In multiple sclerosis , damage to the myelin in the central nervous system (CNS), and to the nerve Sexual Dysfunction

n fibers themselves, interferes with the transmission of nerve signals between the brain and spinal cord Sexual problems are often experienced by people with MS, but they are very common in the general and other parts of the body. This disruption of nerve signals produces the primary symptoms of MS, population as well. Sexual arousal begins in the central nervous system, as the brain sends messages to which vary depending on where the damage has occurred.
the sexual organs along nerves running through the spinal cord. If MS damages these nerve pathways, sexual responseincluding arousal and orgasmcan be directly affected. Sexual problems also stem Over the course of the disease, some symptoms will come and go, while others may be more lasting. from MS symptoms such as fatigue or spasticity, as well as from psychological factors relating to selfesteem and mood changes.

Symptoms

Most Common Symptoms Some symptoms of MS are much more common than others.
Fatigue Fatigue is one of the most common symptoms of MS, occurring in about 80% of people. Fatigue can significantly interfere with a person's ability to function at home and at work, and may be the most prominent symptom in a person who otherwise has minimal activity limitations. Numbness Numbness of the face, body, or extremities (arms and legs) is one of the most common symptoms of MS, and is often the first symptom experienced by those eventually diagnosed as having MS. Walking (Gait), Balance, & Coordination Problems Problems with gait (difficulty in walking) are among the most common mobility limitations in MS. Gait problems are related to several factors. Bladder Dysfunction Bladder dysfunction, which occurs in at least 80% of people with MS, usually can be managed quite successfully Bowel Dysfunction Constipation is a particular concern among people living with MS, as is loss of control of the bowels. Diarrhea and other problems of the stomach and bowels also can occur. Vision Problems A vision problem is the first symptom of MS for many people. The sudden onset of double vision, poor contrast, eye pain, or heavy blurring is frankly terrifying-and the knowledge that vision may be compromised can make people with MS anxious about the future. Dizziness and Vertigo Dizziness is a common symptom of MS. People with MS may feel off balance or lightheaded. Much less often, they have the sensation that they or their surroundings are spinning, a condition known as vertigo.

Pain Pain syndromes are common in MS. In one study, 55% of people with MS had "clinically significant pain" at some time. Almost half were troubled by chronic pain. Cognitive Dysfunction Cognition refers to a range of high-level brain functions, including the ability to learn and remember information: organize, plan, and problem-solve; focus, maintain, and shift attention as necessary; understand and use language; accurately perceive the environment, and perform calculations. Cognitive changes are common in people with MSapproximately 50% of people with MS will develop problems with cognition. Emotional Changes Emotional changes are very common in MSas a reaction to the stresses of living with a chronic, unpredictable illness and because of neurologic and immune changes caused by the disease. Bouts of severe depression (which is different from the healthy grieving that needs to occur in the face of losses and changes caused by MS), mood swings, irritability, and episodes of uncontrollable laughing and crying (called pseudobulbar affect) pose significant challenges for people with MS and their family members. Depression Depression is common during the course of multiple sclerosis. In fact, studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions. Spasticity Spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms (sustained muscle contractions or sudden movements). It is one of the more common symptoms of MS. Spasticity may be as mild as the feeling of tightness of muscles or may be so severe as to produce painful, uncontrollable spasms of extremities, usually of the legs. Spasticity may also produce feelings of pain or tightness in and around joints, and can cause low back pain. Although spasticity can occur in any limb, it is much more common in the legs.

Less Common Symptoms These symptoms also occur in MS, but much less frequently.
Speech Disorders Speech and voice problems occur in approximately 25-40 percent of people with MS, particularly during relapses or periods of extreme fatigue. The problems are of two typesdysarthria refers to changes in the production of speech, including slurring, unclear articulation of words, and difficulty controlling loudness; dysphonia is the term used for changes in voice quality, including hoarseness, breathiness, nasality, poor control of pitch.

contribute to MS-related fatigue and interfere with speech and voice production, should be evaluated and treated by nurses or rehabilitation professionals with expertise in respiratory problems. Itching Pruritis (itching) may occur as a symptom of MS. It is one of the family of abnormal sensations such as "pins and needles" and burning, stabbing, or tearing painswhich may be experienced by people with MS. These sensations are known as dysesthesias, and they are neurologic in origin.

