/Users/andrea/_magisterarbeit/korpus/clean/trainkorpus/30/file4.html NN ----------------------------------------- : Multiple JJ sclerosis NN From IN Wikipedia NP , , the DT free JJ encyclopedia NN . SENT Jump VV to TO . SENT navigation NN , , search NN Multiple NN sclerosis NN ICD NP 10 CD code NN . SENT G NP 35 CD ICD NP 9 CD code NN . SENT 340 CD MRI NP image NN showing VVG a DT bright JJ spot NN where WRB multiple JJ sclerosis NN has VHZ damaged VVN myelin NN in IN the DT brain NN Multiple JJ sclerosis NN MS NN is VBZ a DT chronic JJ disease NN that WDT affects VVZ the DT brain NN and CC spinal JJ cord NN . SENT MS NN can MD cause VV a DT variety NN of IN symptoms NNS , , including VVG changes NNS in IN sensation NN , , visual JJ problems NNS , , weakness NN , , depression NN , , and CC difficulties NNS with IN coordination NN and CC speech NN . SENT Although IN many JJ patients NNS lead VVP full JJ and CC rewarding JJ lives NNS , , MS NN can MD cause VV impaired JJ mobility NN and CC disability NN in IN the DT more JJR severe JJ cases NNS . SENT Multiple JJ sclerosis NN affects VVZ neurons NNS , , the DT cells NNS of IN the DT brain NN and CC spinal JJ cord NN that WDT carry VVP information NN , , create VV thought NN and CC perception NN , , and CC allow VV the DT brain NN to TO control VV the DT body NN . SENT Surrounding VVG and CC protecting VVG these DT neurons NNS is VBZ a DT layer NN of IN fat NN , , called VVN myelin NN , , which WDT helps VVZ neurons NNS carry VV electrical JJ signals NNS . SENT MS NN causes VVZ gradual JJ destruction NN of IN myelin NN demyelination NN in IN patches NNS throughout IN the DT brain NN and CC or CC spinal JJ cord NN , , causing VVG various JJ symptoms NNS depending VVG upon IN which WDT signals NNS are VBP interrupted VVN . SENT The DT name NN multiple NN sclerosis NN refers VVZ to TO the DT multiple JJ scars NNS or CC scleroses NNS on IN the DT myelin NN sheaths NNS . SENT MS NN results NNS from IN attacks NNS by IN an DT individual's JJ immune JJ system NN on IN his PP$ or CC her PP$ own JJ nervous JJ system NN , , and CC it PP is VBZ therefore RB categorized VVN as IN an DT autoimmune JJ disease NN . SENT Multiple JJ sclerosis NN can MD take VV several JJ different JJ forms NNS , , with IN new JJ symptoms NNS occurring VVG in IN discrete JJ attacks NNS or CC slowly RB accruing VVG over IN time NN . SENT Between IN attacks NNS symptoms NNS may MD resolve VV completely RB , , but CC permanent JJ neurologic JJ problems NNS often RB persist VVP . SENT Although IN much RB is VBZ known VVN about IN how WRB MS NN causes VVZ damage NN , , the DT exact JJ cause NN of IN MS NN remains VVZ unknown JJ . SENT MS NN currently RB does VVZ not RB have VH a DT cure NN , , though IN several JJ treatments NNS are VBP available JJ which WDT may MD slow VV the DT appearance NN of IN new JJ symptoms NNS . SENT MS NN primarily RB affects VVZ adults NNS , , with IN an DT age NN of IN onset NN typically RB between IN 20 CD and CC 40 CD years NNS , , and CC is VBZ more RBR common JJ in IN women NNS than IN in IN men NNS . SENT 1 CD 2 CD Contents NNS 1 CD Signs NNS and CC symptoms NNS 2 CD Diagnosis NN 3 CD Disease NN course NN and CC clinical JJ subtypes NNS 4 CD Factors NNS triggering VVG a DT relapse NN 5 CD Pathophysiology NN 5 CD . SENT 1 CD How WRB multiple JJ sclerosis NN causes NNS damage NN 5 CD . SENT 2 CD Why WRB multiple JJ sclerosis NN occurs VVZ 6 CD Treatment NP 6 CD . SENT 1 CD Management NN of IN acute JJ attacks NNS 6 CD . SENT 2 CD Management NN of IN relapsing VVG remitting VVG MS NN 6 CD . SENT 3 CD Management NN of IN progressive JJ MS NN 6 CD . SENT 4 CD Management NN of IN demyelination NN without IN a DT diagnosis NN of IN MS NN 6 CD . SENT 5 CD Management NN of IN the DT effects NNS of IN MS NN 6 CD . SENT 6 CD Therapies NNS under IN investigation NN 6 CD . SENT 7 CD Side NP effects NNS of IN medications NNS for IN relapsing VVG remitting VVG MS NN 7 CD Prognosis NN 8 CD Epidemiology NN 9 CD History NN 10 CD Multiple NN sclerosis NN in IN fiction NN 11 CD References NNS 12 CD External NP links NNS edit VV Signs NNS and CC symptoms NNS Individuals NNS with IN multiple JJ sclerosis NN may MD experience VV a DT wide JJ variety NN of IN symptoms NNS . SENT The DT initial JJ attacks NNS are VBP often RB transient JJ , , mild JJ or CC asymptomatic JJ , , and CC self NN limited VVN . SENT They PP often RB do VVP not RB prompt VV a DT health NN care NN visit NN and CC sometimes RB are VBP only RB identified VVN in IN retrospect NN once IN the DT diagnosis NN has VHZ been VBN made VVN based VVN on IN further JJR attacks NNS . SENT The DT most RBS common JJ initial JJ symptoms NNS reported VVN are VBP . SENT changes NNS in IN sensation NN in IN the DT arms NNS , , legs NNS or CC face VVP 33 CD , , complete JJ or CC partial JJ vision NN loss NN optic NN neuritis NN 16 CD , , weakness NN 13 CD , , double JJ vision NN 7 CD , , unsteadiness NN when WRB walking VVG 5 CD , , and CC balance NN problems NNS 3 CD . SENT Fifteen CD percent NN of IN individuals NNS have VHP multiple JJ symptoms NNS when WRB they PP first RB seek VVP medical JJ attention NN . SENT 3 CD Most JJS people NNS find VVP their PP$ initial JJ MS NN symptoms NNS occur VVP over IN a DT period NN of IN hours NNS to TO weeks NNS . SENT For IN some DT people NNS the DT initial JJ MS NN attack NN is VBZ preceded VVN by IN infection NN , , trauma NN or CC strenuous JJ physical JJ effort NN . SENT Other JJ symptoms NNS and CC physical JJ findings NNS common JJ in IN MS NN are VBP flickering VVG eye NN movements NNS nystagmus NN , , speech NN difficulties NNS , , tremor NN , , clumsiness NN of IN the DT hands NNS , , abnormal JJ muscle NN spasms NNS , , bladder NN and CC bowel NN difficulties NNS , , and CC sexual JJ dysfunction NN . SENT Cognitive JJ impairments NNS are VBP also RB common JJ , , such JJ as IN difficulty NN performing VVG multiple JJ tasks NNS at IN once RB , , difficulty NN following VVG detailed JJ instructions NNS , , loss NN of IN short JJ term NN memory NN , , emotional JJ instability NN , , and CC fatigue NN . SENT Emotional JJ symptoms NNS are VBP common JJ and CC can MD be VB the DT normal JJ response NN to TO having VHG a DT debilitating JJ disease NN or CC the DT result NN of IN damage NN to TO the DT nerves NNS that WDT generate VVP and CC control NN emotions NNS . SENT The DT most RBS common JJ condition NN , , clinical JJ depression NN , , is VBZ a DT product NN of IN both DT causes NNS . SENT Feelings NNS such JJ as IN anger NN , , anxiety NN , , frustration NN , , and CC hopelessness NN are VBP also RB common JJ , , and CC suicide NN is VBZ a DT very RB real JJ threat NN . SENT Three CD clinical JJ entities NNS warrant VVP further JJR discussion NN because IN affected JJ individuals NNS are VBP often RB eventually RB diagnosed VVN with IN MS NN . SENT However RB , , MS NN is VBZ only RB one CD of IN several JJ potential JJ causes NNS for IN these DT entities NNS . SENT Optic JJ neuritis NN Individuals NNS typically RB experience VVP rapid JJ onset NN of IN pain NN in IN one CD eye NN , , followed VVN by IN blurry JJ vision NN in IN part NN or CC all DT of IN the DT visual JJ field NN of IN that DT eye NN . SENT This DT is VBZ a DT result NN of IN involvement NN of IN the DT optic JJ nerve NN by IN MS NN . SENT At IN least JJS 15 CD and CC as RB many JJ as IN 75 CD of IN individuals NNS who WP have VHP an DT episode NN of IN optic JJ neuritis NN go VV on IN to TO develop VV MS NN . SENT The DT blurred VVD vision NN usually RB resolves VVZ within IN six CD months NNS , , but CC individuals NNS are VBP often RB left VVN with IN less JJR vivid JJ color NN vision NN especially RB red JJ in IN the DT affected JJ eye NN . SENT Internuclear JJ ophthalmoplegia NN video NN Individuals NNS usually RB notice VVP binocular JJ diplopia NN double JJ vision NN with IN both DT eyes NNS open VVP when WRB looking VVG to TO one CD side NN . SENT Internuclear JJ ophthalmoplegia NN occurs VVZ when WRB MS NN affects VVZ a DT part NN of IN the DT brain NN stem NN called VVD the DT medial JJ longitudinal JJ fasciculus NN , , which WDT is VBZ responsible JJ for IN communication NN between IN the DT two CD eyes NNS . SENT This DT results NNS in IN the DT failure NN of IN the DT medial JJ rectus NN muscle NN to TO contract VV appropriately RB , , so RB that IN the DT eyes NNS do VVP not RB move VV equally RB called VVN disconjugate NN gaze VVP . SENT Transverse JJ myelitis