " slightly decreased N-acetylaspartate peak and a mildly elevated choline peak;... findings... compatible with demyelination with neuronal loss and increased cell membrane turnover." (Wilson and Islam)

Challenging Characteristics

MS can adversely impact a number of body functions with symptoms displayed as: pain, speech and visual impairment, loss of memory, muscle weakness, loss of coordination, depression, numbness, and bowel and bladder problems. Sexual dysfunction may also be experienced by individuals with MS.

According to National Multiple Sclerosis Society, MS affects as many as 400,000 people in the U.S. Approximately, 2.5 million individual may be affected throughout the world. Most individuals diagnosed with MS are females between 20 and 50 years old. ("RNew MRI Finding") Out of the four classifications of MS, the two most prevalent types include relapsing-remitting and secondary-progressive. Individuals with relapsing-remitting MS experience symptom flare-ups, followed with times when MS does not progress. A person with secondary- progressive MS, however, undergoes an initial period of relapsing-remitting MS, followed by MS steadily progressing. ("RNew MRI Finding")

Resources in the book review of Multiple Sclerosis: A Guide for Rehabilitation and Health Care Professionals, edited by Rumrill and Hennessey, Doughty reports that in addition to exploring the challenging characteristics of MS, this work depicts a vital virile volume of information relating to MS. Basically, in Multiple Sclerosis: A Guide for Rehabilitation and Health Care Professionals, contributing authors, including nurses, individuals with MS, and others knowledgeable about the illness offer the reader a comprehensive, interdisciplinary view of MS.

This work includes topic areas, germane to lives of individuals with MS, as at the end of each chapter, the contributing authors, with MS, wrote personal prospective relating to particular issues presented in each chapter (Doughty). Hennessey and Rumrill, cited by Doughty, orient the reader to MS, as they present credible context and prepare the foundation for information accessible in subsequent chapters. The physiological and psychological impacts on issues, including family and community concerns, employment and/or lack of career development are also related to the reader. Randall T. Schapiro enhances introductory information relating strategies on how to best manage MS, while also encouraging the reader to apply relevant knowledge to daily life challenges and issues. Lynn C. Koch and Connie J. McReynolds, cited by Doughty, examine symptom management issues, along with psychological factors for individuals with MS.

Peggy a. Crawford, cited by Doughty, discusses how MS may affect an individual's children, his/her marital relationship, as well as other family members. Koch and McReynolds, cited by Doughty, examine parenting issues. Nancy Cooper, Wendy Sullivan, and Rosemary Zuck, Doughty notes, focus on challenging contemporary, community living issues for individuals with MS, as they provide information on community-based care programs such as respite care, adult day programs, and assisted living facilities. The authors also share information regarding services the National MS Society in local area(s) offer. Other components covered in Multiple Sclerosis: A Guide for Rehabilitation and Health Care Professionals include:

Techniques aimed to foster and/or strengthen independence among individuals with MS.

Career development and employment issues for individuals with MS, including physiological and psychological factors that affect the critical rate of unemployment among individuals with MS.

Wilson and Islam note the following known characteristics about MS:

Race: MS is most prevalent in white persons of northern European descent (Hauser, 1994).

Sex: Male-to-female ratio is approximately 1:2 (Noseworthy, 2000).

Age: MS is a disease of early adulthood.

Onset has been documented in patients aged 2-74 years, although the disease usually appears between the late teenage years and the fourth decade of life, peaking at approximately age 35 years.

In men, the onset is slightly later than in women (Hauser, 1994).

Anatomy: MS is a demyelinating CNS disorder, and it may affect any central white matter. Lesions are commonly located in the optic nerves and tracts, throughout the supratentorial and infratentorial white matter, and along the myelinated tracts of the spinal cord. Locations may include the corpus callosum, cerebellar white matter, and corticospinal tracts.

Clinical Diagnosis: A diagnosis of MS is made on the basis of clinical findings by using supporting evidence from ancillary tests such as cerebrospinal fluid (CSF) examination for oligoclonal banding and MRI.

