Over the last four decades that I have dealt with persons diagnosed with MS, I have learned that each person reacts somewhat differently to a new diagnosis of MS. In many patients, the diagnosis is welcomed as an explanation for an event affecting their health that had previously remained unexplained. Others anticipated the diagnosis on the basis of life experience (the experience of a friend, relative, or celebrity dealing with MS). In some, surfing the web or reading provided some insight into the illness. However, many come to MS centers for a "second opinion" because of an uncertain prior diagnosis.
Syphilis an infection due to Treponema pallidum. These infections are similar in type to infections by tuberculosis but are potentially more serious.
System lupus erythematosus (SLE)
The first step in dealing with MS is acceptance of the diagnosis (i.e., what does the diagnosis mean?). A diagnosis may be easy for the neurologist, but the affected person may not react positively or may even be suspicious about the seeming ease of establishing the diagnosis. Obviously, the confidence in the physician is a prerequisite in accepting the diagnosis. Although physicians other than neurologists may suspect the diagnosis, the diagnosis of MS must be made by a neurologist. It is also assumed that appropriate clinical neurologic examinations and tests such as MRIs of the brain and spinal cord, cerebrospinal fluid (CSF) examination, and certain blood work will be performed and the results reviewed. These tests are usually needed to eliminate other diseases. Illnesses that can sometimes mimic MS, such as syphilis, system lupus erythematosus (SLE) , and vitamin B12 deficiency, must be eliminated from consideration. Occasionally, patients will have MS as well as another disorder. One of the most common additional conditions found in MS is hypothyroidism.
An important practical point is that until the patient readily accepts the diagnosis any decision regarding therapy has to be considered a tentative or a temporary decision. The evidence is clear that early treatment in MS is more effective, and withdrawal of treatment may seem to precipitate additional (rebound) attacks in some people. Despite the importance of initiating treatment, some patients cannot readily accept the diagnosis and need assistance in dealing with the realities of their disease. The classic book Denial of Illness was based on the author's (Dr. Weinstein) experience with MS patients in a New York City MS clinic. It was the difficulty of MS patients in accepting the diagnosis and the implications of such a diagnosis that led to his classic publication. Denial of illness is not uncommon in young adults, but it seems to be seen disproportionately more often in persons with MS.
A patient may accept the authority of the diagnosing neurologist without question, but in these times, this is somewhat unusual. It is important that patients who are faced with the pronouncement of the diagnosis of MS are able to discuss the basis of the diagnosis and communicate with their neurologist. Most patients ask the questions posed in Part I, such this: "What is MS?" These are real questions asked by real people. Although we know a great deal about the disease process in MS, we do not know the cause of MS (any more than we know the cause of cancer). However, in today's world, every new treatment is based on theories of how drugs interact with one or more steps in the disease process in MS. The results of these trials, regardless of a positive or negative outcome, provide
Hypothyroidism a disease of the thyroid associated with decreased secretion of thyroid hormone.
new and better understanding of MS. With the great progress that has been made in the last 10 years, I anticipate that clarification of each step of the patho-genesis of the disease process will be accomplished and accepted in the near future.
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