NN Individuals NNS typically RB develop VVP rapid JJ onset NN of IN numbness NN , , weakness NN , , bowel NN or CC bladder NN dysfunction NN , , and CC or CC loss NN of IN muscle NN function NN , , typically RB in IN the DT lower JJR half NN of IN the DT body NN . SENT This DT is VBZ the DT result NN of IN MS NN attacking VVG the DT spinal JJ cord NN . SENT As RB many JJ as IN 80 CD of IN individuals NNS with IN transverse JJ myelitis NN are VBP left VVN with IN lasting JJ disabilities NNS , , even RB though IN there EX is VBZ usually RB some DT improvement NN during IN the DT first JJ two CD years NNS . SENT edit VV Diagnosis NN Multiple JJ sclerosis NN is VBZ difficult JJ to TO diagnose VV in IN its PP$ early JJ stages NNS . SENT In IN fact NN , , definite JJ diagnosis NN of IN MS NN cannot NN be VB made VVN until IN there EX is VBZ evidence NN of IN at IN least JJS two CD anatomically RB separate JJ demyelinating VVG events NNS occurring VVG at IN least JJS thirty CD days NNS apart RB . SENT The DT McDonald NP criteria NNS represent VVP international JJ efforts NNS to TO standardize VV the DT diagnosis NN of IN MS NN using VVG clinical JJ data NNS , , laboratory NN data NNS , , and CC radiologic JJ data NNS . SENT 4 CD Clinical JJ data NNS alone RB may MD be VB sufficient JJ for IN a DT diagnosis NN of IN MS NN . SENT If IN an DT individual NN has VHZ suffered VVN two CD separate JJ episodes NNS of IN neurologic JJ symptoms NNS characteristic JJ of IN MS NN , , and CC the DT individual NN also RB has VHZ consistent JJ abnormalities NNS on IN physical JJ examination NN , , a DT diagnosis NN of IN MS NN can MD be VB made VVN with IN no DT further JJR testing NN . SENT Since IN some DT people NNS with IN MS NN seek VVP medical JJ attention NN after IN only RB one CD attack NN , , other JJ testing NN may MD hasten VV the DT diagnosis NN and CC allow VV earlier JJR initiation NN of IN therapy NN . SENT Magnetic JJ resonance NN imaging NN MRI NP of IN the DT brain NN is VBZ often RB used VVN to TO evaluate VV individuals NNS with IN suspected JJ MS NN . SENT MRI NP shows VVZ areas NNS of IN demyelination NN as IN bright JJ lesions NNS on IN T NN 2 CD images NNS or CC when WRB gadolinium NN contrast NN is VBZ used VVN . SENT Because IN MRI NP can MD reveal VV lesions NNS which WDT occurred VVD previously RB but CC produced VVD no DT clinical JJ symptoms NNS , , it PP can MD provide VV the DT evidence NN of IN chronicity NN needed VVN for IN a DT definite JJ diagnosis NN of IN MS NN . SENT Testing VVG of IN cerebrospinal JJ fluid JJ CSF NP can MD provide VV evidence NN of IN chronic JJ inflammation NN of IN the DT central JJ nervous JJ system NN . SENT The DT CSF NP is VBZ tested VVN for IN oligoclonal JJ bands NNS , , which WDT are VBP immunoglobulins NNS found VVN in IN 85 CD to TO 95 CD of IN people NNS with IN definite JJ MS NN but CC also RB found VVN in IN people NNS with IN other JJ diseases NNS . SENT 5 LS Combined VVN with IN MRI NP and CC clinical JJ data NNS , , the DT presence NN of IN oligoclonal JJ bands NNS can MD help VV make VV a DT definite JJ diagnosis NN of IN MS NN . SENT Lumbar JJ puncture NN is VBZ the DT procedure NN used VVN to TO collect VV a DT sample NN of IN CSF NP . SENT The DT brain NN of IN a DT person NN with IN MS NN often RB responds VVZ less RBR actively RB to TO stimulation NN of IN the DT optic JJ nerve NN and CC sensory JJ nerves NNS . SENT These DT brain NN responses NNS can MD be VB examined VVN using VVG Visual NP evoked VVD potentials NNS VEPs NP and CC somatosensory JJ evoked VVN potentials NNS SEPs NP . SENT Decreased VVN activity NN on IN either DT test NN can MD reveal VV demyelination NN which WDT may MD be VB otherwise RB asymptomatic JJ . SENT Along RB with IN other JJ data NNS , , these DT exams NNS can MD help VV find VV the DT widespread JJ nerve NN involvement NN required VVN for IN a DT definite JJ diagnosis NN of IN MS NN . SENT 6 CD Another DT test NN which WDT may MD become VV important JJ in IN the DT future NN is VBZ measurement NN of IN antibodies NNS against IN myelin NN proteins NNS such JJ as IN myelin NN oligodendrocyte NN glycoprotein NN MOG NN and CC myelin NN basic JJ protein NN MBP NN . SENT As IN of IN 2005 CD , , however RB , , there EX is VBZ no DT established JJ role NN for IN these DT tests NNS in IN diagnosing VVG MS NN . SENT The DT signs NNS and CC symptoms NNS of IN MS NN can MD be VB similar JJ to TO other JJ medical JJ problems NNS , , such JJ as IN stroke NN , , brain NN inflammation NN , , infections NNS , , tumors NNS , , and CC other JJ autoimmune JJ problems NNS , , such JJ as IN lupus NN . SENT Additional JJ testing NN may MD be VB needed VVN to TO help VV distinguish VV MS NN from IN these DT other JJ problems NNS . SENT edit VV Disease NP course NN and CC clinical JJ subtypes NNS Graph NN representing VVG the DT different JJ types NNS of IN multiple JJ sclerosis NN The DT course NN of IN MS NN is VBZ difficult JJ to TO predict VV , , and CC the DT disease NN may MD at IN times NNS either CC lie VV dormant JJ or CC progress NN steadily RB . SENT Several JJ subtypes NNS , , or CC patterns NNS of IN progression NN , , have VHP been VBN described VVN . SENT Subtypes NNS use VVP the DT past JJ course NN of IN the DT disease NN in IN an DT attempt NN to TO predict VV the DT future JJ course NN . SENT A DT person NN diagnosed VVN with IN a DT particular JJ subtype NN may MD , , for IN unclear JJ reasons NNS , , switch NN from IN one CD subtype NN to TO another DT over IN time NN . SENT Subtypes NNS are VBP important JJ not RB only RB for IN prognosis NN but CC also RB for IN therapeutic JJ decisions NNS . SENT In IN 1996 CD the DT United NP States NPS National NP Multiple JJ Sclerosis NN Society NP standardized JJ the DT following VVG four CD subtype NN definitions NNS . SENT 7 CD Relapsing VVG remitting VVG Relapsing VVG remitting VVG describes VVZ the DT initial JJ course NN of IN 85 CD to TO 90 CD of IN individuals NNS with IN MS NN . SENT This DT subtype NN is VBZ characterized VVN by IN unpredictable JJ attacks NNS relapses NNS followed VVD by IN periods NNS of IN months NNS to TO years NNS of IN relative JJ quiet JJ remission NN with IN no DT new JJ signs NNS of IN disease NN activity NN . SENT Deficits NNS suffered VVD during IN the DT attacks NNS may MD either RB resolve VV or CC may MD be VB permanent JJ . SENT When WRB deficits NNS always RB resolve VV between IN attacks NNS , , this DT is VBZ referred VVN to TO as RB benign JJ MS NN . SENT Secondary JJ progressive JJ Secondary JJ progressive JJ describes VVZ around IN 80 CD of IN those DT with IN initial JJ relapsing VVG remitting VVG MS NN , , who WP then RB begin VVP to TO have VH neurologic JJ decline NN between IN their PP$ acute JJ attacks NNS without IN any DT definite JJ periods NNS of IN remission NN . SENT This DT decline NN may MD include VV new JJ neurologic JJ symptoms NNS , , worsening VVG cognitive JJ function NN , , or CC other JJ deficits NNS . SENT Secondary JJ progressive JJ is VBZ the DT most RBS common JJ type NN of IN MS NN and CC causes VVZ the DT greatest JJS amount NN of IN disability NN . SENT Primary JJ progressive JJ Primary JJ progressive JJ describes VVZ the DT approximately RB 10 CD of IN individuals NNS who WP never RB have VHP remission NN after IN their PP$ initial JJ MS NN symptoms NNS . SENT Decline NN occurs VVZ continuously RB without IN clear JJ attacks NNS . SENT The DT primary JJ progressive JJ subtype NN tends VVZ to TO affect VV people NNS who WP are VBP older JJR at IN disease NN onset NN . SENT Progressive JJ relapsing VVG Progressive JJ relapsing VVG describes VVZ those DT individuals NNS who WP , , from IN the DT onset NN of IN their PP$ MS NN , , have VHP a DT steady JJ neurologic JJ decline NN but CC also RB suffer VV superimposed VVN attacks NNS . SENT edit VV Factors NNS triggering VVG a DT relapse NN Multiple JJ sclerosis NN relapses NNS are VBP often RB unpredictable JJ and CC can MD occur VV without IN warning VVG with IN no DT obvious JJ inciting VVG factors NNS . SENT Some DT attacks NNS , , however RB , , are VBP preceded VVN by IN common JJ triggers NNS . SENT In IN general JJ , , relapses NNS occur VVP more RBR frequently RB during IN spring NN and CC summer NN than IN during IN autumn NN and CC winter NN . SENT Infections NNS , , such JJ as IN the DT common JJ cold NN , , influenza NN , , and CC gastroenteritis NN , , increase VV the DT risk NN for IN a DT relapse NN . SENT