Incidence and Prevalence of MS

Swallowing Problems The following observations have been drawn from existing epidemiological studies: Swallowing problemsreferred to as dysphagiaresult from damage to the nerves controlling the many small muscles in the mouth and throat. When dysphagia occurs, food and liquids can pass into the airway 1. Although more people are being diagnosed with MS today than in the past, the reasons for and lungs, causing the person to cough and choke. Because particles that remain in the lungs can cause this are not clear. Likely contributors, however, include greater awareness of the disease, aspiration pneumoniaa serious complication of MSprompt evaluation and treatment by a better access to medical care, and improved diagnostic capabilities. There is no definitive evidence that the rate of MS is generally on the increase. speech/language pathologist are essential. Headache Although headache is not a common symptom of MS, some reports suggest that people with MS have an increased incidence of certain types of headache. Hearing Loss Hearing loss is an uncommon symptom of MS. About 6% of people who have MS complain of impaired hearing. In very rare cases, hearing loss has been reported as the first symptom of the disease. Deafness due to MS is exceedingly rare, and most acute episodes of hearing deficit caused by MS tend to improve. Seizures Seizures, which are the result of abnormal electrical discharges in an injured or scarred area of the brain, are fairly uncommon among people with MS. Their incidence has been estimated at 2% to 5%, compared to the estimated 3% incidence of seizures in the general population. Tremor Many people with MS experience some degree of tremor, or uncontrollable shaking. It can occur in various parts of the body. Respiration / Breathing Problems Respiration problems occur in people whose chest muscles have been severely weakened by damage to the nerves that control those muscles. Aspiration pneumonia (resulting from the food particles and/or liquids passing into the lungs) can also make breathing more difficult. Breathing problems, which can

2. Most people are diagnosed between the ages of 20 and 50, although MS can occur in young children and significantly older adults. 3. Worldwide, MS occurs with much greater frequency above 40 latitude than closer to the equator. However, prevalence rates may differ significantly even within a geographic area, where latitude and climate are fairly consistent. These differences demonstrate that geographical factors are not the only ones involved. 4. MS is more common among Caucasians (particularly those of northern European ancestry) than other ethnic groups, but people of African, Asian, and Hispanic ancestry also develop the disease. In spite of the latitude at which they live, MS is almost unheard of in some populations, such as Inuit, Yakutes, Hutterites, Hungarian Romani, Norwegian Lapps, Australian Aborigines and New Zealand Maoris indicating that ethnicity and geography interact in some complex way to impact prevalence figures in different parts of the world. 5. Scientists have long searched for an infectious agent that might trigger MS. While many different viruses have been suggested including rabies, herpes simplex virus, measles, corona virus, canine distemper virus, HTLV-1, Epstein-Barr virus and others none has been confirmed. To date, the most promising candidate appears to be the Epstein-Barr virus. Chlamydia pneumoniae, a bacterial agent, has also been suggested but never proven. Although no trigger has yet been confirmed, most MS experts believe that some infectious agent is involved in initiating the disease process. 6. Migration from one geographic area to another seems to alter a persons risk of developing MS. Studies indicate that immigrants and their descendents tend to take on the risk level either higher or lower of the area to which they move. The change in risk, however, may not appear immediately. Those who move in early childhood tend to take on the new risk themselves. For those who move later in life, the change in risk level may not appear until the next generation. While underlining the complex relationship between environmental and genetic factors in determining who develops MS, these studies have also provided support for

