Stress And Multiple Sclerosis



KEY WORDS: multiple sclerosis, stress, herpes, EAE, autoimmune diseases, cytokines, interferons, Copaxone, bee pollen, serotonin, tryptophan, magnetotherapy

As noted in prior Newsletters, stress can have important influences on the course of multiple sclerosis (MS). Charcot noted that emotional distress was often a precipitating factor in his initial description of the disease, and subsequent investigators have corroborated this. Similarly, many patients link the development of disabling symptoms to some distressful event or a period of prolonged stress. Others believe that stress is responsible for causing their condition to rapidly deteriorate, or to recur after having been quiescent for months or even years.

The disease often begins with the fairly abrupt onset of neurologic symptoms such as numbness and tingling, marked weakness or paralysis, double vision or loss of vision in one eye, brief but excruciating episodes of facial pain, dizziness and difficulty in maintaining balance, or problems with bladder control. This may progress to severe vertigo and incoordination, spasticity or paralysis of one or more extremities, various speech difficulties, bladder and bowel incontinence, marked fatigue, depression, and emotional lability.

The course of the illness and the nature and severity of complaints varies tremendously. Some individuals may experience a transient episode of loss of vision, disturbed speech, or unilateral facial pain in their twenties, with no recurrence for months or years, and no apparent permanent neurologic damage. Others pursue a progressive downhill course that confines them to wheelchairs, and require constant assistance to perform daily functions.

MS is believed to be due to a disturbance in immune system function, in which normal tissues are perceived as being foreign invaders. This leads to an attack by the body's defense mechanisms that result in destruction of myelin, the lipid substance that surrounds nerve fibers to protect them from damage. A specific cause for MS has not been identified, but heredity, infections, stress, and other environmental factors seem to play a role in certain patients.

The deterioration and loss of myelin hinders the ability of nerves to relay information. Since the distribution of these lesions is patchy, signs and symptoms are erratic and unpredictable, but are apt to be most severe when the transmission of nerve signals is disrupted in the spinal cord and brain. These can cause speech and visual disturbances, motor dysfunction that makes it difficult to walk or maintain balance, and various cognitive and emotional deficits. The diagnosis for years depended on finding the "Charcot triad" of tremor, nystagmus, and erratic speech. However, it is now apparent that these signs are absent in many patients, or may not appear for years.

Making The Diagnosis

Establishing the diagnosis of MS can therefore be extremely difficult, especially when it first starts. The abrupt onset of unexplained, excruciating facial pain that lasts for a few hours or days in a young woman is often assumed to be trigeminal neuralgia, until other neurologic complaints surface months or years later. Symptoms and signs can be similar to those seen in other demyelinating diseases of the nervous system, like the encephalomyelitis that often follows viral infections. They may also resemble immune-mediated or deficiency diseases that affect the nervous system, such as lupus and sarcoidosis, or Vitamin B-12 deficiency.

Unlike the above disorders, there are no blood tests, x-rays or other diagnostic procedures that are definitive. Spinal fluid examination may reveal increased amounts of certain immunoglobulins resuLting from chronic immune system stimulation in well established cases. Lesions in the brain can often be detected by special sensory-evoked potentials, but both of these are complex research procedure that are still not specific. The most useful technique is magnetic resonance imaging (MRI) of the brain, which can display many of the areas of demyelinization. Serial studies are able to show how these increase over time, and using a contrast agent like gadolinium, will identify recent damage.

The American Institute of Stress.

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