Emotional JJ and CC physical JJ stress NN may MD also RB trigger VV an DT attack NN , , as RB can MD severe JJ illness NN of IN any DT kind NN . SENT Statistically RB , , there EX is VBZ no DT good JJ evidence NN that IN either DT trauma NN or CC surgery NN trigger NN relapses NNS . SENT People NNS with IN MS NN can MD participate VV in IN sports NNS , , but CC they PP should MD probably RB avoid VV extremely RB strenuous JJ exertion NN , , such JJ as IN marathon NN running NN . SENT Heat NN can MD transiently RB increase VV symptoms NNS , , which WDT is VBZ known VVN as IN Uhthoff's NP phenomenon NN . SENT This DT is VBZ why WRB some DT people NNS with IN MS NN avoid VV saunas NNS or CC even RB hot JJ showers NNS . SENT However RB , , heat NN is VBZ not RB an DT established VVN trigger NN of IN relapses NNS . SENT Pregnancy NN can MD directly RB affect VV the DT susceptibility NN for IN relapse NN . SENT The DT last JJ three CD months NNS of IN pregnancy NN offer VVP a DT natural JJ protection NN against IN relapses NNS . SENT However RB , , during IN the DT first JJ few JJ months NNS after IN delivery NN , , the DT risk NN for IN a DT relapse NN is VBZ increased VVN 20 CD 40 CD . SENT Pregnancy NN does VVZ not RB seem VV to TO influence VV long JJ term NN disability NN . SENT Children NNS born VVN to TO mothers NNS with IN MS NN are VBP not RB at IN increased JJ risk NN for IN birth NN defects NNS or CC other JJ problems NNS . SENT 8 CD Many JJ potential NN triggers VVZ have VH been VBN examined VVN and CC found VVN not RB to TO influence VV relapse NN rates NNS in IN MS NN . SENT Influenza NN vaccination NN is VBZ safe JJ , , does VVZ not RB trigger VV relapses NNS , , and CC can MD therefore RB be VB recommended VVN for IN people NNS with IN MS NN . SENT There EX is VBZ also RB no DT evidence NN that IN hepatitis NP B NP , , varicella NN , , tetanus NN , , or CC Bacille NP Calmette NP Guerin NP immunization NN for IN tuberculosis NN increases NNS the DT risk NN for IN relapse NN . SENT 9 CD edit VV Pathophysiology NN Although IN much RB is VBZ known VVN about IN how WRB multiple JJ sclerosis NN causes NNS damage NN , , the DT reasons NNS why WRB multiple JJ sclerosis NN occurs VVZ are NN not RB known VVN . SENT edit VV How WRB multiple JJ sclerosis NN causes VVZ damage NN Multiple JJ sclerosis NN is VBZ a DT disease NN in IN which WDT the DT body's JJ immune JJ system NN attacks NNS the DT myelin NN surrounding VVG nerve NN cells NNS . SENT Myelin NN is VBZ a DT fatty JJ substance NN which WDT covers VVZ the DT axons NNS of IN nerve NN cells NNS and CC is VBZ important JJ for IN proper JJ nerve NN conduction NN . SENT A DT special JJ subset NN of IN white JJ blood NN cells NNS , , called VVD T NN cells NNS , , plays VVZ a DT key JJ role NN in IN the DT development NN of IN MS NN . SENT Under IN normal JJ circumstances NNS , , these DT lymphocytes NNS can MD distinguish VV between IN self NN and CC non JJ self NN . SENT However RB , , in IN a DT person NN with IN MS NN , , these DT cells NNS recognize VVP healthy JJ parts NNS of IN the DT central JJ nervous JJ system NN as IN foreign JJ and CC attack VV them PP as IN if IN they PP were VBD an DT invading VVG virus NN . SENT In IN MS NN , , certain JJ T NN cells NNS trigger VVP inflammatory JJ processes NNS when WRB they PP encounter VV myelin NN , , stimulating VVG other JJ immune JJ cells NNS and CC soluble JJ factors NNS like IN cytokines NNS and CC antibodies NNS . SENT Normally RB , , there EX is VBZ a DT tight JJ barrier NN between IN the DT blood NN and CC brain NN , , called VVD the DT blood NN brain NN barrier NN , , built VVN up RP of IN endothelial JJ cells NNS lining VVG the DT blood NN vessel NN walls NNS . SENT The DT inflammatory JJ processes NNS triggered VVN by IN the DT T NN cells NNS create VVP leaks NNS in IN the DT blood NN brain NN barrier NN . SENT These DT leaks NNS , , in IN turn NN , , cause VV a DT number NN of IN other JJ damaging JJ effects NNS such JJ as IN swelling VVG , , activation NN of IN macrophages NNS , , and CC more JJR activation NN of IN cytokines NNS and CC other JJ destructive JJ proteins NNS such JJ as IN matrix NN metalloproteinases NNS . SENT The DT final JJ result NN is VBZ destruction NN of IN myelin NN , , called VVD demyelination NN . SENT Repair NN processes NNS , , called VVN remyelination NN , , also RB play VV an DT important JJ role NN in IN MS NN . SENT Remyelination NP is VBZ one CD of IN the DT reasons NNS why WRB , , especially RB in IN early JJ phases NNS of IN the DT disease NN , , symptoms NNS tend VVP to TO decrease VV or CC disappear VV temporarily RB . SENT Nevertheless RB , , nerve NN damage NN and CC irreversible JJ loss NN of IN neurons NNS occur VVP early RB in IN MS NN . SENT Often RB , , the DT brain NN is VBZ able JJ to TO compensate VV for IN some DT of IN this DT damage NN , , due JJ to TO an DT ability NN called VVD plasticity NN . SENT MS NN symptoms NNS develop VVP as IN the DT cumulative JJ result NN of IN multiple JJ lesions NNS in IN the DT brain NN and CC spinal JJ cord NN . SENT This DT is VBZ why WRB symptoms NNS can MD vary VV greatly RB between IN different JJ individuals NNS , , depending VVG on IN where WRB their PP$ lesions NNS occur VVP . SENT The DT oligodendrocytes NNS that WDT originally RB formed VVD a DT myelin NN sheath NN cannot NN completely RB rebuild VV a DT destroyed VVN myelin NN sheath NN . SENT However RB , , the DT brain NN can MD recruit VV stem NN cells NNS , , which WDT migrate VV from IN other JJ unknown JJ regions NNS of IN the DT brain NN , , differentiate VV into IN mature JJ oligodendrocytes NNS , , and CC rebuild VV the DT myelin NN sheath NN . SENT These DT new JJ myelin NN sheaths NNS are VBP often RB not RB as RB effective JJ as IN the DT original JJ ones NNS . SENT Repeated JJ attacks NNS lead VVP to TO successively RB less JJR effective JJ remyelinations NNS , , until IN a DT scar NN like IN plaque NN is VBZ built VVN up RP around IN the DT damaged JJ axons NNS . SENT Under IN laboratory NN conditions NNS , , stem VVP cells NNS are VBP quite RB capable JJ of IN differentiating VVG and CC remyelinating VVG axons NNS . SENT it PP is VBZ therefore RB suspected VVN that IN inflammatory JJ conditions NNS or CC axonal JJ damage NN somehow RB inhibit VVP stem VV cell NN differentiation NN in IN the DT body NN . SENT edit VV Why WRB multiple JJ sclerosis NN occurs VVZ Although IN many JJ risk NN factors NNS for IN multiple JJ sclerosis NN have VHP been VBN identified VVN , , no DT definitive JJ cause NN has VHZ been VBN found VVN . SENT MS NN likely RB occurs VVZ as IN a DT result NN of IN some DT combination NN of IN both DT environmental JJ and CC genetic JJ factors NNS . SENT Various JJ theories NNS try VVP to TO combine VV the DT known VVN data NNS into IN plausible JJ explanations NNS . SENT Although IN most JJS accept VV an DT autoimmune JJ explanation NN , , several JJ theories NNS suggest VVP that DT MS NN is VBZ an DT appropriate JJ immune JJ response NN to TO an DT underlying JJ condition NN . SENT Environmental JJ The DT most RBS popular JJ hypothesis NN is VBZ that IN a DT viral JJ infection NN or CC retroviral JJ reactivation NN primes VVZ a DT susceptible JJ immune JJ system NN for IN an DT abnormal JJ reaction NN later RBR in IN life NN . SENT On IN a DT molecular JJ level NN , , this DT might MD occur VV if IN there EX is VBZ a DT structural JJ similarity NN between IN the DT infectious JJ virus NN and CC some DT component NN of IN the DT central JJ nervous JJ system NN , , leading VVG to TO eventual JJ confusion NN in IN the DT immune JJ system NN . SENT Since IN MS NN seems VVZ to TO be VB more RBR common JJ in IN people NNS who WP live VVP further RBR from IN the DT equator NN , , another DT theory NN proposes VVZ that DT decreased VVN sunlight NN exposure NN 10 CD and CC possibly RB decreased VVD vitamin NN D NP production NN may MD help VV cause NN MS NN . SENT Other JJ theories NNS , , noting VVG that DT MS NN is VBZ less RBR common JJ in IN children NNS with IN siblings NNS , , suggest VVP that DT less JJR exposure NN to TO illness NN in IN childhood NN leads VVZ to TO an DT immune JJ system NN which WDT is VBZ not RB primed VVN to TO fight VV infection NN and CC is VBZ thus RB more RBR likely JJ to TO attack VV the DT body NN . SENT One CD explanation NN for IN this DT would MD be VB an DT imbalance NN between IN the DT Th NN 1 CD type NN of IN helper NN T NN cells NNS , , which WDT fight