A small number of patients have malignant MS, which is marked by a rapid decline that leads to disability and possibly death. MS is rarely fatal, however, and most people with the disease have a normal life expectancy.

Women who harbor the stomach bacteria Helicobacter pylori(or H. pylori) may be less likely to develop multiple sclerosis (MS), a new study suggests.
In the study, researchers found that among women with MS -- an often disabling disease of the central nervous system -- 14 percent had evidence of past infection with H. pylori. But 22 percent of healthy women in the study had evidence of a previous H. pylori infection.
H. pylori bacteria settle in the gut, and while the bug usually causes no problems, it can eventually lead to ulcers or even stomach cancer. It's estimated that half of the world's population carries H. pylori, but the prevalence is much lower in wealthier countries than developing ones, according to background information in the study.
"Helicobacter is typically acquired in childhood and correlates directly with hygiene," explained Dr. Allan Kermode, the senior researcher on the new study and a professor of neurology at the University of Western Australia in Perth.
The reason for the connection between H. pylori and MS isn't clear, and researchers only found an association, not a cause-and-effect link.
But Kermode said his study supports the theory that certain infections early in life might curb the risk of MS later on -- which means the increasingly hygienic surroundings in developed countries could have a downside.
"It's plausible," agreed Bruce Bebo, executive vice-president of research for the National Multiple Sclerosis Society in New York City. "The theory is, our modernimmune system may be more susceptible to developing autoimmune disease."
Multiple sclerosis is thought to arise when the immune system mistakenly attacks the protective sheath around nerve fibers in the brain and spine, according to an editorial published with the study on Jan. 19 in the Journal of Neurology, Neurosurgery and Psychiatry.
No one knows what triggers that abnormal immune response. But according to the "hygiene hypothesis," Bebo explained, early life encounters with bacteria and other bugs may help steer the immune system into disease-fighting mode -- and away from attacks on the body's healthy tissue.
So, people who have not been exposed to common pathogens, like H. pylori, might be at increased risk of autoimmune diseases like MS. That's the theory, anyway, he said.
"These findings suggest H. pylori might provide some protection," said Bebo. "But more studies are required before we can jump to that conclusion."
The findings are based on blood samples from 550 people with MS and 299 healthy individuals of the same age. All were white and lived in Western Australia.
Kermode's team found that women with MS were less likely to have immune system antibodies against H. pylori -- which is evidence of a past infection -- than women without MS.
What's more, among the women with multiple sclerosis, those with a past H. pyloriinfection tended to have less-severe MS symptoms.
There were no such patterns among men, though.
According to Kermode, that difference between women and men is "arguably one of the most fascinating observations of our study."
"In the last 100 years, the prevalence of MS has increased markedly, and the majority of this increase has occurred in women," Kermode said. "The fact that over the same period, prevalence of helicobacter in western countries has declined markedly is a tantalizing observation."
Much more research is needed to understand its importance, Kermode said.
Bebo also urged caution. For one, he said, there were relatively few men in this study, which could skew the results.
In the bigger picture, Bebo said, this study is one more step toward weeding out the environmental factors that affect MS risk. Researchers are looking at a range of possibilities.
As an example, Bebo pointed to vitamin D, which is important in immune system function. A number of studies have tied higher vitamin D levels in the blood to a lower risk of developing MS, as well as a slower progression of the disease.
"Understanding the whole picture of environmental influences is vital," Bebo said.
And what if H. pylori is confirmed to affect MS risk, or its severity? According to Kermode, it's possible that the bacteria could somehow be used to help treat the disease.
Bebo agreed. "You can envision this leading to strategies based on the bacteria, or components of the bacteria, for treating MS."
But any such therapy would be a long way off, he said.

Multiple Sclerosis Overview


Multiple sclerosis is more common in individuals of northern European descent.Multiple sclerosis (MS) can be thought of as an immune-mediated inflammatory process involving different areas of the central nervous system (CNS) at various points in time. As the name suggests, multiple sclerosis affects many areas of the CNS.
  • Women are more than twice as likely to develop multiple sclerosis as men.
  • Multiple sclerosis usually affects people between the ages of 20 and 50 years, and the average age of onset is approximately 34 years.

