Stephen F. Austin State University
February 20, 2002
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Joyce Bohen recently wrote a book about her experience withmultiple sclerosis. She told about her battle with multiple sclerosisand one of her major symptoms, optic neuritis. In this book, she toldeach individual to imagine life from one day being able to see brightcolors and distinct pictures to only realize that as each day goes bythe world is beginning to look darker and darker until you can seenothing but black. Not only did she experience blindness but alsocame the intense pain. After seeing a neurologist many times andcontinuously being treated with steroids to help her vision return,she finally gave up her battle and began to accept the idea that shewould never be able to see again. The goal of her book was to helpthose with low vision accept the idea that life will never be thesame and that there are strategic ways to get around this disability.One of the coping mechanisms she suggested was to outline doorways,steps, and wall switches with high contrast or textured tape. Thisstory of one woman's dedication and perseverance to get through herdisability should give researchers all the persuasion needed tocontinue on discovering permanent treatments or even preventivemethods for optic neuritis (Cohen, Dinerstein, & Katz, 2001).
Another woman's determination went beyond coping mechanisms. Afterbeing touched by her brother's battle with multiple sclerosis SilviaLawry created the National Multiple Sclerosis Society. Her goal wasto begin research that could help end the suffering of all thoseindividuals who were diagnosed with multiple sclerosis. Her dream isto try to help discover a cure for symptoms such as optic neuritis(Scott, 2001).
Multiple sclerosis can be defined as an inflammatory, autoimmune,and demyelinating complex disease of the central nervous system(Kidd, 2001). More common in women than men, the disease can strikeat an early age, "especially when reproduction is a majorconsideration" (Sadovnick, Guimond, & Dwosh, 2001 p374). It isknown to be the most common cause of "neurological disabilities inyoung adults" (Kidd, 2001 p540).
The most common type of multiple sclerosis is the relapseremitting which later turns into secondarily progressing. This meansthat the patient will no longer go into relapse but rather beginsprogressing farther into the disease. There is a disability scalecalled Kurtzke's Extended Disability Status Scale that determines thestatus and progression of the disability. For example with a ratingof 6 at twelve to fifteen years of the illness, individuals are nolonger able to walk on their own. No single gene has been identifiedyet researchers are finding a familial component (Kidd, 2001). Yetsome of the symptoms that are related to the disease researchers areable to explain their components. Some of the symptoms associatedwith the disease are loss of balance, muscle weakness, and impairedvision. One of the most common vision impairments is known as opticneuritis.
Optic neuritis can be defined as an inflammation of the opticnerve. This inflammation can cause the signals sent to the brain tobe interrupted. The end result is blurred vision, loss of colorvision, an inability to see low contrast, high sensitivity to brightlight and pain during eye movement. Optic neuritis rarely effectsboth eyes at the same time. Therefore a patient could have blurryvision during one period of the illness in the right eye, and lateron during the illness the blur may move to the left eye. Theblindness that does occur in the eye only lasts for a two to fourdays, and after reaching its maximum point, vision begins to returnin about four to twelve weeks. Optic neuritis can either be a symptomof multiple sclerosis or can be the "initial manifestation ofmultiple sclerosis" (Newman, 1999, p781). Newman also states that ifit is the initial manifestation then this may indicate a shorter lifeexpectancy.
Palace (2001) points out that understanding the visual system,especially the anterior pathways, can be beneficial in diagnosingmultiple sclerosis. Neurologist can look at the visual evokedpotentials and recognize any abnormalities. The most commonabnormality is the delay in the P100, which occurs due to aninterference with demyelination. When optic neuritis has reached itsacute phase, the firing rate can be either greatly reduced orabsent.
Researchers over the years have determined that there are 3treatment categories for the disease: (1) symptoms specific; (2)relapse/exacerbation management and (3) disease modifying (goal is toreduce that amount of lesions that appear on the MRI). Optic neuritiscan be categorized under symptom specific.
While there is currently no cure for multiple sclerosis,researchers are trying to find certain preventive methods and ways ofslowing the disease down. Kidd (2001) notes in his research that theearly stages of the disease are the hardest to detect because thesymptoms are not static; rather they are dynamic. He also points outthat over one half of the victims die of suicide rather than ofnatural causes.