VVP infection NN , , and CC the DT Th NN 2 CD type NN , , which WDT are VBP more RBR active JJ in IN allergy NN and CC more RBR likely JJ to TO attack VV the DT body NN . SENT Another DT theory NN describes VVZ MS NN as IN an DT immune JJ response NN to TO a DT chronic JJ viral JJ infection NN . SENT The DT association NN of IN MS NN with IN the DT Epstein NP Barr NP virus NN suggests VVZ a DT potential JJ viral JJ contribution NN in IN at IN least JJS some DT individuals NNS . SENT 11 CD Genetic JJ MS NN is VBZ not RB strictly RB a DT hereditary JJ disease NN . SENT However RB , , increasing VVG scientific JJ evidence NN suggests VVZ that DT genetics NN may MD play VV a DT role NN in IN determining VVG a DT person's JJ susceptibility NN to TO MS NN . SENT Some DT populations NNS , , such JJ as IN Gypsies NNS , , Eskimos NNS , , and CC Bantus NNS , , never RB get VV MS NN . SENT Native JJ Indians NPS of IN North NP and CC South NP America NP , , the DT Japanese JJ , , and CC other JJ Asian JJ peoples NNS have VHP very RB low JJ incidence NN rates NNS . SENT It PP is VBZ unclear JJ whether IN this DT is VBZ due JJ mostly RB to TO genetic JJ or CC environmental JJ factors NNS . SENT In IN the DT population NN at IN large JJ , , the DT chance NN of IN developing VVG MS NN is VBZ less JJR than IN a DT tenth NN of IN one CD percent NN . SENT However RB , , if IN one CD person NN in IN a DT family NN has VHZ MS NN , , that IN person's JJ first JJ degree NN relatives NNS parents NNS , , children NNS , , and CC siblings NNS have VHP a DT one CD to TO three CD percent NN chance NN of IN getting VVG the DT disease NN . SENT For IN identical JJ twins NNS , , the DT likelihood NN that IN the DT second JJ twin NN may MD develop VV MS NN if IN the DT first JJ twin JJ does VVZ is VBZ about RB 30 CD percent NN . SENT for IN fraternal JJ twins NNS who WP do VVP not RB inherit VVP identical JJ gene NN pools NNS , , the DT likelihood NN is VBZ closer JJR to TO that DT for IN non JJ twin JJ siblings NNS , , or CC about RB 4 CD percent NN . SENT The DT fact NN that IN the DT rate NN for IN identical JJ twins NNS both CC developing VVG MS NN is VBZ significantly RB less JJR than IN 100 CD percent NN suggests VVZ that IN the DT disease NN is VBZ not RB entirely RB genetically RB controlled VVN . SENT Some DT but CC definitely RB not RB all RB of IN this DT effect NN may MD be VB due JJ to TO shared VVN exposure NN to TO something NN in IN the DT environment NN , , or CC to TO the DT fact NN that IN some DT people NNS with IN MS NN lesions NNS remain VVP essentially RB asymptomatic JJ throughout IN their PP$ lives NNS . SENT Further JJR indications NNS that IN more JJR than IN one CD gene NN is VBZ involved VVN in IN MS NN susceptibility NN comes VVZ from IN studies NNS of IN families NNS in IN which WDT more JJR than IN one CD member NN has VHZ MS NN . SENT Several JJ research NN teams NNS found VVN that IN people NNS with IN MS NN inherit VVP certain JJ regions NNS on IN individual JJ genes NNS more RBR frequently RB than IN people NNS without IN MS NN . SENT Of IN particular JJ interest NN is VBZ the DT human JJ leukocyte NN antigen NN HLA NP or CC major JJ histocompatibility NN complex JJ region NN on IN chromosome NN 6 CD . SENT HLAs NNS are VBP genetically RB determined VVN proteins NNS that WDT influence VVP the DT immune JJ system NN . SENT The DT HLA NP patterns NNS of IN MS NN patients NNS tend VVP to TO be VB different JJ from IN those DT of IN people NNS without IN the DT disease NN . SENT Investigations NNS in IN northern JJ Europe NP and CC America NP have VHP detected VVN three CD HLAs NNS that WDT are VBP more RBR prevalent JJ in IN people NNS with IN MS NN than IN in IN the DT general JJ population NN . SENT Studies NNS of IN American JJ MS NN patients NNS have VHP shown VVN that IN people NNS with IN MS NN also RB tend VVP to TO exhibit VV these DT HLAs NP in IN combination NN that WDT is VBZ , , they PP have VHP more JJR than IN one CD of IN the DT three CD HLAs NNS more RBR frequently RB than IN the DT rest NN of IN the DT population NN . SENT Furthermore RB , , there EX is VBZ evidence NN that IN different JJ combinations NNS of IN the DT HLAs NP may MD correspond VV to TO variations NNS in IN disease NN severity NN and CC progression NN . SENT Studies NNS of IN families NNS with IN multiple JJ cases NNS of IN MS NN and CC research NN comparing VVG genetic JJ regions NNS of IN humans NNS to TO those DT of IN mice NNS with IN EAE NP suggest VVP that IN another DT area NN related VVN to TO MS NN susceptibility NN may MD be VB located VVN on IN chromosome NN 5 CD . SENT Other JJ regions NNS on IN chromosomes NNS 2 CD , , 3 CD , , 7 CD , , 11 CD , , 17 CD , , 19 CD , , and CC X NP have VHP also RB been VBN identified VVN as IN possibly RB containing VVG genes NNS involved VVN in IN the DT development NN of IN MS NN . SENT These DT studies NNS strengthen VVP the DT theory NN that IN MS NN is VBZ the DT result NN of IN a DT number NN of IN factors NNS rather RB than IN a DT single JJ gene NN or CC other JJ agent NN . SENT Development NN of IN MS NN is VBZ likely JJ to TO be VB influenced VVN by IN the DT interactions NNS of IN a DT number NN of IN genes NNS , , each DT of IN which WDT individually RB has VHZ only RB a DT modest JJ effect NN . SENT Additional JJ studies NNS are VBP needed VVN to TO specifically RB pinpoint VV which WDT genes NNS are VBP involved VVN , , determine VV their PP$ function NN , , and CC learn VV how WRB each DT gene's JJ interactions NNS with IN other JJ genes NNS and CC with IN the DT environment NN make VV an DT individual NN susceptible JJ to TO MS NN . SENT edit VV Treatment NP There RB is VBZ no RB known VVN definitive JJ cure NN for IN multiple JJ sclerosis NN . SENT However RB , , several JJ types NNS of IN therapy NN have VHP proven VVN to TO be VB helpful JJ . SENT Different JJ therapies NNS are VBP used VVN for IN patients NNS experiencing VVG acute JJ attacks NNS , , for IN patients NNS who WP have VHP the DT relapsing VVG remitting VVG subtype NN , , for IN patients NNS who WP have VHP the DT progressive JJ subtypes NNS , , for IN patients NNS without IN a DT diagnosis NN of IN MS NN who WP have VHP a DT demyelinating VVG event NN , , and CC for IN managing VVG the DT various JJ consequences NNS of IN MS NN attacks NNS . SENT Treatment NN is VBZ aimed VVN at IN returning VVG function NN after IN an DT attack NN , , preventing VVG new JJ attacks NNS , , and CC preventing VVG disability NN . SENT edit VV Management NP of IN acute JJ attacks NNS During IN symptomatic JJ attacks NNS , , patients NNS may MD be VB hospitalized VVN . SENT They PP are VBP typically RB given VVN high JJ doses NNS of IN intravenous JJ corticosteroids NNS , , such JJ as IN methylprednisolone NN , , to TO end VV the DT attack NN sooner RBR and CC leave VVP fewer JJR lasting JJ deficits NNS . SENT There EX is VBZ also RB some DT support NN for IN using VVG oral JJ corticosteroid NN pills NNS during IN an DT attack NN , , but CC clinical JJ practice NN varies VVZ . SENT However RB , , there EX is VBZ no DT data NN to TO support VV the DT continued JJ use NN of IN steroids NNS for IN preventing VVG MS NN after IN an DT initial JJ attack NN . SENT edit VV Management NP of IN relapsing VVG remitting VVG MS NN In IN the DT United NP States NPS , , as RB of IN 2005 CD there RB are VBP five CD FDA NP approved VVD treatments NNS for IN patients NNS with IN relapsing VVG remitting VVG MS NN . SENT Three NP are VBP interferons NNS . SENT Interferon NP beta NN 1 CD a DT Avonex NP and CC Rebif NP or CC beta JJ 1 CD b SYM Betaseron NP in IN Europe NP Betaferon NP . SENT The DT interferons NNS are VBP medications NNS derived VVN from IN human JJ cytokines NNS which WDT help VVP regulate VV the DT immune JJ system NN . SENT A DT fourth JJ medication NN is VBZ glatiramer JJR acetate NN Copaxone NP , , a DT mixture NN of IN polypeptides NNS which WDT may MD protect VV important JJ myelin NN proteins NNS by IN substituting VVG itself PP as IN the DT target NN of IN immune JJ system NN attack NN . SENT The DT final JJ medication NN , , mitoxantrone NN is VBZ effective JJ but CC is VBZ limited VVN by IN cardiac JJ toxicity NN . SENT All DT five CD medications NNS have VHP been VBN proven VVN to TO be VB modestly RB effective JJ at IN decreasing VVG the DT number NN of IN attacks NNS and CC slowing VVG progression NN to TO disability NN . SENT They PP differ VVP primarily RB in IN ease NN of