292 CHAPTER 19 | Nutrition Management of Neurological Disorders


Women are two to three times more likely to develop MS than men. White individuals, especially those of northern European descent, also have a higher risk of MS.84


Diagnosis and Treatment


MS is difficult to diagnose, as there are no definitive tests. Signs and symptoms vary greatly from person to person, depending on the location of the affected nerve fibers. Symptoms of MS frequently affect move- ment and may include the following82


:


• numbness or weakness in one or more extremi- ties, generally occurring on one side of the body at a time;


• electric-shock sensations that occur with certain neck movements, especially when the neck is bent forward (known as the Lhermitte sign); or


• tremor, lack of coordination, or unsteady gait. Vision problems are also common and may include


partial or complete loss of vision (usually one eye at a time), pain during eye movement, prolonged double vision, and blurry vision. Other symptoms include fatigue, slurred speech, dizziness, tingling or pain in parts of the body, problems with sexual function, and bowel and bladder issues.82 Although there are no specific tests to diagnose MS, the 2017 revised McDonald criteria include spe- cific guidelines for diagnosis.85 are used to make a diagnosis86


The following tools :


• medical history, including past or present symp- toms that might be caused by MS, information about birthplace, family history, environmental exposures, history of other illnesses, and places traveled;


• a comprehensive neurologic examination that includes tests of cranial nerves (vision, hearing, facial sensation, strength, and swallowing), sensa- tion, reflexes, coordination, walking, and balance; and


• blood tests, which can be useful to rule out other conditions that cause similar symptoms, including lupus erythematosus, Sjögren syndrome, vitamin and mineral deficiencies, some infections, and rare hereditary diseases.


Treatment includes slowing disease progression, managing symptoms, and focusing on quick recovery from attacks. If MS is caught early, aggressive treat- ment with medications can lower the relapse rate, reduce the formation of new lesions, and potentially reduce the risk of brain atrophy and resultant disabil- ity. Some individuals have mild symptoms that do not require intervention. Both corticosteroids (either oral or intravenous) and plasmapheresis are used to treat MS attacks. Treatments to modify disease pro- gression include ocrelizumab (Ocrevus), which is currently the only disease-modifying agent approved by the US Food and Drug Administration for primary progressive MS.82 disease-modifying


For relapsing-remitting MS, several agents


are available, including


peginterferon beta-1a (Plegridy), alemtuzumab, glati- ramer acetate (Copaxone, Glatopa), mitoxantrone, natalizumab, fingolimod, and teriflunomide. These immune-modifying drugs may cause nausea, diar- rhea, liver damage, flu-like symptoms, headache, infection, and anemia.43


Antispasmodic drugs such


as baclofen may be administered but also may cause nausea, diarrhea, and constipation. Many individu- als with MS seek alternative therapies. For example, cannabinoids have been used in MS treatment.87 Additionally, physical therapy, muscle relaxants, and medications to reduce fatigue and to increase walking speed can be used to help manage symptoms. Some lifestyle factors can aid in the management


of MS. These include obtaining adequate sleep, exer- cising, cooling down when overheated, eating a bal- anced diet, and reducing stress. MS symptoms can be aggravated when body temperature rises. Walking, stretching, low-impact aerobics, stationary bicycling, yoga, and tai chi are appropriate exercises for people with MS.


Nutritional Impact and Medical Nutrition Therapy


The role of nutrition in the prevention and man- agement of MS has not been thoroughly clarified. Although the evidence is not conclusive, diet may affect MS in several ways88


:


• Establishing and maintaining a desirable weight is associated with a decreased risk of debility and disease activity.


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