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Tuesday, July 16, 2019  Spokane, Washington  Est. May 19, 1883
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Shining a light on MS rates

Dr. Alisa Hideg

The Pacific Northwest is a great place to live. However, we have one of the highest rates of multiple sclerosis.

A couple factors contribute to our region’s high rate of MS. One, our population is predominantly of northern European descent, the ethnic group at the highest risk of MS. And second, growing evidence suggests our low levels of vitamin D – the “sunshine vitamin” – may play a role in development of MS. (Prevalence of MS in sunny southern states is much lower than northern states.)

About 400,000 people in the United States have some form of MS. People between ages 20 and 50 are at higher risk for MS, as are women. And while the identical twin of someone with MS (who shares all the same genes) has a 25 percent chance of developing the disease, most people with MS do not have a family history of it.

In a person with MS, the immune system attacks the myelin – a fatty substance that coats nerve cells like plastic coating on electrical wires – for reasons not yet known. These attacks can damage myelin and the nerve cells and cause scar tissue to form, all of which can impair and slow down the transmission of nerve impulses throughout the body.

Disrupted nerve impulses may result in symptoms including fatigue, difficulty walking, numbness, tingling, spasticity, weakness, vision problems, dizziness, bladder problems, sexual problems, bowel problems, pain, memory problems, and emotional changes.

Less common symptoms include speech difficulty, swallowing problems, tremor, seizures, breathing problems, itching, headache and hearing loss.

Each person with MS will have some combination of these symptoms, and the symptoms can change over time.

Because there are so many possible symptoms in MS, part of making a diagnosis is ruling out other conditions. A neurologic exam and blood tests are used to rule out other diseases. Tests done to confirm a diagnosis include magnetic resonance imaging of the brain, a spinal tap to check the fluid that bathes the brain and spinal cord, and tests measuring electrical activity of the brain in response to stimulation.

MS is classified according to how it progresses from the first onset of symptoms. It may be relapsing-remitting, primary-progressive, secondary-progressive or progressive-relapsing MS. In relapsing-remitting MS, attacks of symptoms are followed by periods of improvement, possibly returning to normal. RRMS often becomes secondary-progressive MS, when symptoms do not go away and they get progressively worse over time. In primary-progressive MS, steady worsening starts from the time of initial diagnosis. Progressive-relapsing MS is the least common form of MS, with steady worsening over time and periodic attacks without remission.

There are 12 disease-modifying medications available in the United States, but there is no cure for MS. Some of these medications are delivered by injection, others taken orally, and a few delivered intravenously. For many people, these medications can reduce flare-ups and slow progression of MS. Corticosteroids may be prescribed to manage severe relapses.

Other things that help people manage MS include light exercise like yoga, tai chi, water exercise, or weight training, and healthy eating. Avoiding tobacco, alcohol and extreme heat can also reduce flare-ups and increase responsiveness to medication. Services that can help reduce the disability caused by MS are cognitive and vocational rehabilitation and physical and occupational therapy.

We still have a lot to learn about MS. You can learn more about it by reading about current research, getting tips on healthy living with MS and finding local resources to help cope with MS at the National Multiple Sclerosis Society website, www.nationalmssociety.org.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.

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