Clinical course: The clinical course of MS can follow different patterns, and this observation has led to the classification of distinct types of MS. The most common form of MS is termed relapsing-remitting MS, in which progression involves symptoms of neurologic dysfunction frequently followed by partial or complete clinical recovery. In relapsing-remitting MS, global clinical deterioration has traditionally been attributed to cumulative deficit due to incomplete recovery from repeated occurrences of individual relapses. Recently, however, this cumulative deficit has been questioned, because evidence increasingly suggests an ongoing background neurologic deterioration that is independent of the relapses.... (Wilson and Islam)

New Insight

An ASNA News Release on August 28, 2007, entitled "RNew MRI Finding Sheds Light on Multiple Sclerosis Disease Progression," purports that from the use of magnetic resonance (MR) images of the brain, researchers recently delineated a previously unrecognized abnormality related to the progression of MS, and the disability accompanying this disease.

Based on these findings, "Rohit Bakshi, M.D., associate professor of neurology and radiology at Harvard Medical School and director of clinical MS-MRI at Brigham and Women's Hospital and Partners MS Center in Boston; leader of this study contends, "physicians may be able to diagnose multiple sclerosis more accurately and identify patients at risk for developing progressive disease." ("RNew MRI Finding")

The following questions and answers to the FDA Consumer Quiz relate several prominent points about MS (Appendix contains full test text):

At what age is multiple sclerosis most frequently diagnosed?… READ MORE

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Quoted Instructions for "Multiple Sclerosis Etiology Multiple Sclerosis, Some Researchers" Assignment:

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Multiple Sclerosis

A.) Following an introduction of theb topic to be covered, the non-diseased or normal condition and/or body system(s) involved should be described in full detail. Here the student should adequately describe the normal anatomy and/or physiology, with emphasis on normal mechanisms, so that explanation of abnormal is based upon the reader understanding normal.

b.) The known or suspected cause of the condition should be explained, describing the mechanism of the condition and how the condition develops or how it differs from the normal anatomical or physiological condition (i.e. sequence how the condition develops from a previous normal condition). Make sure to cover anatomical, physiological, genetic, molecular, or any other mechanisms that cause the disease to develop.

C.) A brief explanation of the prevalence(total number of cases normally occuring in a population) and incidence (number of new cases that occur annually in the population)of the condition is important, as it helps keep a perspective on the significance of the disease. Here the student should provide total numbers and/or percentages of people affected in the U.S. population, or North American population, or even in the world population. Any differences by race, gender, age, etc. should also be described when such statistical data are available.

D.) The student should also describe the clinial signs (an objective finding that can be observed and/or measured by another person), symptoms (subjective findings observed by the patient) and lesions (micro or macrscopic physical or chemical changes) that accompany the condition. This description should be more than a mere listing of symptoms, clinical signs, and lesions, but should include a brief explanation of the mechanism how or why such symptoms, signs, and lesions occur.

E.) Explain how the diagnosis is generally made, including description of any unique or specific diagnostic tests, is another critical component. Obviously symptoms are the reason people seek medical attention, but the reader needs to know how the medical team sifts through edical history,physical exam findings, standard diagnostic tests and any high tech and unique diagnostic tests to reach a diagnosis. In this section be sure to briefly explain the mechanisms of such diagnostic procedures and the meaning or significance of the results. Simply listing clinical signs or mentioning tests that are performed without explaination of mechanisms and manings of results is not sufficient. Also, many diagnostic tests are used to rule out conditions, and this concept needs to clear the reader where pertinent.

F.) Successful surgical, medical or any other type of treatment that either ease the condition, cure the patient, or prevent the condition should be explained, including a description of the mechanism(s) of how and why such treatments work. Here, even if there are older generation treatments that provide limited bnefit, they should also be described if said treatments are still in common usage. If there are numerous medications, for example, they should be desribed in groups based upon their mechanisms of action. In describing classes of medications or treatments, for example, be sure to describe the goal of said treatment and the mechanism of action that seeks to fulfill the goal.

G.) Since many diseases do not have cures and many are far from fully understood, there should be a discussion of the current theories or direction(s) of medical research on the disease, giving attention to the mechanisms that are being investigated, such as into discovering the genetic, physiologic or biochemical cause of the condition, approaches to prevent or cure the condition, or surgical or technologically advanced approaches to correct the anatomy or physiology of te condition, etc. Be sure to cite a minium of two to three examples of researchers' ongoing or recent work and findings (dont just mention something like thanks to all the research, theres hope in the future).

H.) The report should have a minimum of 10 references. At least 3 of the 10 must come from scientifically reviewed medical journals. Try to find more known sources make sure there is credibility (New England Journal of Medicine). Also, the student must not use any source older than 2001.

I.) Cite in MLA format-give credit where credit is due and be sure, however, not to overuse quotes.

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