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GLOSSARY Glossary Adapted with Permission from R GLOSSARY Glossary adapted with permission from R. Kalb (ed.) Multiple Sclerosis: The Questions You Have: The Answers You Need (5th ed.) New York: Demos Medical Publishing, 2012. This glossary is available in its entirety (as well as additional MS terms) online at nationalMSsociety.org/glossary. 106 | KNOWLEDGE IS POWER 106 | KNOWLEDGE IS POWER Americans with Disabilities Act Blood-brain barrier (ADA) A semi-permeable cell layer around The first comprehensive legislation blood vessels in the brain and spinal to prohibit discrimination on the cord that prevents large molecules, basis of disability. The ADA (passed immune cells, and potentially in 1990) guarantees full participation damaging substances and disease- in society to people with disabilities. causing organisms (e.g., viruses) from The four areas of social activity passing out of the blood stream into the covered by the ADA are employment; central nervous system (brain, spinal public services and accommodations; cord and optic nerves). A break in the transportation; and communications blood-brain barrier may underlie the Autoimmune(e.g., telephone disease services). Centraldisease process nervous in system MS. A process in which the body’s immune The part of the nervous system that system causes illness by mistakenly includes the brain, optic nerves, and attacking healthy cells, organs or tissues Cerebrospinalspinal cord. fluid (CSF) in the body that are essential for good health. In multiple sclerosis, the specific antigen — or target — that the immune A watery, colorless, clear fluid that cells are sensitized to attack remains bathes and protects the brain and unknown, which is why MS is considered spinal cord. The composition of this by many experts to be “immune- fluid can be altered by a variety of Axonmediated” rather than “autoimmune.” diseases. Certain changes in CSF that are characteristic of MS can be detected with a lumbar punctureSee The extension or prolongation of a nerve Lumbar(spinal tap), puncture a test sometimes used cell (neuron) that conducts impulses to to help make the MS diagnosis. Axonalother nerve damage cells or muscles. Chronic . see Axon Injury to the axon ( ) in Of long duration, not acute; a term the nervous system. In addition to often used to describe a disease that damaging the myelin coating around Clinicallyshows gradual isolated worsening. syndrome (CIS) nerve fibers, MS is known to damage or even sever the underlying nerve fibers as well. This irreversible damage A first neurologic event that is can occur at any point in the disease, suggestive of demyelination, even during the earliest phases. GLOSSARY | 107 accompanied by multiple, clinically of physical trauma or disease. ‘silent’ (asymptomatic) lesions on Rehabilitation strategies are designed MRI that are typical of MS. Individuals to improve the impaired function with this syndrome are at high risk for via repetitive drills or practice, or to Clinicaldeveloping trial clinically definite MS. compensate for impaired functions that are not likely to improve. Cognitive rehabilitation is provided by psychologists and neuropsychologists, Rigorously controlled study designed speech/language pathologists, and to provide extensive data that allow occupational therapists. While these for statisticallySee alsovalid Double-blind evaluation of specialists use different assessment clinicalthe safety study; and efficacy Placebo of a particular tools and treatment strategies, they treatment. share the common goal of improving . Cognition the individual’s ability to function Seeas Neuropsychologist;independently and safely Occupational as possible in therapist;the home and Speech/language work environment. High level functions carried out by the pathologist human brain, including comprehension and use of speech, visual perception Controlled study. and construction, calculation ability, attention (information processing), See Placebo-controlled clinical trial. memory, and executive functions such as planning, problem-solving and Corticosteroid Cognitiveself-monitoring. impairment Any of the natural or synthetic hormones associated with the adrenal Changes in cognitive function caused cortex (which influences or controls by trauma or disease process. Some many body processes). Corticosteroids degree of cognitive impairment occurs include glucocorticoids, which in approximately 50 to 60 percent have an anti inflammatory and of people with MS, with memory, See also Glucocorticoids.immunosuppressive role in the information processing,See Cognition and executive treatment of MS relapses. functions being the most commonly Demyelination Cognitiveaffected functions. remediation . (also called cognitive rehabilitation) A loss of myelin in the white matter of the