Multiple Sclerosis Causes

The central nervous system is made up of the brain and spinal cord. They process information from our environment and control voluntary muscle movements to allow the body to do certain things.
  • When you touch something hot, for example, signals are sent from sensory nerve endings in your hand up long nerves in your arm, eventually reaching the spinal cord.
  • From there, the signal is transferred up your spinal cord to your brain, where the information is processed. Your brain then sends a signal back down the spinal cord to the nerves in your arm.
  • These nerves cause the muscles in your arm to contract, pulling your hand away from the heat.
This neural system works efficiently, unless there is a disease process affecting the pathways in the spinal cord and brain. Multiple sclerosis is one of the diseases that can affect these pathways.
  • Signals are transmitted within the central nervous system along pathways.
  • These pathways are made up of long fibers called nerves.
  • Nerves are capable of transmitting information from the environment to the brain.
  • Everything you see, touch, taste, smell, or feel is transmitted along nerves to your brain.
  • Nerves also carry information responsible for our alertness, behavior, ability to understand and think rationally, capacity to communicate with others, and feeling and interpreting emotions.
  • To help transmit all this information in a timely manner, the nerves are covered by a fatty substance called myelin. Myelin insulates the nerves and allows them to transmit information to and from the brain in a fraction of a second.
  • If the myelin is disrupted in any way, the transmitted information is not only delayed, but it may also be misinterpreted by the brain.
Multiple sclerosis results in destruction of the myelin surrounding the nerves of the CNS. The destruction is caused by the body's immune system attacking the myelin sheath. The reason that the body's immune system attacks the myelin sheath is not understood fully, but it is believed to be related to a combination of a genetic predisposition and acquired or environmental influences.
  • This autoimmune destruction of the myelin sheath leads to areas of demyelination (also known as plaques) in the brain and spinal cord.
  • These plaques disrupt the transmission of information in the CNS and lead to the symptoms seen in multiple sclerosis.
The symptoms of multiple sclerosis can be different from person to person.
Visual, sensory, and motor signs and symptoms are all part of multiple sclerosis.
The clinical manifestations are varied, and therefore there is a wide range of symptoms that can appear.
Some people have mild cases of multiple sclerosis with little or no disability over the years. Others have more severe types of multiple sclerosis, requiring confinement to a wheelchair or bed.
Over 30% of those affected with MS will have significant disability after 20 to 25 years. Still others may live their entire lives symptom-free (some individuals without multiple sclerosis symptoms are found incidentally to have multiple sclerosis lesions by MRI, or individuals in whom an examination of their brain after death unexpectedly reveals that they were affected by the disease). This variability makes it difficult in some cases to diagnose multiple sclerosis. Often the signs and symptoms are mistaken as being psychiatric in origin.
  • The first symptoms of multiple sclerosis are often visual changes.
    • Large number of people with multiple sclerosis develop optic neuritis (inflammation of the optic nerve, which is an extension of the central nervous system), described as a painful vision loss. If a patient is diagnosed with optic neuritis early, treatment could change the course of the disease.
    • Before the actual loss of vision, the patient may have visual changes described by many people as blurred or hazy vision, flashing lights, or alterations in color.
    • The tissues around the eye and moving the eye may be painful.
    • Most people recover over several months. Others are left with permanent visual defects.
    • Double vision occurs when the eyes move in different directions and is another common symptom of multiple sclerosis.
  • Multiple sclerosis commonly affects the cerebellum, the portion of the brain responsible for balance and fine motor coordination. Consequently, people with multiple sclerosis often have difficulty maintaining their balance when walking and performing delicate tasks with their hands. Unexplained dropping of a cup or other object or unusual weakness can occur.
  • Patients may experience facial pain, a sensation of spinning referred to asvertigo, and sometimes hearing loss.
  • Virtually any area of the body can be involved, making this disease the great imitator of other disorders of the nervous system.
    • The patient may experience painful muscle spasms or loss of strength in one or more of the arms or legs.
    • The nerve fibers that conduct touch, pain, and temperature sensations are often affected, causing tingling, numbness or electrical-type pain sensations in the chest, abdomen, arms, or legs.
  • Multiple sclerosis can involve the nerves responsible for involuntary actions of the bladder and intestines.
    • The patient may often have constipation and urinary retention.
    • These symptoms lead to other complications, such as infections of the bladder, kidney, or blood.
  • Most people with multiple sclerosis complain of a constant state of tiredness. Around 70% of people with multiple sclerosis report fatigue. Something as simple as carrying groceries up a flight of stairs may become an impossible task for someone with multiple sclerosis.
  • A peculiar trait of multiple sclerosis is the relationship between higher temperatures and the worsening of symptoms.
    • People often complain of worsening of any of their symptoms after taking a hot shower, or participating in strenuous exercise.
    • The exact reason this occurs is unknown. Perhaps it is because at higher temperatures nerve conduction decreases, which could lead to further slowing in the transmission of messages in nerves that have already lost myelin.
  • Seizures occur in about 5% of people with multiple sclerosis.
  • Those affected may complain of sleep disturbances, depression, or may feel that they are experiencing changes in attention span or memory.

