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as it ran through these fibers. Troublesome grandchildren (myself included) found it a great source of entertainment (and irritation for the grandparents) to jump up and down on these cords, causing a flickering— if not a total extinguishing—of the lamp's light. Demyelination is similar. The normally smooth electrical conduction from the brain (wall socket) to the body (lamp) "flickers" because the smooth flow of nerve signals (electricity) has been interrupted. The CNS has both motor and sensory nerves. This means if you pick up a hot cup of coffee, the motor nerves in your hand provide the strength and coordination to grasp and hold the cup, while the sensory nerves provide information to the brain, registering, "Aha—hot liquid." In MS, nerve damage can result in both motor and sensory abnormalities. STAGES OR FORMS OF MS There is no single clinical portrait of a typical MS patient; in fact, patients are often misdiagnosed because some of their symptoms are associated with conditions such as fibromyalgia, lupus, and scleroderma. Even CNS tumors can mimic the symptoms of MS. In addition, the clinical course of the condition varies widely and is highly dependent on the initial form of MS. Patients usually linger for years or decades in the stage at which they are diagnosed before gradually progressing to a more serious form. Rarely is MS diagnosed as malignant, in which case the condition worsens rapidly and leads to an early death. Patients with benign MS: • Can continue to live relatively symptom-free for decades. • Experience longer survival than with other forms of MS. • Experience one or two early flares. • Sometimes remain in the benign stage (15 percent of patients), but more typically progress to a more serious form of MS. Patients with relapsing/remitting MS (the most common form): • Experience long periods of remission, during which recovery is almost complete, interspersed with definite flares. • Can remain in this form for life, but more often develop the next, more serious, form. Patients with secondary progressive MS: • Follow a similar clinical pattern as relapsing/remitting MS, but healing during remission is less successful. Patients with primary progressive MS: • Experience constant, low-grade flares that allow very little time to heal. • Often steadily decline. Patients with malignant MS (the rarest form): • Experience severe flares that rapidly progress into severe disability or death. HOW ARE MS PATIENTS TREATED MEDICALLY? After the initial diagnosis is confirmed and a baseline MRI is taken, serial MRIs (multiple scans taken at consistent intervals to track disease progression or remission) are used to determine the treatment plan and the progress of the disease. Although a holistic approach to MS incorporating gentle cardiovascular exercise, strength training, high-quality nutrition, stress reduction, and an increase in the quality and quantity of sleep is important, the primary treatment for the condition is largely pharmaceutical. MEDICATIONS YOUR MS CLIENTS MAY BE TAKING • Antineoplastics, such as mitoxantrone hydrochloride (Novantrone) • Antiviral, antiproliferative immunomodulators, such as interferon beta-1a (Avonex, Rebif) • Antiviral immunoregulators, such as interferon beta-1b, recombinant (Betaseron) • Immunomodulators, such as glatiramer acetate (Copaxone) and natalizumab (Tysabri) • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) To learn more about bodywork and medications, including contraindications, read Randall Persad's Massage Therapy & Medications (Curties-Overzet Publications Inc, 2001).