IN use NN , , price NN , , side NN effects NNS , , and CC the DT likelihood NN that IN extended JJ use NN will MD decrease VV their PP$ effects NNS . SENT All DT of IN these DT therapies NNS are VBP expensive JJ and CC require VV frequent JJ injections NNS , , with IN Avonex NP requiring VVG weekly JJ injections NNS and CC Copaxone NP daily JJ injections NNS . SENT All DT of IN the DT interferons NNS can MD lose VV effectiveness NN after IN continued JJ use NN , , with IN Avonex NP being VBG the DT least JJS likely JJ and CC Betaseron NP the DT most RBS likely JJ . SENT This DT is VBZ the DT result NN of IN neutralizing VVG antibodies NNS against IN the DT interferons NNS . SENT The DT interferons NNS all RB require VVP laboratory NN monitoring NN of IN blood NN tests NNS . SENT Even RB with IN appropriate JJ use NN of IN medication NN , , most JJS patients NNS with IN relapsing VVG remitting VVG MS NN still RB suffer VVP from IN some DT attacks NNS and CC subsequent JJ disability NN . SENT Side NN effects NNS are VBP covered VVN below RB . SENT edit VV Management NP of IN progressive JJ MS NN Treatment NP of IN progressive JJ MS NN is VBZ more RBR difficult JJ than IN relapsing VVG remitting VVG MS NN , , and CC many JJ patients NNS do VVP not RB respond VV to TO any DT therapy NN . SENT A DT wide JJ range NN of IN medications NNS have VHP been VBN used VVN to TO try VV to TO slow VV the DT progression NN of IN disease NN . SENT Many JJ therapies NNS have VHP been VBN shown VVN to TO have VH some DT effect NN on IN disease NN progression NN and CC resulting VVG disability NN , , but CC most JJS therapies NNS have VHP significant JJ side NN effects NNS which WDT limit VVP their PP$ long JJ term NN use NN . SENT Therefore RB they PP are VBP often RB appropriate JJ only RB for IN the DT most RBS rapidly RB progressive JJ cases NNS . SENT Azathioprine NN , , cladribine NN , , and CC cyclosporine NN have VHP all RB shown VVN small JJ benefits NNS , , which WDT in IN most JJS cases NNS are VBP outweighed VVN by IN side NN effects NNS such JJ as IN an DT increased JJ cancer NN risk NN . SENT Mitoxantrone NN , , a DT chemotherapy NN drug NN , , offers VVZ a DT significant JJ reduction NN in IN progression NN to TO disability NN , , but CC causes VVZ dose NN dependant JJ cardiac JJ toxicity NN which WDT limits VVZ its PP$ long JJ term NN use NN . SENT Natalizumab NP marketed VVD as IN Tysabri NP showed VVD promise NN in IN early JJ trials NNS but CC has VHZ been VBN withdrawn VVN from IN the DT market NN in IN the DT United NP States NPS because IN of IN an DT association NN with IN progressive JJ multifocal JJ leukoencephalopathy NN . SENT Bone NN marrow NN transplant NN , , plasmapheresis NN , , and CC total JJ lymphoid JJ irradiation NN exposure NN to TO high JJ doses NNS of IN radiation NN in IN order NN to TO kill VV parts NNS of IN the DT immune JJ system NN have VHP been VBN studied VVN and CC are VBP currently RB reserved VVN for IN the DT most RBS dire JJ cases NNS . SENT Cyclophosphamide NN and CC methotrexate NN are VBP chemotherapy NN drugs NNS which WDT can MD slow VV the DT progression NN of IN MS NN , , but CC which WDT also RB have VHP a DT number NN of IN side NN effects NNS . SENT Frequent JJ courses NNS of IN high JJ dose NN corticosteroids NNS , , often RB given VVN weekly JJ or CC monthly JJ , , are VBP also RB commonly RB employed VVN to TO good JJ effect NN . SENT Interferons NNS show VVP promise NN in IN secondary JJ progressive JJ MS NN , , but CC more JJR data NNS is VBZ needed VVN to TO support VV widespread JJ use NN . SENT edit VV Management NP of IN demyelination NN without IN a DT diagnosis NN of IN MS NN Several JJ studies NNS have VHP shown VVN that IN starting VVG treatment NN with IN interferon NN beta NN 1 CD a DT during IN the DT initial JJ attack NN and CC prior RB to TO the DT second JJ attack NN required VVN for IN a DT definite JJ diagnosis NN of IN MS NN can MD decrease VV the DT chance NN that IN a DT patient NN will MD develop VV MS NN . SENT A DT separate JJ medication NN , , intravenous JJ immunoglobulin NN IVIG NN has VHZ also RB shown VVN promise NN in IN reducing VVG progression NN to TO MS NN in IN this DT set NN of IN patients NNS . SENT Therefore RB , , in IN certain JJ patients NNS , , it PP is VBZ important JJ that IN therapy NN be VB started VVN prior RB to TO definite JJ diagnosis NN . SENT 12 CD 13 CD edit VV Management NP of IN the DT effects NNS of IN MS NN Because IN much JJ of IN the DT damage NN caused VVN by IN MS NN is VBZ irreversible JJ , , management NN of IN the DT resulting VVG deficits NNS is VBZ very RB important JJ . SENT As RB for IN any DT patient NN with IN neurologic JJ deficits NNS , , a DT multidisciplinary JJ approach NN is VBZ key JJ to TO limiting VVG and CC overcoming VVG disability NN . SENT Physical JJ therapy NN , , occupational JJ therapy NN , , and CC speech NN therapy NN are VBP all DT important JJ components NNS of IN a DT comprehensive JJ approach NN to TO maintaining VVG quality NN of IN life NN . SENT Treatment NN of IN emotional JJ distress NN and CC depression NN should MD involve VV mental JJ health NN professionals NNS such JJ as IN therapists NNS , , psychologists NNS , , and CC psychiatrists NNS . SENT Neurocognitive JJ testing NN is VBZ important JJ for IN determining VVG the DT extent NN of IN cognitive JJ deficits NNS . SENT Management NN of IN cognitive JJ defects NNS relies VVZ on IN lifestyle NN strategies NNS , , but CC also RB may MD respond VV to TO donepezil NN . SENT Medications NNS such JJ as IN baclofen NN , , tizanidine NN , , dantrolene NP and CC Sativex NP have VHP been VBN shown VVN to TO improve VV spasticity NN . SENT Depression NN can MD be VB treated VVN with IN a DT variety NN of IN antidepressants NNS . SENT selective JJ serotonin NN reuptake NN inhibitors NNS SSRIs NP are VBP most RBS commonly RB employed VVN . SENT The DT anticonvulsant NN drugs NNS gabapentin NN and CC carbamazepine NN and CC the DT antidepressant NN amitriptyline NN can MD improve VV pain NN and CC tingling VVG sensations NNS in IN certain JJ cases NNS . SENT Fatigue NN can MD often RB be VB managed VVN by IN amantadine NN , , pemoline NN , , methylphenidate NN , , and CC modafinil NP . SENT Bladder NN spasms NNS can MD be VB treated VVN by IN oxybutynin NN and CC trospium NN chloride NN . SENT Erectile JJ dysfunction NN may MD respond VV to TO sildenafil NN , , vardenafil NN , , or CC tadalafil NN . SENT edit VV Therapies NNS under IN investigation NN Scientists NNS continue VVP their PP$ extensive JJ efforts NNS to TO create VV new JJ and CC better JJR therapies NNS for IN MS NN . SENT One CD of IN the DT most RBS promising JJ MS NN research NN areas NNS involves VVZ naturally RB occurring VVG antiviral JJ proteins NNS known VVN as IN interferons NNS . SENT Beta JJ interferon NN has VHZ been VBN shown VVN to TO reduce VV the DT number NN of IN exacerbations NNS and CC may MD slow VV the DT progression NN of IN physical JJ disability NN . SENT When WRB attacks NNS do VVP occur VV , , they PP tend VVP to TO be VB shorter JJR and CC less RBR severe JJ . SENT In IN addition NN , , there EX are VBP a DT number NN of IN treatments NNS under IN investigation NN that WDT may MD curtail VV attacks NNS or CC improve VV function NN . SENT Over IN a DT dozen NN clinical JJ trials NNS testing VVG potential JJ therapies NNS are VBP underway JJ , , and CC additional JJ new JJ treatments NNS are VBP being VBG devised VVN and CC tested VVN in IN animal JJ models NNS . SENT A DT family NN of IN cholesterol NN lowering VVG drugs NNS , , the DT statins NNS , , have VHP shown VVN anti JJ inflammatory JJ effects NNS in IN animal JJ models NNS of IN MS NN . SENT However RB , , as RB of IN 2005 CD there RB is VBZ not RB sufficient JJ evidence NN that IN statins NNS are VBP beneficial JJ in IN the DT treatment NN of IN human JJ MS NN patients NNS with IN normal JJ cholesterol NN levels NNS . SENT A DT recent JJ study NN found VVN that IN women NNS who WP took VVD vitamin NN D NP supplements NNS were VBD 40 CD less JJR likely JJ to TO develop VV MS NN than IN women NNS who WP did VVD not RB take VV supplements NNS . SENT However RB , , this DT study NN does VVZ not RB provide VV enough JJ data NNS to TO conclude VV that DT vitamin NN D NP has VHZ a DT beneficial JJ influence NN on IN ongoing JJ MS NN . SENT Furthermore RB , , it PP could MD not RB distinguish VV between IN a DT beneficial JJ effect NN of IN