Researchers searching for treatments of multiple sclerosis havebrought about many new types of drugs, none of which have been provento be fully effective. For the most part researchers are now focusingon reducing the relapse rate and progression. For example Interferonis used to reduce the relapse rate and progression of the disease.However, these drugs do not come freely; they come with consequencesof unwanted side effects and costly expenses each month. As of now,Interferon has not been studied on its long-term benefits forlengthening of life.
What about treatment of optic neuritis? Like multiple sclerosis,patients suffer from relapse or progression in this symptom as well.Studies have shown that there is a type of steroid that can reducethe chance of relapse and slow down progression (Lee, 2001). NancyNewman (1999) created an Optic Neuritis Treatment Trial in whichindividuals received "high-dose intravenous methlyprednisolonetreatment followed by tapering dose of oral prednisone." There was anincrease rate in the recovery of vision loss, without any furtherside effects to the final visual outcome. The rate of progression wasdecreased with the intravenous methlyprednisolone, than compared tothe dose of oral prednisone. After performing an post hoc analysisafter eight weeks, Newman determined that those who had severe visualdysfunction at the beginning of treatment had more of a positiveresponse. Ophthalmologists have begun to take this study intoconsideration and have been giving patients more intravenousmethlyprednisolone.
Current research performed by the National Multiple SclerosisSociety has taken the idea of steroids a step further and focused onan immune system protein, either immunoglobulin or liomide (thechemical that stimulates production of key immune system cells) thataid in the recovery of vision loss (1995). As of 2001,corticosteroinds remain the number one treatment option for acuteoptic neuritis in patients.
Today researchers have begin to focus on the idea that some typeof treatment whether it be steroids or immunoglobulin, is better thanno treatment at all in recovery of vision loss. While society isadvancing so is technology. Unfortunately, the rate of technology isnot climbing at a steady pace to where each individual can have adramatic change in their illness. The researchers are out there andthey are trying to find some type of cure for both multiple sclerosisand optic neuritis. Yet, there are many drawbacks to the advancementin finding a cure. For example, lack of participation and theparticipants not getting the type of results (improvement) in thestudies. Individuals may be either too scared to participate and fearthat something worse may happen or they may participate but becomediscouraged after a few weeks because they are not getting theresults they are wanting.
Another circumstance that needs to be looked at is the amount offunding that goes into research. There are marathons, and differenttype of fundraisers. However does this really raise the concern ofthose individuals not affected in any way by the disease? Over halfof all individuals may not have a full understanding about what thisdisease is and its symptoms. Most of the time all that is seen on thefundraisers are the physical symptoms such as muscle deterioration.No one really sees the child who has lost vision in one eye becauseof a symptom of multiple sclerosis, or the psychological troublesthat they are experiencing inside. It is time to take the diseasedeeper and let the people know, especially women, just how seriousthis disease can be.
Cohen, J.R., Dinerstein, G.R., & Katz, E.R. (2001). Livingwith low vision. Inside MS, 19, 46.
Kidd, P. (2001). Multiple sclerosis, and autoimmune inflammatorydisease: prospects for its integrative management. AlternativeMedicine Review, 6, 540(27).
Lee, A.G. & Galetta, S.L (2001, January 1). Something youshould know about optic neuritis. Ophthalmology Times, 26,10.
Lee, A.G. (2001, May). Treatment of optic neuritis: anevidence-based update.Ophthalmology Times, 26, 6.
a. Newman, N.J. (1999). A randomized, controlled trial of oralhigh-dose methylprednisolone in acute optic neuritis. AmericanJournal of Ophthalmology, 128, 264.
b. Newman, N.J. (1999). Optic neuritis as onset manifestation ofmultiple sclerosis: a nationwide, long-term survey. AmericanJournal of Ophthalmology, 128, 781.
Palace, J. (2001). Making the diagnosis of multiple sclerosis.Journal of Neurology, 71, ii3.
Regaining vision lost to optic neuritis? (1995, Fall) InsideMS, 13, 10-11.
Sadovnick, A.D, Guimond, C., & Dwosh, E. (2001) Treatment ofmultiple sclerosis: teratogentic concerns and other aspects ofreproductive counseling. American Journal of Human Genetics,69, 374.
Scott, Whitney. (2001) Courage: One Woman's Dream and the MightyEffort to Conquer Multiple Sclerosis. Booklists, 98, 366.