When to Seek Medical Care

The symptoms of multiple sclerosis are very variable and differ from patient to patient. They can also be confused with symptoms of many other conditions. A physician should be notified if you or someone you know has any of the signs and symptoms associated with multiple sclerosis. Also check with a doctor if you or someone you know has any signs or symptoms that may not be associated but that are of concern. The person may not have multiple sclerosis, but because of the nonspecific nature of this disease, it is best to let a qualified professional make that determination.
Several of the symptoms of multiple sclerosis may be severe enough to send the patient to a hospital's emergency department.
  • If visual changes and painful eye movements are experienced, visit the nearest emergency department. The patient could have optic neuritis, one of the most common early signs of multiple sclerosis.
  • If the patient experiences personality changes or sudden loss of strength in the arms and legs they should go to the emergency department for evaluation. These symptoms are common with multiple sclerosis, but they can also be signs of other serious diseases that require urgent treatment such as stroke, infection, or chemical imbalances.

Multiple Sclerosis Diagnosis

Diagnosing multiple sclerosis is difficult. The vague and nonspecific nature of this disease mimics many other diseases. Doctors combine history, physical exam, laboratory work, and sophisticated medical imaging techniques to arrive at a diagnosis.
  • A complete blood count, blood chemistry, urinalysis, and often spinal fluid evaluation are all routine laboratory tests used to rule out other conditions and help confirm the diagnosis of multiple sclerosis.
  • An MRI, which creates an image of the brain or the spinal cord, is used to search for changes within the brain or spinal cord that are particular to multiple sclerosis.
  • More often than not, a neurology specialist is required to make a diagnosis.

Multiple Sclerosis Treatment

There are a variety of treatments for multiple sclerosis.

Multiple Sclerosis Prognosis

Despite the above therapies, multiple sclerosis is not curable.
  • A minority of people with multiple sclerosis have a very mild form of the disease with little or no disability. Their neurologic disability may barely affect their daily activities, and the disease does not shorten their life span. However, cases of "benign" multiple sclerosis can only be ascertained retrospectively, after many years, and it is therefore not advisable for multiple sclerosis patients doing well to assume this inactive disease state will be permanent.
  • About 65% of people with multiple sclerosis have a relapsing and remitting form of the disease. They have intermittent worsening of their neurologic symptoms that lasts several days or weeks before returning to their original state of health. Some patients, however, are left with residual deficits (residual disability) after some attacks.
  • Most patients with the relapsing and remitting form progress to a stage where relapses become much less frequent, but they continue to accumulate disabling symptoms. This new phase of the disease is termed secondary progressive multiple sclerosis.
  • In about 15% of people with multiple sclerosis, a relapsing and progressing course is found. With this type (relapsing-progressive multiple sclerosis), patients have relapses superimposed on a pattern of continuous progression of disability.
  • About 5% to 10% of people with multiple sclerosis have a pure progressive (primary progressive multiple sclerosis) form. Their disability progresses in the absence of attacks over time.
  • Death usually results from other causes such as pneumonia or heart attacks, especially in patients who are bedridden, at the latest stages of the disease.

Multiple Sclerosis Prevention

As of yet, no true way of preventing multiple sclerosis has been found.