- - Diagnosis "Each person with MS has a unique set of symptoms depending on where in the central nervous system the demyelination occurs" (Minden). This unique set of symptoms cause great difficulty in determining if the person has MS or not. It also causes difficulty in trying to predict the course of the disease. Those with the disease are uncertain whether they will feel good from one day to the next, or even from one hour to another (Minden). Even though each individual has a unique set of symptoms, the possible symptoms caused by multiple sclerosis are similar. The break down of the myelin causes a variety of symptoms including reduction or loss of sensation (i.e. eyesight, taste, touch, smell and hearing), muscle weakness or fatigue, numbness or tingling in the extremities, vertigo. or double vision (Gertz). The physical symptoms common to MS, such as numbness and dealing with vision, result, usually, from damage to specific, easily identified areas of the brain and spinal cord (LaRoca). None of these symptoms proves though that the person has MS. Some of the symptoms that a person may have, could be caused by other diseases or infections. Intellectual and emotional problems are much harder to evaluate. It is not always clear if the emotional problems are a reaction to MS, or the result of physical damage in the brain caused by the disease. MS has the potential to affect these areas, directly or indirectly (LaRoca). The difficulty in determining the source of emotional problems can be seen in the classification of symptoms in the National Multiple Sclerosis Society Information Resource Center and Library. "Some people with MS experience uncontrollable laughing or crying (called emotional liability), which is a direct result of lesions damaged areas in emotional pathways in the brain" (NMSS). This and other symptoms that result from direct demyelination can be cataloged into a group of primary symptoms. Secondary symptoms begin from complications from the primary symptoms. For example, if a person is paralyzed from MS, bedsores are a secondary symptom to the initial symptom of paralysis. And "tertiary symptoms are the social, vocational and psychological complications of the primary and secondary symptoms" (NMSS). This third set of symptoms may be a loss of livelihood from losing the ability to walk or drive, or could be the disruption of a relationship due to the stress and strain of coping with MS. Depression can be a tertiary symptom, but it can also be a secondary or a primary symptom also. The emotional result of depression can be created by the direct demyelination of a section of the brain, or can be the result of another symptom caused by MS. People with MS, and those around them should realize that depression is common during the course of MS. But, there are people without MS who still become depressed. Even with the classification of symptoms there isnŐt a single "... laboratory test, symptom, or physical finding which, when present or positive, always means a person has MS" (NMSS). For a doctor to diagnose a patient as having multiple sclerosis, the disease must fulfill two conditions, there must have been two attack at least one month apart, and the myelin of the central nervous system must be damaged in more than one area (NMSS). An attack is a sudden worsening of symptoms related to MS which lasts atleast 24 hours. An attack is also known as an exacerbation, flare or relapse. Based from the frequency of the attacks, multiple sclerosis is classified into three areas. The first is when a patient has a few such flare-ups, and then recovers completely. The second, the most common and referred to as relapsing-remitting MS, the patient experiences attacks then total or partial recovery, also called remissions (Gertz). And the third is progressive multiple sclerosis. Progressive MS can be actually grouped into two categories, primary and secondary progressive multiple sclerosis. Cases of primary progressive MS are the rarest, but the symptoms caused by the disease generally do not remit. Secondary progressive MS may begin as relapsing-remitting but becomes more and more progressive in nature. The strange possibility with MS is that all forms of the disease may stabilize or worsen at any time (Minden).

December 9, 1998