vitamin NN D NP and CC that IN of IN multivitamin NN supplements NNS including VVG vitamin NN E NN and CC various JJ B NN vitamins NNS , , which WDT may MD also RB exert VV a DT protective JJ effect NN . SENT 14 CD Low NP dose NN naltrexone NN has VHZ been VBN reported VVN to TO reduce VV the DT progression NN and CC relapse NN rates NNS in IN MS NN . SENT however RB , , as RB of IN 2005 CD , , the DT evidence NN is VBZ principally RB based VVN on IN patient JJ reports NNS , , and CC no DT formal JJ studies NNS have VHP confirmed VVN its PP$ effectiveness NN . SENT Beginning VVG in IN the DT 1960 CD s PP , , a DT possible JJ role NN in IN the DT etiology NN of IN MS NN for IN mercury NN exposure NN from IN amalgam NN used VVN to TO fill VV dental JJ caries NN cavities NNS was VBD explored VVN . SENT Although IN multiple JJ studies NNS 15 RB have VHP shown VVN no DT link NN between IN mercury NN amalgam NN and CC MS NN , , a DT recent JJ study NN 16 CD suggests VVZ an DT improvement NN after IN replacement NN of IN mercury NN amalgam NN in IN a DT small JJ subset NN of IN patients NNS identified VVN by IN a DT blood NN test NN called VVN MELISA NP . SENT edit VV Side NP effects NNS of IN medications NNS for IN relapsing VVG remitting VVG MS NN The DT two CD most RBS common JJ types NNS of IN medications NNS used VVN to TO treat VV relapsing VVG remitting VVG MS NN have VHP significant JJ side NN effects NNS which WDT warrant VVP further JJR discussion NN . SENT Both CC the DT interferons NNS and CC glatiramer NN acetate NN are VBP available JJ only RB in IN injectable JJ forms NNS , , and CC both DT can MD cause VV irritation NN at IN the DT injection NN site NN . SENT Interferons NNS are VBP produced VVN in IN the DT body NN during IN illnesses NNS such JJ as IN influenza NN in IN order NN to TO help VV fight VV the DT infection NN . SENT They PP are VBP responsible JJ for IN the DT fever NN , , muscle NN aches NNS , , fatigue NN , , and CC headache NN common NN during IN influenza NN infections NNS . SENT Many JJ patients NNS report NN influenza NN like IN symptoms NNS when WRB using VVG interferon NN to TO fight VV MS NN . SENT Although IN this DT reaction NN often RB lessens VVZ over IN time NN and CC can MD be VB treated VVN with IN paracetamol NN acetaminophen NN or CC ibuprofen NN , , many JJ patients NNS choose VVP not RB to TO take VV interferon NN as IN a DT result NN , , citing VVG a DT loss NN in IN their PP$ quality NN of IN life NN . SENT Additionally RB , , interferons NNS can MD cause VV liver NN damage NN , , and CC laboratory NN blood NN tests NNS must MD be VB monitored VVN to TO ensure VV safe JJ use NN . SENT Patients NNS taking VVG glatiramer JJR acetate NN often RB experience VV a DT post NN injection NN reaction NN manifested VVN by IN flushing VVG , , chest NN tightness NN , , heart NN palpitations NNS , , breathlessness NN , , and CC anxiety NN . SENT edit VV Prognosis NN The DT future JJ course NN of IN the DT disease NN or CC prognosis NN for IN people NNS with IN multiple JJ sclerosis NN depends VVZ on IN the DT subtype NN of IN the DT disease NN , , the DT individual's JJ sex NN and CC race NN , , their PP$ age NN , , their PP$ initial JJ symptoms NNS , , and CC the DT degree NN of IN disability NN they PP experience VVP . SENT The DT life NN expectancy NN of IN people NNS with IN MS NN is VBZ now RB nearly RB the DT same JJ as RB that IN of IN unaffected JJ people NNS . SENT This DT is VBZ mainly RB due JJ to TO improved JJ methods NNS of IN limiting VVG disability NN , , such JJ as IN physical JJ therapy NN and CC speech NN therapy NN , , and CC more RBR successful JJ treatment NN of IN common JJ complications NNS of IN disability NN , , such JJ as IN pneumonia NN and CC urinary JJ tract NN infections NNS . SENT 17 CD Individuals NNS with IN progressive JJ subtypes NNS of IN MS NN , , particularly RB the DT primary JJ progressive JJ subtype NN , , have VHP a DT more RBR rapid JJ decline NN in IN function NN . SENT In IN the DT primary JJ progressive JJ subtype NN , , a DT wheelchair NN is VBZ often RB needed VVN after IN six CD to TO seven CD years NNS . SENT In IN contrast NN , , when WRB the DT initial JJ disease NN course NN is VBZ the DT relapsing VVG remitting VVG subtype NN , , the DT average JJ time NN until IN a DT wheelchair NN is VBZ needed VVN is VBZ twenty CD years NNS . SENT This DT means VVZ that IN many JJ individuals NNS with IN MS NN will MD never RB need VV a DT wheelchair NN . SENT The DT earlier RBR in IN life NN MS NN occurs VVZ , , the DT slower JJR disability NN progresses VVZ . SENT Individuals NNS who WP are VBP older JJR than IN fifty CD when WRB diagnosed VVN are NN more RBR likely JJ to TO experience VV a DT chronic JJ progressive JJ course NN , , with IN more JJR rapid JJ progression NN of IN disability NN . SENT Those DT diagnosed VVN before IN age NN 35 CD have VHP the DT best JJS prognosis NN . SENT Females NNS generally RB have VHP a DT better JJR prognosis NN than IN males NNS . SENT Although IN black JJ individuals NNS tend VVP to TO develop VV MS NN less RBR frequently RB , , they PP are VBP often RB older JJR at IN the DT time NN of IN onset NN and CC may MD have VH a DT worse JJR prognosis NN . SENT Initial JJ MS NN symptoms NNS of IN visual JJ loss NN or CC sensory JJ problems NNS , , such JJ as IN numbness NN or CC tingling VVG , , are VBP markers NNS for IN a DT relatively RB good JJ prognosis NN , , whereas IN difficulty NN walking NN and CC weakness NN are VBP markers NNS for IN a DT relatively RB poor JJ prognosis NN . SENT Better JJR outcomes NNS are VBP also RB associated VVN with IN the DT presence NN of IN only RB a DT single JJ symptom NN at IN onset NN , , the DT rapid JJ development NN of IN initial JJ symptoms NNS , , and CC the DT rapid JJ regression NN of IN initial JJ symptoms NNS . SENT The DT degree NN of IN disability NN varies VVZ among IN individuals NNS with IN MS NN . SENT In IN general JJ , , one CD of IN three CD individuals NNS will MD still RB be VB able JJ to TO work VV after IN 15 CD 20 CD years NNS . SENT Fifteen CD percent NN of IN people NNS diagnosed VVN with IN MS NN never RB have VHP a DT second JJ relapse NN , , and CC these DT people NNS have VHP minimal JJ or CC no DT disability NN after IN ten CD years NNS . SENT 18 CD The DT degree NN of IN disability NN after IN five CD years NNS correlates VVZ well RB with IN the DT degree NN of IN disability NN after IN fifteen CD years NNS . SENT This DT means VVZ that IN two CD thirds NNS of IN people NNS with IN MS NN with IN low JJ disability NN after IN five CD years NNS will MD not RB get VV much RB worse JJR during IN the DT next JJ ten CD years NNS . SENT It PP should MD be VB noted VVN that IN most JJS of IN these DT outcomes NNS were VBD observed VVN before IN the DT use NN of IN medications NNS such JJ as IN interferon NN , , which WDT can MD delay VV disease NN progression NN for IN several JJ years NNS . SENT Currently RB there EX are VBP no RB clinically RB established VVN laboratory NN investigations NNS available JJ that WDT can MD predict VV prognosis NN or CC response NN to TO treatment NN . SENT However RB , , several JJ promising JJ approaches NNS have VHP been VBN proposed VVN . SENT These DT include VVP measurement NN of IN the DT two CD antibodies NNS anti JJ myelin NN oligodendrocyte NN glycoprotein NN and CC anti JJ myelin NN basic JJ protein NN , , and CC measurement NN of IN TRAIL NN TNF NP Related NP Apoptosis NN Inducing VVG Ligand NN . SENT 19 RB edit VV Epidemiology NN World NN map NN showing VVG the DT that DT risk NN for IN MS NN increases NNS away RB from IN the DT equator NN In IN northern JJ Europe NP , , continental JJ North NP America NP , , and CC Australasia NP , , about RB one CD of IN every DT 1000 CD citizens NNS suffers VVZ from IN multiple JJ sclerosis NN , , whereas IN in IN the DT Arabian JJ peninsula NN , , Asia NP , , and CC continental JJ South NP America NP , , the DT frequency NN is VBZ much RB lower JJR . SENT In IN sub NN Saharan JJ Africa NP , , MS NN is VBZ extremely RB rare JJ . SENT With IN important JJ exceptions NNS , , there EX is VBZ a DT north NN to TO south RB gradient JJ in IN the DT northern JJ hemisphere NN and CC a DT south NN to TO north RB gradient JJ in IN the DT southern JJ hemisphere NN , , with IN MS NN being VBG much RB less JJR common JJ in IN people NNS living VVG near IN the DT equator NN . SENT Climate NN , , diet NN , , geomagnetism NN , , toxins NNS , , sunlight NN exposure NN , , genetic JJ factors NNS , , and CC infectious JJ diseases NNS have VHP all RB been VBN discussed VVN as IN possible JJ reasons NNS for IN these DT regional JJ differences NNS . SENT Environmental JJ factors NNS during IN childhood NN may MD play VV an DT important JJ role NN in IN the DT development NN of IN MS NN later RBR in IN life NN . SENT This DT idea NN is VBZ based VVN on IN several JJ studies NNS of IN migrants NNS showing VVG that IN if IN migration NN occurs VVZ before IN the DT age NN of IN fifteen CD , , the DT migrant NN acquires VVZ the DT new JJ region's NN susceptibility NN to TO MS NN . SENT If IN migration NN takes VVZ place NN after IN age NN fifteen CD , , the DT migrant NN keeps VVZ the DT susceptibility NN of IN his PP$ home NN country NN . SENT 20 CD Additionally RB , , smoking NN has VHZ been VBN shown VVN to TO be VB an DT independent JJ risk NN factor NN for IN developing VVG MS NN . SENT 21 CD MS NN occurs VVZ mainly RB in IN Caucasians NNS . SENT It PP is VBZ twenty CD fold NN lower JJR in IN the DT Inuit NP people NNS of IN Canada NP than IN in IN other JJ Canadians NNS living VVG in IN the DT same JJ region NN . SENT It PP is VBZ also RB rare JJ in IN the DT Native JJ American JJ tribes NNS of IN North NP America NP , , the DT Australian JJ Aborigines NNS and CC the DT Maori NN of IN New NP Zealand NP . SENT These DT few JJ examples NNS point VVP out RP that DT genetic JJ background NN plays VVZ an DT important JJ role NN in IN the DT development NN of IN MS NN . SENT As IN observed VVN in IN many JJ autoimmune JJ disorders NNS , , MS NN is VBZ more RBR common JJ in IN females NNS than IN males NNS . SENT the DT mean JJ sex NN ratio NN is VBZ about RB two CD females NNS for IN every DT male NN . SENT In IN children NNS who WP rarely RB develop VVP MS NN the DT sex NN ratio NN may MD reach VV three CD females NNS for IN each DT male NN . SENT In IN people NNS over IN age NN fifty CD , , MS NN affects VVZ males NNS and CC females NNS equally RB . SENT Onset NN of IN symptoms NNS usually RB occurs VVZ between IN twenty CD to TO forty NN years NNS of IN age NN , , rarely RB before IN age NN fifteen CD or CC after IN age NN sixty CD . SENT As IN previously RB discussed VVN , , there EX is VBZ a DT genetic JJ component NN to TO MS NN . SENT On IN average JJ one NN of IN every DT 25 CD siblings NNS of IN individuals NNS with IN MS NN will MD also RB develop VV MS NN . SENT Almost RB half NN of IN the DT identical JJ twins NNS of IN MS NN affected VVN individuals NNS will MD develop VV MS NN , , but CC only RB one CD of IN twenty CD fraternal JJ twins NNS . SENT If IN one CD parent NN is VBZ affected VVN by IN MS NN , , each DT child NN has VHZ a DT risk NN of IN only RB about IN one CD in IN forty NN of IN developing VVG MS NN later RBR in IN life NN . SENT 22 RB edit VV History NN A DT French JJ neurologist NN named VVN Jean NP Martin NP Charcot NP 1825 CD 93 CD was VBD the DT first JJ person NN to TO recognize VV multiple JJ sclerosis NN as IN a DT distinct JJ , , separate JJ disease NN in IN 1868 CD . SENT Summarizing VVG previous JJ reports NNS and CC adding VVG his PP$ own JJ important JJ clinical JJ and CC pathological JJ observations NNS , , Charcot NP called VVD the DT disease NN sclerose NN en IN plaques NNS . SENT The DT three CD signs NNS of IN MS NN now RB known VVN as IN Charcot's NP triad NN are VBP dysarthria NN problems NNS with IN speech NN , , ataxia NN problems NNS with IN coordination NN , , and CC tremor NN . SENT 23 CD Prior RB to TO Charcot NP , , Robert NP Hooper NP 1773 CD 1835 CD , , a DT British JJ pathologist NN and CC practicing VVG physician NN , , Robert NP Carswell NP 1793 CD 1857 CD , , a DT British JJ professor NN of IN pathology NN , , and CC Jean NP Cruveilhier NP 1791 CD 1873 CD , , a DT French JJ professor NN of IN pathologic JJ anatomy NN , , had VHD described VVN and CC illustrated VVN many JJ of IN the DT disease's JJ clinical JJ details NNS . SENT There EX are VBP several JJ historical JJ accounts NNS of IN people NNS who WP probably RB had VHD MS NN . SENT Saint NP Lidwina NP of IN Schiedam NP 1380 CD 1433 CD , , a DT Dutch JJ nun NN , , may MD have VH been VBN the DT first JJ identifiable JJ MS NN patient NN . SENT From IN the DT age NN of IN sixteen CD until IN her PP$ death NN at IN age NN 53 CD , , she PP suffered VVD intermittent JJ pain NN , , weakness NN of IN the DT legs NNS , , and CC vision NN loss NN symptoms NNS typical JJ of IN MS NN . SENT Augustus NP Frederick NP d'Este NP 1794 CD 1848 CD , , an DT illegitimate JJ grandson NN of IN King NP George NP III NP of IN Great NP Britain NP , , almost RB certainly RB suffered VVN from IN MS NN . SENT D'Este NP left VVD a DT detailed JJ diary NN describing VVG his PP$ 22 CD years NNS living VVG with IN the DT disease NN . SENT His PP$ symptoms NNS began VVD at IN age NN 28 CD with IN a DT sudden JJ transient JJ visual JJ loss NN after IN the DT funeral NN of IN a DT friend NN . SENT During IN the DT course NN of IN his PP$ disease NN he PP developed VVD weakness NN of IN the DT legs NNS , , clumsiness NN of IN the DT hands NNS , , numbness NN , , dizziness NN , , bladder NN disturbances NNS , , and CC erectile JJ dysfunction NN . SENT In IN 1844 CD , , he PP was VBD confined VVN to TO a DT wheelchair NN . SENT Despite IN his PP$ illness NN , , he PP kept VVD an DT optimistic JJ view NN of IN life NN . SENT Another DT early JJ account NN of IN MS NN was VBD kept VVN by IN the DT British JJ diarist NN W NP . SENT N NP . SENT P NN . SENT Barbellion NP , , who WP maintained VVD a DT detailed JJ log NN of IN his PP$ diagnosis NN and CC struggle NN with IN MS NN . SENT His PP$ diary NN was VBD published VVN in IN 1919 CD as IN The DT Journal NP of IN a DT Disappointed JJ Man NN . SENT edit VV Multiple JJ sclerosis NN in IN fiction NN In IN the DT American JJ television NN series NN The DT West NP Wing NP , , the DT fictional JJ United NP States NPS President NP , , Josiah NP Jed NP Bartlet NP , , has VHZ the DT relapsing VVG remitting VVG subtype NN of IN MS NN . SENT The DT storylines NNS have VHP educated VVN many JJ viewers NNS about IN the DT nature NN of IN MS NN and CC have VHP helped VVN to TO dispel VV some DT of IN the DT myths NNS about IN the DT disease NN . SENT edit VV References NNS Dangond NP , , F NP . SENT Multiple JJ sclerosis NN . SENT eMedicine NN Neurology NN . SENT Updated VVN 2005 CD Apr NN 25 CD . SENT full JJ text NN . SENT Calabresi NP PA NN . SENT Diagnosis NN and CC management NN of IN multiple JJ sclerosis NN . SENT Am NP Fam NP Physician NN . SENT PMID NP 15571060 CD full JJ text NN . SENT Paty NP D NP , , Studney NP D NP , , Redekop NP K NP , , Lublin NP F NP . SENT MS NN COSTAR NN . SENT a DT computerized JJ patient NN record NN adapted VVN for IN clinical JJ research NN purposes NNS . SENT Ann NP Neurol NP 1994 CD . SENT 36 CD Suppl NP . SENT S NP 134 CD 5 CD . SENT PMID NP 8017875 CD McDonald NP WI NP . SENT Compston NP A NP . SENT Edan NP G NP . SENT Goodkin NP D NP . SENT Hartung NP HP NP . SENT Lublin NP FD NP . SENT McFarland NP HF NP . SENT Paty NP DW NP . SENT Polman NP CH NP . SENT Reingold NP SC NP . SENT Sandberg NP Wollheim NP M NP . SENT Sibley NP W NP . SENT Thompson NP A NP . SENT van NP den NN Noort NP S NP . SENT Weinshenker NP BY IN . SENT Wolinsky NP JS NP . SENT Recommended VVN diagnostic JJ criteria NNS for IN multiple JJ sclerosis NN . SENT guidelines NNS from IN the DT International NP Panel NN on IN the DT diagnosis NN of IN multiple JJ sclerosis NN . SENT Ann NP Neurol NP 2001 CD Jul NN . SENT 50 CD 1 CD . SENT 121 CD 7 CD PMID NN 11456302 CD Rudick NP , , RA NP , , Whitaker NP , , JN NP . SENT Cerebrospinal JJ fluid JJ tests NNS for IN multiple JJ sclerosis NN . SENT In IN Scheinberg NP , , P NN Ed NP . SENT Neurology NN neurosurgery NN update NN series NN , , Vol NP . SENT 7 CD , , CPEC NP . SENT Princeton NP , , NJ NP 1987 CD Gronseth NP GS NP . SENT Ashman NP EJ NP . SENT Practice NN parameter NN . SENT the DT usefulness NN of IN evoked VVN potentials NNS in IN identifying VVG clinically RB silent JJ lesions NNS in IN patients NNS with IN suspected JJ multiple JJ sclerosis NN an DT evidence NN based VVN review NN . SENT Report NN of IN the DT Quality NP Standards NPS Subcommittee NP of IN the DT American NP Academy NP of IN Neurology NN . SENT Neurology NN 2000 CD May NP 9 CD . SENT 54 CD 9 CD . SENT 1720 CD 5 CD . SENT PMID NP 10802774 CD Lublin NP FD NP . SENT