Multiple Sclerosis

What is multiple sclerosis?

Multiple Sclerosis (commonly known as M.S.) is a common chronic, often disabling condition of the central nervous system (brain and spinal cord).  The McKenzie Study at the University of Dundee examined GP records and reported that in 2010 approximately 107,000 people in the U.K. were living with a diagnosis of Multiple Sclerosis, with the number growing by a little over 5,000 each year.

Multiple sclerosis is the result of damage to the myelin sheath.

The myelin sheath is a protective covering that surrounds the nerve fibres in the brain and spinal cord. When myelin is working properly, electrical impulses get through quickly allowing fast and co-ordinated movement. However, when myelin is damaged the messages are slower, distorted or even non-existent, causing many of the symptoms associated with M.S. Damaged areas of myelin are known as plaques or lesions and these appear as hardened scar areas in the brain and spinal cord.

The name multiple sclerosis means – ‘multiple’ as it can affect many areas of the brain and spinal cord at different times, and ‘sclerosis’, which means damaged areas, scars.

There are 4 main types of multiple sclerosis, they are as follows:

Benign M.S. – starts with a few mild attacks and is then followed by a complete recovery. There is not usually permanent disability with this type of M.S. Benign M.S. can only be diagnosed if after 10-15 years there is minimal disability.

Relapse/ remitting M.S. – this is the type of M.S. that most people with the condition start with. This type of M.S. starts with attacks and then periods of remission. These remissions, when there are no or few symptoms can last for months or even years. A relapse (attack) is unpredictable the symptoms may only last a few hours or could go on and last for months and new symptoms may occur with each attack.

Secondary progressive M.S. – this type starts in the same way as relapsing/remitting M.S. but after a few attacks the remission periods stop. This type of M.S. will usually develop after 15-20 years after the first diagnosis of M.S.

Primary progressive M.S. – this accounts for about 15% of M.S. cases in the U.K. This type of M.S. never has periods of remission and people with this type of M.S. experience steadily worsening symptoms and progressive disability.

What is a relapse?

A relapse is when your symptoms suddenly become worse. A relapse can last for a few days or a few months. New symptoms may occur with each relapse.

What causes multiple sclerosis?

The exact cause of M.S. is still unknown. However, through worldwide scientific research there are a number of factors thought to be involved with the development of the illness. One major factor in the damage of myelin due to an abnormal response of the body’s immune system. M.S. is often classified as a ‘auto-immune’ disease. The immune system usually defends against invading organisms, but if you have a auto-immune disease, your body’s immune system attacks its own cells and tissues. In the case of M.S. the body is attacking myelin. It has not been pinpointed what triggers the immune system to do this, but the possibility of a virus may play a major role in developing the illness. It is also possible that perhaps there is not just one M.S. virus, but many common viruses, such as glandular fever, measles or herpes, that lie dormant and then act as a trigger for M.S.

Am I at risk of getting multiple sclerosis?

Figures show, women are much more likely to develop M.S. than men. In the majority of cases, M.S. tends to be a young person’s disease and is most likely to appear between the ages of 20 and 40. M.S. is not contagious, therefore your friends and family cannot catch it from you. Children can get M.S. but this is very rare.

M.S. is found to be most prevalent in Northern Europe, North America, Australia and New Zealand, although certain ethnic groups within these regions, such as the Sami or Lapps of northern Scandinavia, the Inuits of Canada and Maoris of New Zealand have very low rates.  This has led to speculation that M.S. has been carried round the world by European colonists and even further back, to the Vikings colonisation of parts of northern Europe where M.S. is most prevalent.

What are the symptoms of multiple sclerosis?

Multiple sclerosis symptoms can vary from person to person. The severity of the symptoms depends on the areas of the central nervous system that are affected. There is no set pattern to M.S. development, some can experience very mild symptoms, whilst others can have severe and rapid progression of the disease. Symptoms you may have include:

• Numbness and ‘pins and needles’ in the limbs.
• Difficulty in walking/ loss of balance.
• Clumsiness.
• Vision problems and/or pain at the back of the eye.
• The need to urinate frequently and urgently.
• Impotence.
• Lack of concentration.
• Forgetfulness.
• Slurred speech.
• Fatigue.
• Mood changes/ depression.

How is multiple sclerosis diagnosed?

Diagnosing M.S. can be very frustrating as there is no single test that is 100% conclusive. There are several tests and procedures that are needed to establish a diagnosis of M.S. and these include:

• Medical history – your doctor will require a detailed report of all the symptoms you have experienced and will check your present state of health.
• A lumbar puncture – this test looks for the presence of antibodies in the fluid (known as cerebrospinal fluid), which flows around the brain and spinal cord. The procedure involves a thin needle being inserted into the spine, and a small amount of the fluid is withdrawn. A local anaesthetic will be given to numb the skin. This procedure may be uncomfortable, but it is not painful as the skin around the area where the fluid is removed is numb. This test is not totally conclusive to make a M.S. diagnosis and other tests will be required.
• Evoked potential tests – this test involves small electrodes being attached to the neck and head, this will help to indicate how the nervous system is working and if there is any slowing of the nerve messages in the various parts of the brain.
• Magnetic Resonance Imaging scan (M.R.I.) – this is a scan that takes a very detailed picture of the brain and spinal cord, the scan will show any affected areas.
• Neurological examination – a neurologist will test for abnormalities in nerve pathways. Common neurological signs involve changes in eye movements, limb co-ordination, balance, sensation, speech, weakness and reflexes. Problems in these areas can be caused by many other illnesses, so once again this test cannot conclude if M.S. is causing the abnormalities and other tests will need to be carried out.

As you can see it is not always clear-cut to make a M.S. diagnosis and therefore a good relationship with your doctor is essential, to keep a close check on your general health.

Is there a cure for multiple sclerosis?

As yet there is no cure for M.S. sufferers, but there are many treatments that can help and ease some of the symptoms. Your doctor will discuss all the options available.

What treatments are available for multiple sclerosis?

Depending on the severity of your symptoms the treatment available may include:

• Steroids – these are used to help relapses.
• Injections of interferon beta – interferons are chemicals found in everyone’s body, they play an important part in the immune system. Interferon beta helps reduce relapses, increase the time in remission and reduce the progression of disability. Interferon beta will only be available to M.S. patients who meet the prescriptions criteria.
• Anti-spasmodic drugs – for muscle spasms caused by the damage of nerves.
• Physiotherapy – to help with balance and walking.

What course may the illness take?

It is very hard to predict accurately what course M.S. will take for each individual and the majority of people with M.S. will have symptoms that come and go. However, the way in which the illness progresses in the first 5 years after the initial diagnosis, may give some indication of how it will continue. Over time M.S. may progress and cause disability and poor co-ordination. It is important to realize that many people with M.S. lead relatively normal lives and will have manageable disabilities (e.g. a limp or fatigue).

How can I help myself?

Finding out as much as you can about M.S. is vital, as it will often reduce the worry of some of the early symptoms. Always try to get regular rest and relaxation, this is very important as becoming over tired can cause problems. Stick to a healthy balanced diet to help maintain good health. Some exercise such as basic aerobic exercise is recommended as long as you do not over exhaust yourself.