central nervous system (brain, Techniques designed to improve the spinal cord). functioning of individuals whose cognition is impaired because 108 | KNOWLEDGE IS POWER Disability Occasional plateaus and minor, As defined by the World Health temporary improvements may occur. Organization, a disability (resulting Approximately 15 percent of people from a physical or mental impairment) • Sareecondary diagnosed progressive with this disease MS course. is a restriction or lack of ability to perform an activity in the manner or begins within the range considered normal initially with a relapsing-remitting for a human being. course that later evolves into a more Disease course consistently progressive course, (also referred to as disease types) Double-blindwith or without relapses. There are four basic disease courses Refers to a clinical trial in which none of in• MS:Clinically isolated syndrome the participants, including experimental subjects, examining doctors, attending nurses, or any other research staff, is a first episode of neurologic know who is taking the test agent and symptoms caused by inflammation who is taking a control or placebo and demyelination in the central agent. The purpose of this research nervous system. A person who design is to avoid unintentional bias experiences clinically isolated of the test results. In all studies, syndrome may or may not go on to procedures are designed to ‘break the develop MS, with the chances being See Placebo; Placebo-controlled blind’ if medical circumstances require higher in someone who has lesions clinical trial it. on MRI that are similar to those • Relapsing-remitting MS . seen in MS. Evoked potentials (EPs) is characterized by clearly defined relapses (also called attacks or EPs are recordings of the nervous exacerbations) that last from days system’s electrical response to the to weeks and then subside, with full stimulation of specific sensory pathways or partial recovery and no apparent (e.g., visual, auditory, general sensory). disease progression between attacks. In tests of evoked potentials, a person’s recorded responses are displayed on an • PrimaryApproximately progressive 85 percent MS of people begin with this disease course. oscilloscope and analyzed on a computer that allows comparison with normal is response times. Demyelination results characterized by a gradual but in a slowing of response time. EPs can steady progression of disability demonstrate lesions along specific nerve from the onset of symptoms, pathways whether or not the lesions are with no relapses or remissions. producing symptoms, thus making this GLOSSARY | 109 Gadolinium-enhancing lesion test useful in confirming the diagnosis Seeof MS. Visual Visual evoked evoked potential. potentials are A lesion appearing on magnetic considered the most useful in MS. resonance imagery, following injection Exacerbation of the chemical compound gadolinium, See Relapse. that reveals a breakdown in the blood- brain barrier. This breakdown of the blood-brain barrier indicates either a Failure to empty (bladder) See Gadolinium newly active lesion or the re-activation Glucocorticoidof an old one. hormones . A type of bladder dysfunction in MS resulting from demyelination in the voiding reflex center of the spinal Steroid hormones that are produced cord. The bladder tends to overfill and by the adrenal glands in response to become flaccid, resulting in symptoms stimulation by adrenocorticotropic of urinary urgency, hesitancy, dribbling hormone (ACTH) from the pituitary. These hormones, which can also Failureand incontinence. to store (bladder) be manufactured synthetically (prednisone, prednisolone, methylprednisolone, betamethasone, A type of bladder dysfunction in MS dexamethasone), serve both an resulting from demyelination of the immunosuppressive and an anti- pathways between the spinal cord and inflammatory role in the treatment brain. Typically seen in a small, spastic of MS exacerbations: they damage or bladder, storage failure can cause destroy certain types of T-lymphocytes symptoms of urinary urgency, frequency, that are involved in the overactive incontinence and nocturia (getting up immune response, and interfere with FDAfrequently at night to urinate). the release of certain inflammation- See U.S. Food and Drug Immuneproducing system enzymes. Administration (FDA). Gadolinium A complex network of glands, tissues, circulating cells, and processes that protect the body by identifying A chemical compound that can be abnormal or foreign substances and administered to a person during Immune-mediatedneutralizing them. disease magnetic resonance imaging to help distinguish between new lesions and old lesions. The gadolinium causes new A disease in which components of the or active lesions to appear very bright. immune
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