Reingold NP SC NP . SENT Defining VVG the DT clinical JJ course NN of IN multiple JJ sclerosis NN . SENT results NNS of IN an DT international JJ survey NN . SENT National JJ Multiple JJ Sclerosis NN Society NP USA NP Advisory NP Committee NP on IN Clinical JJ Trials NNS of IN New NP Agents NPS in IN Multiple JJ Sclerosis NN . SENT Neurology NN 1996 CD Apr NN . SENT 46 CD 4 CD . SENT 907 CD 11 CD . SENT PMID NP 8780061 CD Worthington NP J NP . SENT Jones NP R NP . SENT Crawford NP M NP . SENT Forti NP A NP . SENT Pregnancy NN and CC multiple JJ sclerosis NN a DT 3 CD year NN prospective JJ study NN . SENT J NP Neurol NP 1994 CD Feb NN . SENT 241 CD 4 CD . SENT 228 CD 33 CD . SENT PMID NP 8195822 CD Confavreux NP C NP . SENT Suissa NP S NP . SENT Saddier JJR P NN . SENT Bourdes NP V NN . SENT Vukusic NP S NP . SENT Vaccinations NNS and CC the DT risk NN of IN relapse NN in IN multiple JJ sclerosis NN . SENT Vaccines NNS in IN Multiple JJ Sclerosis NN Study NP Group NP . SENT N NP Engl NP J NP Med NP 2001 CD Feb NN 1 CD . SENT 344 CD 5 CD . SENT 319 CD 26 CD . SENT PMID NP 11172162 CD van NP der NP Mei NP , , IA NP , , Ponsonby NP , , AL NP , , Dwyer NP , , T NN , , et NP al NP . SENT Past JJ exposure NN to TO sun NN , , skin NN phenotype NN , , and CC risk NN of IN multiple JJ sclerosis NN . SENT case NN control NN study NN . SENT BMJ NP 2003 CD . SENT 327 CD . SENT 316 CD . SENT PMID NP 12907484 CD Levin NP LI NP , , Munger NP KL NP , , Rubertone NP MV NP , , Peck NP CA MD , , Lennette NP ET NP , , Spiegelman NP D NP , , Ascherio NP A NP . SENT Temporal JJ relationship NN between IN elevation NN of IN epstein NP barr NP virus NN antibody NN titers NNS and CC initial JJ onset NN of IN neurological JJ symptoms NNS in IN multiple JJ sclerosis NN . SENT JAMA NP . SENT 2005 CD May NP 25 CD . SENT 293 CD 20 CD . SENT 2496 CD 500 CD . SENT PMID NP 15914750 CD . SENT Jacobs NP LD NP . SENT Beck NP RW NP . SENT Simon NP JH NP . SENT Kinkel NP RP NP . SENT Brownscheidle NP CM NP . SENT Murray NP TJ NP . SENT Simonian NP NA TO . SENT Slasor NP PJ NP . SENT Sandrock NP AW NP . SENT Intramuscular JJ interferon NN beta NN 1 CD a DT therapy NN initiated VVN during IN a DT first JJ demyelinating NN event NN in IN multiple JJ sclerosis NN . SENT CHAMPS NNS Study NP Group NP . SENT N NP Engl NP J NP Med NP 2000 CD Sep NN 28 CD . SENT 343 CD 13 CD . SENT 898 CD 904 CD . SENT PMID NP 11006365 CD Comi NP G NP . SENT Filippi NP M NP . SENT Barkhof NP F NP . SENT Durelli NP L NP . SENT Edan NP G NP . SENT Fernandez NP O NP . SENT Hartung NP H NP . SENT Seeldrayers NP P NN . SENT Sorensen NP PS NP . SENT Rovaris NP M NP . SENT Martinelli NP V NN . SENT Hommes NP OR CC . SENT Effect NN of IN early JJ interferon NN treatment NN on IN conversion NN to TO definite JJ multiple JJ sclerosis NN . SENT a DT randomised VVN study NN . SENT Lancet NP 2001 CD May NP 19 CD . SENT 357 CD 9268 CD . SENT 1576 CD 82 CD . SENT PMID NP 11377645 CD Munger NP KL NP , , Zhang NP SM NP , , O'Reilly NP E NP , , Hernan NP MA NN , , Olek NP MJ NP , , Willett NP WC NN , , Ascherio NP A NP . SENT Vitamin NN D NP intake NN and CC incidence NN of IN multiple JJ sclerosis NN . SENT Neurology NN . SENT 2004 CD Jan NP 13 CD . SENT 62 CD 1 CD . SENT 60 CD 5 CD . SENT PMID NP 14718698 CD Yip NP HK NP , , Li NP DK NP , , Yau NP DC NP . SENT Dental JJ amalgam NN and CC human JJ health NN . SENT Int NP Dent NP J NP . SENT 2003 CD Dec NP . SENT 53 CD 6 CD . SENT 464 CD 8 CD . SENT PMID NP 14725374 CD Bates NP MN NP , , Fawcett NP J NP , , Garrett NP N NP , , Cutress NP T NN , , Kjellstrom NP T NN . SENT The DT beneficial JJ effect NN of IN amalgam NN replacement NN on IN health NN in IN patients NNS with IN autoimmunity NN . SENT Neuro NP Endocrinol NP Lett NP . SENT 2004 CD Jun NN . SENT 25 CD 3 CD . SENT 211 CD 8 CD . SENT PMID NP 15349088 CD Weinshenker NP BG NP . SENT Natural JJ history NN of IN multiple JJ sclerosis NN . SENT Ann NP Neurol NP 1994 CD . SENT 36 CD Suppl NP . SENT S NP 6 CD 11 CD . SENT PMID NP 8017890 CD Pittock NP SJ NP . SENT McClelland NP RL NP . SENT Mayr NP WT NP . SENT Jorgensen NP NW NP . SENT Weinshenker NP BG NP . SENT Noseworthy NP J NP . SENT Rodriguez NP M NP . SENT Clinical JJ implications NNS of IN benign JJ multiple JJ sclerosis NN . SENT a DT 20 CD year NN population NN based VVN follow VVP up RB study VV Ann NP Neurol NP 2004 CD Aug NN . SENT 56 CD 2 CD . SENT 303 CD 6 CD . SENT PMID NP 15293286 CD Berger NP T NN , , Rubner NP P NN , , Schautzer NP F NP , , Egg NP R NP , , Ulmer NP H NP , , Mayringer NP I NP , , Dilitz NP E NP , , Deisenhammer NP F NP , , Reindl NP M NP . SENT Antimyelin NN antibodies NNS as IN a DT predictor NN of IN clinically RB definite JJ multiple JJ sclerosis NN after IN a DT first JJ demyelinating NN event NN . SENT N NP Engl NP J NP Med NP . SENT 2003 CD Jul NN 10 CD . SENT 349 CD 2 CD . SENT 139 CD 45 CD . SENT PMID NP 12853586 NP Franklin NP , , GM NP , , Nelson NP , , L NP . SENT Environmental JJ risk NN factors NNS in IN multiple JJ sclerosis NN . SENT Causes NNS , , triggers VVZ , , and CC patient JJ autonomy NN . SENT Neurology NN 2003 CD . SENT 61 CD . SENT 1032 CD . SENT PMID NP 14581658 NP Marrie NP , , RA NP . SENT Environmental JJ risk NN factors NNS in IN multiple JJ sclerosis NN aetiology NN . SENT Lancet NP Neurol NP . SENT 2004 CD Dec NP . SENT 3 CD 12 CD . SENT 709 CD 18 CD . SENT Review NN . SENT PMID NP 15556803 NP Sadovnick NP , , AD NN , , Ebers NP , , GC NP , , Dyment NP , , DA NP , , Risch NP , , NJ NP . SENT Evidence NN for IN genetic JJ basis NN of IN multiple JJ sclerosis NN . SENT The DT Canadian JJ Collaborative JJ Study NP Group NP . SENT Lancet NP 1996 CD . SENT 347 CD . SENT 1728 CD . SENT PMID NP 8656905 NP Charcot NP , , J NP . SENT Histologie NP de FW la FW sclerose NN en IN plaques NNS . SENT Gazette VV des NP hopitaux NP , , Paris NP , , 1868 CD . SENT 41 CD . SENT 554 CD 555 CD . SENT edit VV External NP links NNS Resources NP . SENT eMedicine NP Consumer NP Health NP version NN updated VVN 2005 CD Mar NP 1 CD The DT patient's NN journey NN . SENT multiple JJ sclerosis NN Langgartner NP M NP , , Langgartner NP I NP , , Drlicek NP M NP . SENT The DT patient's NNS journey NN . SENT multiple JJ sclerosis NN . SENT BMJ NP . SENT 2005 CD Apr NN 16 CD . SENT 330 CD 7496 CD . SENT 885 CD 8 CD . SENT PMID NP 15831874 CD . SENT Multiple JJ Sclerosis NN from IN MedlinePlus NP provides VVZ links NNS to TO news NN , , general JJ sites NNS , , treatment NN and CC alternative NN therapies NNS , , clinical JJ trials NNS , , coping VVG with IN the DT illness NN , , legal JJ aspects NNS , , organizations NNS , , and CC more JJR . SENT Also RB , , links NNS to TO pre NP formulated VVN searches NNS of IN the DT MEDLINE NP PubMed NP for IN recent JJ research NN articles NNS . SENT Article NN on IN psychological JJ aspects NNS of IN MS NN Famous NP people NNS with IN MS NN Organizations NNS . SENT The DT Multiple JJ Sclerosis NN Resource NP Centre NP Accelerated VVD Cure NP Project NP for IN MS NN National NP Multiple JJ Sclerosis NN Society NP of IN the DT United NP States NPS Multiple JJ Sclerosis NN Society NP of IN the DT United NP Kingdom NP Multiple JJ Sclerosis NN Society NP of IN Canada NP Multiple JJ Sclerosis NN Society NP of IN Australia NP Multiple JJ Sclerosis NN Society NP of IN Ireland NP Multiple JJ Sclerosis NN Society NP of IN New NP Zealand NP Multiple JJ Sclerosis NN South NP Africa NP Retrieved VVD from IN http NN . SENT en FW . SENT wikipedia NN . SENT org NP wiki NP Multiple JJ sclerosis NN Categories NNS . SENT Autoimmune JJ diseases NNS Neurologic JJ disorders NNS Views NNS ArticleDiscussionEdit NP this DT pageHistory JJ Personal JJ tools NNS Sign VV in IN create VV account NN Navigation NP Main NP PageCommunity NP PortalCurrent NP eventsRecent JJ changesRandom NN articleHelpContact NN usDonations NNS Search NP Toolbox NP What WP links VVZ here RB Related JJ changes NNS Upload NN file VVP Special JJ pages NNS Printable JJ version NN Permanent JJ link NN In IN other JJ languages NNS Deutsch NP Espa NP ol JJ Fran NP ais NNS Italiano NP Nederlands NP Norsk NP bokm NN l NN Polski NP Portugu NP s PP Suomi NP Svenska NP This DT page NN was VBD last RB modified VVN 01 CD . SENT 46 CD , , 13 CD November NP 2005 CD . SENT All DT text NN is VBZ available JJ under IN the DT terms NNS of IN the DT GNU NN Free JJ Documentation NN License NN see VVP Copyrights NNS for IN details NNS . SENT Privacy NN policy NN About IN Wikipedia NP Disclaimers NNS