Other scientists study MS clusterswhich are defined as higher-than-expected numbers of cases of While the cause (etiology) of MS is still not known, scientists believe that a combination of several MS that have occurred over a specific time period and/or in a certain area. These clusters are of factors may be involved. Studies are ongoing in the areas of immunology (the science of the bodys interest because they may provide clues to environmental (such as environmental and industrial toxins, immune system), epidemiology (that looks at patterns of disease in the population), and genetics in an diet, or trace metal exposures) factors that might cause or trigger the disease. So far, cluster studies have not produced clear evidence for the existence of any triggering factor or factors in MS. effort to answer this important question. Understanding what causes MS will be an important step toward finding more effective ways to treat it andultimatelycure it, or even prevent it from occurring in the first place. Infectious The major scientific theories about the causes of MS include the following: Since initial exposure to numerous viruses, bacteria and other microbes occurs during childhood, and since viruses are well recognized as causes of demyelination and inflammation, it is possible that a virus or other infectious agent is the triggering factor in MS. More than a dozen viruses and bacteria, Immunologic including measles, canine distemper, human herpes virus-6, Epstein-Barr, and Chlamydia pneumonia have been or are being investigated to determine if they are involved in the development of MS, but It is now generally accepted that MS involves an immune-mediated processan abnormal response of none have been definitively proven to trigger MS. the bodys immune system that is directed against the myelin (the fatty sheath that surrounds and insulates the nerve fibers) in the central nervous system (CNSthe brain, spinal cord and optic nerves). The exact antigen, or target that the immune cells are sensitized to attack, remains unknown --Genetic which is why MS is considered by most experts to be immune-mediated rather than autoimmune. In recent years, however, researchers have been able to identify which immune cells are mounting the While MS is not hereditary in a strict sense, having a first-degree relative such as a parent or sibling attack, some of the factors that cause them to attack, and some of the sites, or receptors, on the with MS increases an individual's risk of developing the disease several-fold above the risk for the attacking cells that appear to be attracted to the myelin to begin the destructive process. Ongoing general population. Studies have shown that there is a higher prevalence of certain genes in efforts to learn more about the immune-mediated process in MSwhat sets it in motion, how it works, populations with higher rates of MS. Common genetic factors have also been found in some families and how to slow or stop itare bringing us closer to understanding the cause of MS. where there is more than one person with MS. Some researchers theorize that MS develops because a person is born with a genetic predisposition to react to some environmental agent that, upon exposure, triggers an autoimmune response. Sophisticated new techniques for identifying genes may help answer questions about the role of genes in the development of MS.

the opinion that MS is caused by early exposure to some environmental trigger in genetically susceptible individuals. 7. MS is at least two to three times more common in women than in men, suggesting that hormones may also play a significant role in determining susceptibility to MS. And some recent studies have suggested that the female to male ratio may be as high as three or four to one. 8. Genetic factors are thought to play a significant role in determining who develops MS. The average person in the United States has about one chance in 750 of developing MS. For firstdegree relatives of a person with MS, such as children, siblings or non-identical twins, the risk rises to approximately one in 40 with the risk being potentially higher in families that have several family members with the disease. The identical twin of someone with MS, who shares all the same genes, has a one in four chance of developing the disease. If genes were solely responsible for determining who gets MS, an identical twin of someone with MS would have a 100% chance of developing the disease; the fact that the risk is only one in four demonstrates that other factors, including geography, ethnicity, and the elusive infectious trigger, are likely involved as well. 9. Certain outbreaks or clusters of MS have been identified, but the cause and significance of these outbreaks are not known.

Environmental
MS is known to occur more frequently in areas that are farther from the equator. Epidemiologists scientists who study disease patternsare looking at many factors, including variations in geography, demographics (age, gender, and ethnic background), genetics, infectious causes, and migration patterns, in an effort to understand why. Studies of migration patterns have shown that people born in an area of the world with a high risk of MS who then move to an area with a lower risk before the age of 15, acquire the risk of their new area. Such data suggest that exposure to some environmental agent that occurs before puberty may predispose a person to develop MS later on. Some scientists think the reason may have something to do with vitamin D (.pdf), which the human body produces naturally when the skin is exposed to sunlight. People who live closer to the equator are exposed to greater amounts of sunlight year-round. As a result, they tend to have higher levels of naturally-produced vitamin D, which is thought to have a beneficial impact on immune function and may help protect against autoimmune diseases like MS. The possible relationship between MS and sunlight exposure is currently being looked at in a Society-funded epidemiological study in Australia.